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07/23/96
10:17
002
Child Immunization
What specifically have we done to increase the number of children
receiving immunizations? What statistics can we use to prove that?
The President established the Childhood Immunization Initiative
(CII) to ensure vaccinations and healthy futures for all children.
CII has contributed to the immunization rate of 75% of 2 year-old
children in 1995, an historic high. Most childhood vaccine-
preventable diseases are at all-time lows (measles, mumps, rubella,
diphtheria, etc.).
The best known and most controversial part of the CII is the
Vaccines for Children (VFC) program. VFC provides an entitlement
to free vaccine for children on Medicaid and uninsured and
underinsured children. VFC's main advantage is that uninsured
children can receive shots at their private doctors' offices,
rather than having to make an extra trip to a public health clinic.
It is common for private physicians to send uninsured children to
clinics for their shots because they are free in that setting.
However, often these children do not make it to the clinic,
resulting in missed opportunities for immunization.
But other parts of CII are equally important. These include grants
to states and localities to expand public clinic services, increase
clinic hours, and build up local infrastructure; a huge, community-
based outreach effort to educate parents and providers; better
detection of vaccination levels and outbreaks of infection; and a
standardized immunization schedules to make it easier for parents
to know when vaccinations are due. The deterioration of the public
health system and rapidly rising vaccine costs was one important
cause of the measles epidemic of 1989-91 that cost
lives
How do our efforts compare to the Republican Congress'?
They have approved most of our requested increases in the budget
for childhood immunization. However, they have tried on a number
of occasions to repeal the Vaccines for Children program as part of
broader Medicaid legislation.
What did GAO conclude about our Child Immunization efforts and why?
Did we respond to this report?
In June 1995, GAO released a report critical of VFC program (not of
the CII overall). It stated that cost of vaccines (which VFC is
targeted to address) is not a significant barrier to immunization
and that CDC has not managed the program well. They agreed with
Senator Bumpers' criticism that the children most likely to be
behind on their shots are seen regularly by public clinics and
private doctors, and that they miss their shots not because of
cost, but because their parents are not aware of the immunization
schedule (which is quite complex), or because the parents are not
well-organized or responsible enough to see to it that the
vaccinations take place. These critics point to the fact that
07/23/96
10:18
003
-2-
almost all children get their shots by age 6, when they must have
them in order to start school. They would prefer to focus on
enhancing public clinic outreach to these families rather than
creating a new child entitlement.
HHS responded that GAO's report was seriously flawed; that there is
considerable evidence that the cost of vaccine creates missed
opportunities for immunization; that they agree that cost is not
the only barrier, which is why VFC is just one of five parts of the
larger CII strategy; and that they are working out the various
start-up problems in VFC satisfactorily.
GAO charged that HHS's accountability system could not ensure that
vaccine goes only to eligible children. HHS responded that GAO's
proposed solution would be extremely burdensome to administer.
GAO also alleged that enrollment of private doctors in the VFC
program was proceeding too slowly. HHS responded they expected
some start-up delays.
Why have people been advised that the best source for information
is the "Vaccines for Children Program" and why does HHS only use
the "doubled" funding statistic and are there any other statistics
that can be used to describe our efforts?
We have not advised people in this way. The VFC program is not a
source of information. The Centers for Disease Control and the CII
initiative are.
There have been a number of problems with the Vaccines for Children
program. HAS's original plan to rent a single warehouse to store
vaccine was strongly criticized and ultimately dropped. [Jeremy
wants me to describe this more fully.] Vaccine manufacturers
oppose VFC because of its below-market prices, charging this hurts
their ability to do research and development.
The statistic of 75% of two-year-olds. appropriately vaccinated is
a good one. However, for a number of reasons, we are careful not
to take full credit for the increase over the past few years, but
rather to say that the CII has contributed to a rate that is the
highest ever. First, there is a lag in reporting that means that
what we call the 1995 statistics include some vaccinations that
took place in 1992 or 1993. In addition, the survey methodology
changed in ways that make it very difficult to compare the 75%
figure to a prior point. A change in the survey instrument
produced a minor uptick in the immunization rate. However asking
doctors as well as parents for immunization records, an innovation
begun in 1994, increased the estimate from 68% to 73%. Therefore,
the statements we have been making represent a prudent balance.
04/23/96 09:51
NO.968 P003/003
Goals 2000 also reduces class size and funds ed ication
counseling. [XXX]
The Bill Passed Despite Republicans Voting No 66% of the
Republicans (115 Republican Members and 21 Republican
Senators out of 205 voting Republicans) in Con gress voted
against the Goals 2000: Educate America Act (I.R. 1804).
[Congressional Record, Mar. 26, 1994, Senate \ ote No. 86, p. S-
14206 ; Congressional Record, Mar. 23, 1994, I louse Vote No.
86, P. H.J
Recently, In the 104th Congress, Bob Dole blas ed Clinton-
supported Goals 2000 legislation, calling it "a 1 000 page, $65
billion education bill that dictates how schools should discipline
students, what parents and teachers should disct SS, and the
average salaries of assistant coaches in men's an 1 women's
athletics." [Bob Dole for President News Releas e, 11/4/95)
And, Appropriations Chairman Bob Livingston ecent proposed to
eliminate money for the Goals 2000 program in the FY96
appropriations package currently under consider tion. [New York
Times, 3/6/96]
Free vaccine to immunize
On August 10, 1993, President Clinton signed t LC Omnibus
children against disease.
Budget Reconciliation Act of 1993 which inclu ed a new
President Clinton passed it.
initiative, the Vaccines for Children program. he President's
Republicans oppose it.
efforts have increase childhood immunization TE :cs from 55
percent in 1992 to 75 percent today. [1993 CO Almanac; HHS
Report on the Fiscal Year 1997 Budget]
Recent
100% of Republicans - every single Republicar in Congress --
voted against OBRA-93. [Congressional Recor 1, Aug. 5, 1993,
cite ?
House Vote No. 406, P. S-xxx ; Congressional Record, Aug. 8,
1993, Senate Vote No. 247, p. H-xxx]
or
More recently, Republican Budget (H.R. 2491) ncluded Cuts to
attack
?
the Vaccines For Children program. HR 2491 yould have
repealed the Vaccines for Children program, jeo bardizing $1.5
billion in funding for immunizations over 9 yea S. [cite ?, OMB,
12/6/95]
The Republicans will do
anything, anything to stop
President Clinton.
President Clinton. Meeting our
challenges. Protecting our
values.
documents . include that in we Other the could tien document Genis
EXECUTIVE OFFICE OF THE PRESIDENT
19-Apr-1996 10:34am
TO:
Gordon P. Agress
FROM:
Diana M. Fortuna
Domestic Policy Council
SUBJECT: numbers
We're cancelled today, but here's what I was picturing:
Combined Series -- quarter by quarter
Q1
Q2
Q3
Q4
current I
NHIS X
X
X
X'
x'
NIS
-
-
y
y'
y'
Q1 would be however far back we think we need to go, probably
FY92-ish. In my example, Q4 is the first quarter where both
systems had provider verification, so we would draw a vertical
line to show where that started.
All of this assumes they can't back out the effect of provider
verification.
To me, this would really lay it out clearly. What do you think?
04/17/96
13:12
202 690 5673
HHS-PUBLIC AFFAI
002
President Clinton Quote on National Infant Immunization Week
"Today, more American children than ever before are properly
immunized -- and fewer children than ever before are suffering from
vaccine-preventable diseases. Yet more than one million American
preschoolers are not fully immunized against life-threatening and
preventable disease. All of us must continue to work hard to
build on our success and ensure that every child in this country
gets an equal shot at a healthy life."
04/17/96
13:13
202 690 5673
HHS-PUBLIC AFFAI
003
HHS NEWS
U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES
FOR IMMEDIATE RELEASE
Contact: CDC Press Office
(404) 639-3286
Americans have two new records to celebrate--one high, one
low--during this year' S National Infant Immunization Week (NIIW),
April 21-27. In the United States, the national infant
immunization rate is at an all-time high and vaccine-preventable
childhood diseases are at historic all-time lows.
The Centers for Disease Control and Prevention reports that
seven vaccine-preventable diseases were at record lows in the United
States in 1995. Fewer children than ever before suffered from
measles, mumps, rubella, diphtheria, tetanus, polio and a form of
bacterial meningitis. Compared to the pre-vaccine era, these life-
threatening diseases have declined 95 percent or more.
morestes
1
move
According to CDC' S National Immunization Survey, which surveys
two
parents of preschoolers nationwide, 75 percent of 2-year-olds in the
United States received their full series of shots as recommended.
Yet, despite this record high, more than one million American
children remain vulnerable to disease because they need one or more
doses of vaccine.
In 1994, President Clinton officially proclaimed "National
Infant Immunization Week" as the last week in April every year to
focus attention on the target population of the Childhood
Immunization Initiative--infants and toddlers. This year
communities across the nation will be participating in outreach
activities during the week. State and local health departments and
- More -
04/17/96
13:14
202 690 5673
HHS-PUBLIC AFFAI
004
2
community immunization coalitions have planned special activities
on
during NIIW April 22, in Atlanta, the 1996 Olympic Game
mascot, Izzy, is going to check his immunization record on April 23,
Mi
Health and Human Services Secretary Donna Shalala will visit the
and
Secretary snalala
East Valley Clinic in San Jose , and, April 25, will participate in
immunization outreach activities at The Maria de los Santos Clinic
on
in Philadelphia' Empowerment Zone. April 24, Boston' S Commonwealth
Housing is presenting holding a health fair that includes free on-site
will provide
immunizations; Boston' S preschooler immunization rate, at 87
lamong cuties surveyed - if necessary
percent, is the highest in the nation, of cities surveyed.
to include
" Our message during National Infant Immunization Week is one of
hope and concern, said Secretary Shalala. "Vaccines work they
Vaccines are superb, cost-effective tools to prevent disease.
However, with one of every four infants in the United States missing
a needed shot, parents can' t be sure their child is fully protected
until they check. We encourage parents and health care providers to
stop and check their preschoolers' shot records during National
Infant Immunization Week and at every health care visit throughout
the year.
The
National Infant Immunization Week is an annual special
observance that highlights the importance of public and private
partnerships in increasing infant immunization. During the past two
years, successful immunization partnerships have been launched with
and the kiwanis and Rotan clubs
organizat
Gerbers, K-Mart MacDonalds, and Hope for Kids. "Deadly viruses do suchas
not respect state or community borders; the problem of under -
immunization of infants affects every community in this nation,"
- More -
Q4/17/96
13:15
202 690 5673
HHS-PUBLIC AFFAI
005
3 -
said CDC Director, Dr. David Satcher. "While no single factor
accounts for under immunization, achieving and sustaining high
action
coverage requires interventions by health-care providers, parents
and communities.'
Lum at, the decline
Bignificant
Despite the availability of measles vaccine since 1963
whole
when
from
start of this decade a measles epidemic swept the nation
From
the nomb
ofcases.
1989 to 1991, 55,000 cases of measles were reported, which killed
more than 130 children and adults. Nationwide, vaccination levels
were estimated at 55 percent and, in some communities, were
believed to be as low as 10 percent.
ID contrast, In 1995, state
lead
health departments have reported the lowest number of measles cases
w/
decrea
since reporting began in 1912. The provisional total for 1995 is
301 cases, down 69 percent from the 963 reported cases in 1994.
The National Infant Immunization Week is an important part of
the broader outreach effort within the Administration' S Childhood
Immunization Initiative. The initiative, launched by CDC in 1994,
aims to further increase infant immunization levels and reduce
sustain high rates and
diseases, like measles, while building a system to deliver new and
1
safer vaccines to generations of children to come. "It is
a
travesty to have the means to prevent disease and death and not have
a
system to protect children year after year, said Secretary
Shalala. "For too long, children in America did not have a
To truly
consistent means to ensure equal access to life-saving vaccines.
Success
we mus
That is why this administration has more than doubled the funding
breakde
for childhood immunizations, helped states and communities reduce
all of
immunization barriers, and built a national outreach effort the likes
the
barriers
of which this country has never seen."
that present our
- More -
children From bing
immunized on Time .
04/17/96 13:16
202 690 5673
HHS-PUBLIC AFFAI
006
4
National, state, and local outreach *initiatives are working to
increase vaccination levels to at least 90 percent among
preschoolers by the year 2000 These initiatives include 1)
increasing immunization clinic hours 2) assessing vaccination
practices withined clinic or practice, 3) linking immunization
services with the successful Women, Infants, and Children (WIC)
services, 4) standardizing strategies to remind parents when
vaccinations are needed, and 5) forming partnerships among
traditional health partners and community civic, religious and
business leaders.
###
Information on NIIW and childhood immunization is now available on
the Internet. Visit CDC' S home page at http://www.cdc.gov/ for the
most current information on childhood immunizations. For more
information on 1 NIW activities), please call
local . -
contact CDCS
community Outreach and
Planning branch at
20
(404) 639-8375.
in your state,
REMARKS
DONNA E. SHALALA
SECRETARY OF HEALTH AND HUMAN SERVICES
AT
AMERICAN NURSES ASSOCIATION IMMUNIZATION PARTNERSHIP
DECEMBER 12, 1995
20'd 94566238
01
FROM
14:51
1
Thank you, Mrs. Promboin, for that gracious introduction.
My thanks to Geri Marullo and the ANA for your tireless efforts
to bring health and hope to all Americans. I also want to
recognize the remarkable contributions of Dr. Redlener; First
Ladies Romer and Symington; and my colleague Dr. Orenstein, who
is doing a superb job overseeing the National Immunization
Program.
And I couldn't begin my remarks without paying a special
tribute to Rosalynn Carter and Betty Bumpers: Two visionary
leaders who understand the importance of both enthusiasm and
stamina; leaders who, for nearly two decades, have raised
awareness and sparked action; leaders who are teaching Americans
that WE must immunize our children - - and we must do it early;
and, through it all, leaders who are truly an inspiration to all
of us.
Whenever I'm preparing to give a speech about children, I am
reminded of the great tradition of storytelling in America. I'm
talking about the folk tales, the fairy tales, and the down-home
wisdom we all heard when we were young - - and pass down to the
next generation as we get older.
Remember the Native American trickster tales and the African
American folk tradition? Golden oldies like Cinderella and The
Wizard of OZ? And, the Mexican-American song about a mother duck
who protects and provides for her ducklings?
These stories have one thing in common. In each case, the
children get saved because of the intervention of caring adults:
The Fairy Godmother. Glenda the Good Witch. The kindly
woodcutter. The loving parents.
You are those caring adults. Whether you're teaming up with
our schools to make immunizations as common to students as
reading, writing, and arithmetic; pounding the pavement to
remind parents to get their childrens' shots on time; or helping
states climb onto the Information Superhighway with centralized
registries that keep track of who's immunized -- and who's not --
you are serving on the frontlines, creating healthier todays and
stronger tomorrows for all our children.
And we are proud to stand with you. Under our watch, we're
fighting to make sure that all children get the right start in
life -- with better, stronger Head Start and Child Care.
With our historic tobacco initiative, we're fighting to
ensure that children get their information about smoking from
their parents and other caring adults -- not from Joe Camel.
94562878 P.03
01
FROM
DEC-12-1995 14:31
2
We're fighting to stop drug use before it occurs by
expanding treatment options for pregnant women and working with
thousands of communities to preach a message of real prevention.
We're fighting for safer neighborhoods with the Brady Bill
and Assault Weapons ban -- the first two curbs on gun violence to
be enacted in more than 25 years!!
And with your help, we're fighting for a healthier America -
- where every child gets all their shots -- not by age five, not
by four, not by three but by twoll And that's a children's
agenda.
Just LWO months after he was sworn into office, President
Clinton personally committed his Administration to an historic,
comprehensive strategy to immunize our youngest and most
vulnerable children. And today - together -- we are making good
on that promise.
But let me be clear: This is not a one shot burot of
energy. This is not a single, short-lived effort. This is not a
band-aid approach to a temporary epidemic. It's a comprehensive
and lasting shift in priorities and practice.
That's why, since 1993, we've increased funding for
immunization grants to states every year -- [or a total of almost
50 percent.
That's why we've abandoned the old "one size fits all"
approach to government -- and helped states develop their own
tailor-made action plans -- SO that they can expand clinic hours,
hire more staff, and find other new ways to vaccinate more
children.
That's why we're teaming up with the managed care
industry -- as HMO's come to understand that immunizations are
good for the bottom lines of people and profits.
That's why we're unlocking the scientific mysteries of
vaccines - - so that one day our children can get all their
immunizations with one shot -- or even by eating a banana.
That's why we've worked with you in communities across
America to hold conferences, create coalitions and build a
national outreach effort the likes of which this country has
never seen!
And that's why, from Minnesota to South Carolina and from
North Dakota to Delaware, under demonstrations approved by HHS,
states are finding innovative ways to increase immunization rates
now - - and sustain them into the future.
P.04
94562878
01
FROM
14:31
3
And that's exactly why all of us are here.
When I spoke at this meeting just two years ago, only 55
percent of children under two were fully vaccinated. Today,
immunization rates are at their highest levels in history.
Today, diseases like measles, mumps, and rubella are nearing all-
time lows. And today, we're on the brink of waving one final
goodbye to the tragedy of polio in America.
That's real progress -- progress we should all be proud of
-- but our work is far from done. There are still over one
million preschool children in this country who don't have all
their shots -- and we cannot rest until they do.
Unfortunately, the Republican Leadership in Congress
disagrees. Let me be clear: What they are proposing is nothing
less than an all-out assault on the health of our neediest
families and the values of our country. And what do I mean by
values?
I mean it's not right to take the promise of Medicaid -- our
country's historic guarantee of health care for vulnerable
families and children -- and replace it with an ill-conceived,
underfunded, block grant.
It's not right to end the guarantee of funding for vaccine
purchases for the states -- taking away hundreds of millions of
dollars that could be used to buy vaccines -- and sending us back
to the days when funds for childrens' immunizations had to
compete for scarce resources with education, AIDS prevention,
drug treatment and other critical efforts.
It's not right to slash $163 billion from Medicaid and put
nearly four million poor children out in the cold -just to help
finance a big tax cut for the wealthy.
It's not right to cut immunization grants to states by $28
million next year, as the House Appropriations bill would do.
And, under the quise of welfare reform, it's not right to
slash child care, school lunches, and aid to disabled children --
and decimate the foundation that keeps families healthy and
strong.
We must send the message loud and clear: We cannot go back
to the days when our children's health needs went unmet, because
their parents couldn't afford to take them to a doctor.
We cannot go back to the days when anguished children gasped
for air from monstrous iron lungs.
94562878 P.05
01
DEC-12-1995 14:32 FROM
4
And we cannot go back to the days when we spent more energy
immunizing chickene and dogs than children. WE cannot - and we
will not.
We believe that Medicaid must remain a guarantee and a
promise for all children who need it.
We bolieve that we can balance the budget in seven years
while still strengthening Medicaid, protecting childhood
immunization funding and safeguarding our future.
And, most important, we believe that government alone cannot
solve our problems -- and that you are the leaders who can help
get this job done.
so, let us leave here today stronger than ever, more
committed than ever, more determined than ever to make good on
the promises we've made to each other and to our children.
Lel us continue to reach out and join hands across
disciplines and across the country -- to ensure that all children
get the shots they need -- no matter where they live or how they
live.
Let us remember the lessons of TB and other public health
tragedies and celebrate our successes not by recting on our
laurels but with a renewed and re-energized commitment to
continue the fight.
And, as we engage in this historic debate about the role of
government and the character of our country, let us all continue
to stand up and speak out for the health of our children.
Because as you know, children don't have lobbyists. They
don't buy T.V. time. And, they can't vote. All of us are the
caring adults that make happy endings come true. We are the
Fairy Godmothers and Godfathers. And, we must make sure that the
fate of our children rests in everybody's hands.
I like the way that the writer Francis Thompson described
the imagination of children: "It is to turn pumpkins into
coaches, and mice into horses; lowness into loftiness, and
nothing into everything.
Together, we must keep that power of dreams alive for this
generation of children -- and every generation to come.
That is our challenge. That is our obligation. And that is
our hope for the future.
Thank you.
90'd
94566238
01
FROM
DEC-12-1995 14:33
CHILDHOOD IMMUNIZATION
What is the problem?
In order to protect children against disease, toddlers should receive a full series of
immunizations by the time they are two years old. One million American children do not.
Almost every child in the United States eventually completes the series, but not on time
(because immunization is required to enter school). Every child who is incompletely
immunized between the ages of two and six is vulnerable to serious illnesses like measles and
bacterial meningitis.
What is the evidence?
While child immunization rates have risen since the 1989-1991 measles epidemic, a 1993
survey found that 33% of pre-school children (with an average age of 27 months) had not
received the three most critical vaccines -- MMR (measles/mumps/rubella), DTP
(diphtheria/tetanus/pertussis) and polio. Roughly 45% had not received the HIB vaccine,
which protects children against bacterial meningitis. An astonishing 84% had not been
vaccinated against Hepatitis B, which causes liver disease.
Lack of immunization is not only dangerous to children, but expensive as well.
Immunizations prevent serious illnesses that require costly treatment. Every dollar spent on
the MMR vaccine saves $21 in potential health care costs. The DTP vaccine saves $30 for
each dollar spent and the polio vaccine saves $6.
Why aren't children properly immunized?
Access. Many children do not have a regular doctor or health center. Cost, distance,
limited hours, and cultural differences create obstacles to seeking regular "well-child" care.
Without a medical home, children are unlikely to complete the full series of immunizations,
which require multiple visits and careful record-keeping.
Cost. The private cost of a full series of immunizations rose from $27 in 1983 to $270 in
1994. As costs rise, parents are less able to pay for immunizations for uninsured or
underinsured children and physicians increasingly refer patients to public clinics for
immunizations. Even children who do have a regular doctor are less likely to be properly
immunized.
Fragmented care. A 1992 survey conducted by the American Academy of Pediatrics
showed that 43% of pediatricians had increased their referrals to public clinics for
vaccinations in the preceding ten years, primarily because of costs. Nationwide, 55% refer
some or all of their patients to a public provider for immunizations. In some states the
figure is dramatically higher. For example, in North Carolina 93% of physicians referred
patients to a public clinic in 1992.
Although public clinics provide free immunizations, the extra step fragments care and
poses an obstacle to full immunization. At a time when efforts are being made to improve
continuity of care and reduce duplicative services, it makes sense to enable families to get all
their children's primary care from one source.
What has the Clinton Administration done?
The Clinton Administration launched a Childhood Immunization Initiative with two goals:
to increase initial and critical immunization doses to 90% for two-year-olds by 1996;
and
to put in place a system to ensure that over 90% of all two-year-olds are fully
immunized by the year 2000.
The Childhood Immunization Initiative draws on five strategies to increase immunization rates:
improving vaccination delivery services;
reducing vaccine costs;
increasing awareness, community participation, and partnerships;
improving the monitoring of disease and vaccination coverage; and
improving vaccines and vaccine use.
The Vaccines For Children program is designed to implement the first two strategies by
encouraging private physicians to administer vaccines to poor and uninsured children and by
making vaccine available to states at a reduced price.
How does the Vaccines for Children (VFC) program work?
Under the VFC program, vaccines are provided by the federal government so that they can
be administered free to every eligible child. To qualify, a child must be Medicaid-eligible,
uninsured, a Native American, or an Alaskan Native. Underinsured children are eligible if they
go to rural health clinics or Federally Qualified Health Centers.
VFC eliminates costs to parents and prevents missed immunization opportunities. Physicians
will not have to worry about costs before immunizing their patients and will therefore be less
likely to refer their patients to public clinics. VFC prevents the missed immunization
opportunities and delays that result from referrals to public clinics. Parents will not have to
worry about fees and will be able to choose whether to go to a public clinic or a private
provider.
VFC saves money for states and allows greater flexibility. Under VFC the federal
government pays the full cost of immunizing children enrolled in Medicaid. As a result, states
save money that they can use to enhance their immunization program. They may keep clinics
open longer, conduct outreach, or purchase more vaccine. Under VFC states may also opt to
purchase vaccine at the lower, government price for all children in the state.
VFC will improve immunization rates. More than one million infants and toddlers without
insurance are guaranteed free vaccines in their doctors' offices. VFC also helps the eight million
older uninsured children who need follow up vaccines at ages four and fifteen.
06/27/95
19:33
202 690 5673
HHS-PUBLIC AFFAI
002
Q.
Does the Administration oppose folding the Vaccines for Children (VFC)
program into a block grant?
A.
The Clinton Administration has a very simple goal -- to improve preschool
immunization rates. Since taking office, the President has lead an aggressive
campaign to reach that goal, and we have made great progress. But we
believe that our current investment in children's immunizations must be
maintained. Childhood immunizations are one of the most cost-effective
public health investments we can make -- they save lives and they save money.
To take just one example, for every dollar spent on the measles/mumps/rubella
vaccine, we save $21 in health care costs.
We are willing to work with Congress to make changes to improve the VFC
program. But we are not willing to watch as Congress slashes funding for
childhood immunizations in just one more shortsighted attempt to cut the
budget.
Q.
Is the Administration's position that VFC must remain an entitlement?
A.
We believe that the federal budget should be balanced, but in a way that makes
sense. The President has laid out a proposal that retains coverage under
Medicaid while reducing spending and giving states more flexibility. Medicaid
is a critical health care program. It can certainly be improved, but not by
cutting it dramatically to balance the budget. The same applies to VFC. If we
can improve the way we are going about our childhood immunization efforts,
we're certainly willing to work on it. But we must maintain poor and
uninsured children's access to life saving and cost-effective vaccines.
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Talking points - Vaccines for Children
The Vaccines for Children program is an important part of the
broader Childhood Immunization Initiative. The CII includes five
key strategies to improve preschool vaccination rates. These
include improving the quality and quantity of vaccination delivery
services; reducing vaccine costs; increasing awareness, community
participation and partnerships; improving the monitoring of disease
and vaccination coverage; and improving vaccines and vaccine use.
Improving preschool immunization rates is one of the Clinton
Administration's highest priorities. Since taking office, the
Clinton Administration has doubled funding, and guaranteed funds
for new vaccines. Legislation to launch a new Childhood
Immunization Initiative was introduced soon after President
Clinton's inauguration. A specific goal was set for 1996:
increasing vaccination levels for two-year-old children to 90
percent for the most critical doses. And a new program to provide
free vaccines to millions of poor and uninsured children was
instituted.
While child immunization rates have improved since the 1989-1991
measles epidemic, VFC is a key part of the national strategy to
reach the one million American children who are not fully
vaccinated by age two. A 1993 survey found that 33 percent of
pre-school children (average age 27 months) had not received a full
series of the three most critical vaccines (MMR, DTP and polio).
About 45 percent had not received the HIB vaccine, which protects
children against bacterial meningitis; and 84 percent had not been
vaccinated against Hepatitis B, which causes liver disease.
As an integral part of the CII, the Vaccines for Children program
focuses on making free vaccines more widely available, reducing
costs and missed opportunities for immunization. In the past ten
years, immunization costs have increased ten-fold: the private cost
of a full series of immunizations increased from about $27 in 1983
to $270 in 1994. A Spring 1992 survey by the American Academy of
Pediatrics showed that 43 percent of pediatricians had increased
their referrals to public clinics for vaccinations in the preceding
ten years, primarily because of costs.
Under the VFC program, vaccines will be provided free to children
who are enrolled in Medicaid or uninsured, and to native Americans
and Alaskan natives. That means that physicians will no longer have
to refer uninsured children to public clinics, a common practice
that means missed opportunities for immunizations and fragmented
care. And parents can choose which provider makes the most sense
for their child, because the difference in price between the two
settings ($270 and $129) won't be a factor.
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This will make a tremendous difference for nine million uninsured
American children. While Medicaid recipients can receive free
vaccines under current law, working families have not had the same
guarantee. Under VFC, more than one million infants and toddlers
without insurance will now be guaranteed free vaccines, and their
parents will pay only a modest administration fee. And because ten
percent of all American children don't have health insurance, VFC
will also help millions more older children who need follow-up
vaccines at age four and fifteen.
Under VFC, every eligible child will receive vaccinations, even if
parents cannot afford to pay the administration fee. Private
doctors will continue to serve their regular patients, even if the
parent or guardian cannot afford to pay the administration fee.
Other needy children will not be charged a fee in public clinics.
In addition, VFC will provide free vaccines to children with
limited insurance in rural health clinics and Federally Qualified
Health Centers. In these settings, additional children whose
insurance plans don't cover vaccinations will continue to be
eligible for free vaccines.
Funds for new vaccines will automatically be provided. Under VFC,
new childhood vaccines recommended by a federal advisory committee
will automatically be purchased by the federal government and
provided free to eligible children -- and budget constraints will
never again limit or delay federal purchase of new vaccines.
States will be able to save money by ordering vaccines at the
lower, government price. Because VFC will lower states' Medicaid
costs for vaccines, these savings can be used to keep clinics open
longer, or take other measures to increase immunization rates. And
more states will be guaranteed the lower CDC price for the vaccines
they do purchase.
Child immunization protects children and saves money. For example,
every dollar spent on the MMR (measles/mumps/rubella) vaccine saves
$21 in potential health care costs. For the DTP (diphtheria/
tetanus/pertussis) vaccine, the cost-benefit ratio is 30 to 1. And
for polio, it's 6 to 1.
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Questions and Answers on the VFC Program
6/15/95
Q:
The GAO has challenged CDC's assertion that the cost of
vaccines is a barrier to childhood immunization. Is cost a
barrier or not?
A:
Cost is a barrier because it contributes to delays in
achieving full immunization of preschool children with today's
vaccines. The cost of the complete vaccine series has
increased ten-fold in the past 12 years. Since parents must
pay about $270 in vaccine costs and an additional amount in
administration fees for the series, those without adequate
insurance may not seek immunizations from their private
doctors, but from public health clinics where vaccine is free
or available at nominal cost. Having to make extra visits to
public clinics can result in delays and missed opportunities
for immunization.
Numerous surveys of practitioners and health departments have
also documented increased referrals of patients from their
primary care providers to public clinics, with cost as the
most important reason cited. A 1992 American Academy of
Pediatrics study revealed that 55 percent of pediatricians
refer some or all or their patients to a public provider for
immunizations. A 1992 North Carolina survey showed that 93
percent of physicians referred patients to health departments
for immunizations, and states such as New York have showed
similar trends.
Q:
The GAO has recommended that the VFC program should be
targeted to certain population groups and areas referred to as
"pockets of need. Doesn't this make sense?
A:
We believe, and Congress has agreed, that the proper goal of
Federal immunization efforts is to raise immunization levels
throughout the nation, and to put in place a sustainable
system that will ensure that immunization rates remain high.
The GAO conclusion assumes that "general immunization rates"
are not now a problem and will not be a problem in the future.
While child immunization rates have improved since the 1989-
1991 measles epidemic, VFC is a key part of a national
strategy to reach the one million American children under two
who are unvaccinated against one or more deadly diseases. A
1993 survey found that 28 percent of pre-school children
(average age 27 months) had not received a full series of the
three most critical vaccines (MMR, DTP and polio). About 40
percent had not received the HIB vaccine, which protects
children against bacterial meningitis; and 84 percent had not
been vaccinated against Hepatitis B, which causes liver
disease.
Q:
Does the Administration oppose folding the Vaccines for Children (VFC) program
into a block grant?
A:
The Clinton Administration has a very simple goal -- to improve preschool
immunization rates. Since taking office, the President has lead an aggressive
campaign to reach that goal, and we have made great progress. But we believe that
our current investment in children's immunizations must be maintained. Childhood
immunizations are one of the most cost-effective public health investments we can
make -- they save lives and they save money. To take just one example, for every
dollar spent on the measles/mumps/rubella vaccine, we save $21 in health care costs.
We are more than willing to work with Congress to make changes to improve the
VFC program. But we are not willing to watch as Congress slashes funding for
childhood immunizations in just one more shortsighted attempt to cut the budget.
Q:
Is the Administration's position that VFC must remain an entitlement?
A:
We believe that the federal budget should be balanced, but in a way that makes
sense. The President has laid out a proposal that retains coverage under Medicaid
while reducing spending and giving states more flexibility. Medicaid is a critical
health care program; it can certainly be improved, but not by cutting it dramatically
to balance the budget. The same applies to VFC. If we can improve the way we
are going about our childhood immunization efforts, we're certainly willing to work
on it. But we must maintain poor and uninsured children's access to life saving and
cost-effective vaccines.
[DRAFT - 3/20/95 10:00pm]
8C. CHILDHOOD IMUNIZATION
"To guarantee that our children's faith in us is justified. we must renew our
commitment to protect them from deadly infectious diseases."
President Clinton
8-14
[DRAFT - 3/20/95 -- 10:00pm]
Actions to Date
The President has launched a comprehensive effort to give our children a
healthy start in life by immunizing them against preventable disease. Under
the Childhood Immunization Initiative, the Administration has:
Provided states and local governments with added support for
immunization programs. Federal spending to support immunization
infrastructure increased by 213) percent, from $45 million to $141
million.
%
our nation's
Started the Vaccines For Children Program which will provide free
vaccines to our nation's neediest children Q about 60% of all children.
1
Helped create information systems to see that all children are properly
immunized.
Formed innovative partnerships with private organizations that will
reach target communities with an immunization message:
-
Gerber Products Company put an immunization message on
the back of baby cereal boxes;
-
Kiwanis International created a national public awareness
campaign, including public service announcements,
billboards, and posters; and
-
McDonalds featured an immunization message in its tray
liners.
Helped thousands of health care providers improve their immunization
procedures by broadcasting information via satellite to 16,000
participants in 44 states. Using this technology, the Centers for
Disease Control and Prevention will have trained more providers
within six weeks than it had trained in the previous ten years.
Simplified what parents and health care professionals need to know to
ensure children are properly immunized, by working with leading
health professionals to get them to agree on a single recommended
immunization schedule.
8 15
[DRAFT - 3/20/95 -- 10:00pm]
Background
"It's a national tragedy that about one-third of America's two-year-olds are not
adequately vaccinated against preventable disease."
President Clinton
Childhood vaccines prevent nine infectious diseases -- polio, measles, diphtheria,
mumps, pertussis, rubella, tetanus, hepatitis-B, and Haemophilus influenzae type B (Hib)
(which causes meningitis). Children need 11 to 15 vaccine doses by the age of two,
requiring about five visits to a doctor or clinic. Yet, too many of America's two-year-old
children do not get the full range of vaccines and full protection from illness and possible
death.
The cost of immunizing a child is much higher today than it was just a few years
ago. The full complement of vaccines has risen from only $28 in 1983 to about $270 in
1994. Costs are up in part because new vaccines are now recommended for all children,
and the prices of some vaccines have gone up. These higher costs mean that more
because
uninsured and underinsured families are unable to pay for vaccines out of their own
pockets. In response, private providers now send more children to public health clinics for
their shots, where Federal or state supplied vaccines are free. Because these referrals break
the continuity of care, children miss opportunities for vaccination.
The influx of children referred from the private sector has overburdened the public
clinic system. This erosion was a direct cause of a measles epidemic during 1989-1991.
Although measles is preventable, failure to provide adequate support for immunization
resulted in 55,000 cases of the disease, 11,000 hospitalizations, 44,000 hospital days, and
130 deaths. The epidemic cost an estimated $150 million in direct medical costs alone,
without including massive indirect costs stemming from lost time on the job, lost
productivity, and lost wages.
By preventing expensive treatment of diseases, vaccines save money. For every
dollar spent on the measles/mumps/rubella vaccine, an estimated $21 is saved. About $29
is saved for every dollar spent on diphtheria/tetanus/pertussis vaccine.
Cases of disease need to be rapidly detected to identify under-immunized
Why
is
populations and to institute disease control efforts. But, surveillance systems often have
the whole
been inadequate to detect cases of disease quickly. As a result, vaccine-preventable
diseases have spread too rapidly, especially within populations that are at greatest risk.
lost-- about this and thrown then 1.) at the
the
to
end, 11 without problems, c.g. address hours, that
8-16
other we are trying to
[DRAFT - 3/20/95 -- 10:00pm]
The Initiative
"The initiative is designed to increase immunization rates now, and build a system
for sustaining these gains into the future. This is not a single short-lived effort.
It is a lasting change in both priorities and practice."
President Clinton
The President's Childhood Immunization Initiative is building a comprehensive
immunization system that marshals the public and private sectors, health care professionals, h nat
an
and volunteer organizations to increase vaccination rates. First, states and local
EFFORTS
governments will improve and expand immunization, efforts using added Federal funds.
To
Second, uninsured children can be immunized by their private physicians through this
you
mean
program. Third, an enormous outreach effort will help providers and families to understand
infrastruct
the importance of immunization and to know which vaccines are needed and when.
Wnat
The Initiative's goal is to immunize at least 90 percent of two-year-olds in this
country with the initial and most critical doses by 1996 and at least 90 percent of all two-
year-olds with the full series of vaccines by 2000.
The Childhood Immunization Initiative will:
1. Improve the quality and quantity of vaccination services:
This 11
bit vague.
In 1993, the Federal government sent $129 million ($83 million in new Federal
resources) to states and local health departments to improve existing services based on
plans they developed. Each area uses its own discretion to allocate these funds to meet
local needs whether longer clinic hours or automating records. Locally tailored systems
mean that parents can visit an immunization clinic at more convenient times and be assured
of prompt, quality service. Automated record-keeping creates easy reminders for providers
and parents that vaccinations are due.
whether by lengthening
2. Reduce vaccine costs for parents:
The Vaccines for Children program will reach more children with free vaccine than
ever before, including many at their own doctor's offices. Sixty percent of our Nation's
children will benefit, including the uninsured, those on Medicaid, Native American children,
and children served by federally qualified health centers. States can buy vaccines at
reduced Federal prices to provide universal access to vaccine for all children in their state.
The Federal government will assist states with more than $200 million to purchase
IS this
vaccines. As a result, cost will no longer be a barrier for our neediest children, and parents
the total
can get their children vaccinated by their family doctor.
program cost? avn't this number stand
8-17
[DRAFT - 3/20/95 -- 10:00pm]
3. Increase participation, education, and partnerships in communities:
The Administration's plan sends outreach coordinators around the country to
increase awareness of the importance of vaccinating children and to encourage health care
providers to use every opportunity to vaccinate children in their care. Community and
business groups, religious and service organizations, schools, and the media are joining
community-based networks to increase infant vaccination efforts. We are encouraging our
immunization partners to take advantage of National Infant Immunization Week (in late
April each year) to focus attention on the vaccination needs of infants and young children.
4. Better monitor diseases and vaccinations:
We are creating a better system to monitor vaccine-preventable diseases so that we
can spot problems early and prevent cases from escalating into epidemics. The Centers for
Disease Control and Prevention is working to pinpoint the populations that are not receiving
the benefits of infant vaccination.
5. Improve vaccines and how they are used:
We are increasing applied research into new vaccines in an effort to reduce the
number of shots children must receive and to ensure safe and effective vaccines. We
developed a single childhood immunization schedule by working with the Advisory
Committee on Immunization Practices, the American Academy of Pediatrics, and the
American Academy of Family Physicians. This single schedule simplifies what parents and
providers must know to ensure proper immunization. Better vaceines mean children are
better protected from disease earlier in life. Although available vaccines are very safe and
effective, the Centers for Disease Control and Prevention is working with states and
selected providers to enhance systems to detect rare adverse events following vaccination.
In addition,
8-18
[DRAFT - 3/20/95 -- 10:00pm]
Case Study: Kathleen
Kathleen, a single parent living in Santa Fe, New Mexico, was worried
about juggling her work schedule to take her young son for vaccinations at
the Santa Fe County Health Office. "I'm a single parent trying to raise a
child alone, and it is not easy to get off work to take him for shots."
IV
To her pleasant surprise, when she called to find out which day the
clinic offered immunizations, she discovered that the Santa Fe County Health
Office clinic was now offering immunizations five days a week and had
extended the hours. In 1993, New Mexico, along with other states and some
urban areas, received an increase in Federal funds to improve their vaccine
delivery infrastructure. Santa Fe County chose to use some of the funds to
increase the number of days it offered vaccinations to children. Nurse
Manager Laurie Spiegel said, "We're trying to be more accessible and people
are really responding. We know that both parents may work and it's difficult
to get to the clinic. Extending the immunization hours also means we've
decreased the waiting time at the clinic."
Kathleen was able to vaccinate her son as recommended and wasn't
forced to miss work. "It's nice to see that people realize how difficult it can
be to get to the clinic during a few fixed hours. I appreciate being able to go
for services at more convenient hours. Finally, a consumer-friendly state
service."
8-19
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National Infant Immunization Week
April 22-29. 1995
THE SEVEN DAYS OF IMMUNIZATION
"At Least Eleven Shots by Two: How Sure are You?"
T
he immunization rates for children under two years of age are far too low, and all members of
our communities can play a role in making sure that all of our youngest children are properly
immunized. Thousands of lives are jcopardized by preventable diseases, and hundreds of
thousands of dollars have been spent on the care of stricken children whose illnesses could have
been avoided. National Infant Immunization Week (NIIW) offers an opportunity to reach
audiences who can help make certain that our nation's children are fully immunized by the age of
two.
The slogan for NIIW 1995 is "At Least Eleven Shots by Two: How Sure Are You?", supported
by the theme: "We need you to get all our babies shots by two." This theme reinforces the need
to get all members of our communities involved in appropriately immunizing our children. The
"Seven Days of Immunization" provides a guideline for community activities during NIIW.
Each of the seven days focuses on a particular scctor of the community and helps to demonstrate
that everyone can play a role in making certain that all of our children are protected against
vaccine-preventable diseases.
April 22 and 23 - Religious Leaders Lead the Way
Religious leaders play an important role in the community and reach a loyal audience every
week. By incorporating immunization messages into their weekly service, religious leaders can
potentially affect a large audience.
April 24 . Elected Officials Voice Their Support
Elected officials, such as governors, mayors, members of Congress, statc legislators, and city
council members, have the ability to reach and mobilize broad cross-sections of the population.
On this day, elected officials could highlight the importance of disease prevention and identify
childhood immunization goals for their respective state, district or city. Their participation can
illustrate the entire community's commitment to our youngest children, and reinforce the
message that disease prevention can be measured in both economic terms and health benefits.
April 26 - Community Partnerships: A Key Element
Public-private partnerships, including health care providers, community-based organizations,
businesses, civic and service groups, the media and numerous others, play crucial roles in state
and community-based immunization efforts. This day of the week provides an opportunity to
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highlight some of these pre-existing partnerships. Through the attention focused on the
partnership activities, it is hoped that new partners will be encouraged to join these efforts.
April 26 . Disease Prevention: The Children's Perspective
For this day of the week, we are suggesting use of a school setting to focus on children's
understanding of disease prevention. Teachers and children can provide a direct link to parents
and younger siblings. The days' activities present an opportunity for teachers and children to
educate parents and peers. As a long-term benefit, schools may incorporate disease prevention
education as an ongoing part of their curriculum.
April 27 . Provider Spotlight: Innovative Strategies
Health care providers play the central role in immunizing children. In addition to administering
vaccine, many health care providers participate in community-based partnerships and undertake
innovative efforts to increase immunization coverage rates. These efforts include extending
office hours to accommodate working parents, making reminder phone calls, and auditing their
own patient records to check the immunization status of all children under their care. This day of
the week provides an opportunity to acknowledge these activities and encourage others to adopt
similar efforts.
April 28 - Childhood Immunization Across the Nation
One barrier to raising childhood immunization rates is the public's lack of awareness that the
problem is so serious and wide-spread. Friday's activities are designed to demonstrate that
under-immunization is a national issue that affects all of us. In addition, this day's activities
provides an opportunity to highlight the different strategies used by states and communities to
address the under-immunization problem.
April 29 - Community Mobilization: Reaching out for Children
Having built up momentum throughout the week, the final day of NIIW will focus on bringing
together existing partners for a "grand finale" event -- highlighting the fact that everyone has a
role to play in raising immunization rates. One suggested activity includes volunteers,
community groups and health care providers combining forces to organize phone banks or
canvassing efforts to reach as many parents as possible to discuss the importance and specific
timing of the necessary immunizations. Reminding parents of the specific timing for needed
immunization has proven to be an effective method for raising infant immunization rates. The
community mobilization activities provide a vchicle to rccognize existing efforts, recruit more
volunteers to these pre-existing efforts, increase public awareness, highlight effective ways to
raise immunization rates, and possibly make the reminder/recall effort an ongoing activity in the
community.