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Is the Nation's Vaccine Program in Trouble?

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WebMD Health News

June 15, 2000 (Washington) -- Even though more Americans than ever are getting vaccinations, the system supporting the effort is "unstable," according to a new report from a panel of experts commissioned by a congressional committee. At the same time, another congressional panel took a hard look Thursday at whether conflicts of interests influenced scientific advisers who recommended an ill-fated vaccine in the late '90s.

As things stand now, the nation's vaccine program is still solid, but cracks are beginning to show, particularly since many states have reduced their immunization efforts, including identifying and reaching out to medically underserved communities. That's a key conclusion of "Calling the Shots, Immunization Finance Policies and Practices," an analysis prepared by the Institute of Medicine (IOM) of the National Academies for the U.S. Senate Appropriations Committee.

The report recommends an overhaul of the way vaccinations are financed, including an injection of $1.5 billion over the next five years by federal and state governments. During the '90s, the experts say, instability in funding at the state level discouraged broader coverage and increased differences between low and high-income groups.

"The infrastructure itself has begun to come apart ... because there isn't as much funding. There aren't as many outreach efforts. There isn't as much work going on with the private sector," panel chair Bernard Guyer, MD, tells WebMD. Guyer is a professor at the Johns Hopkins School of Hygiene and Public Health in Baltimore.

In the meantime, the demand for vaccinations continues to grow. Each day, according to the report, 11,000 children are born in the U.S. who must either be immunized or face life-threatening infections. For example, a measles outbreak in the late '80s led to 43,000 cases and 100 deaths. Diseases that could be prevented by vaccination still kill 300 children and up to 70,000 adults annually, the report says.

Other disturbing trends: Vaccination rates are as much as 19% lower for inner-city children than for those living outside city limits. Some 63% of adults get flu shots, but the percentage for seniors getting pneumonia vaccinations is significantly lower.

Of equal concern, says the report, 9% fewer poor children complete the full series of the most critical vaccines than their wealthier counterparts. One of the reasons for these gaps is that many low-income children have shifted their Medicaid coverage to a managed care organization. HMOs only report on children who've been enrolled continuously for one year.

"This approach tends to undercount or miss children on Medicaid who frequently change [health care] providers," the report's authors say. Meanwhile, the list of available vaccines is rapidly increasing with equal increases in cost. Some states, the IOM says, already are struggling to offer the chicken pox vaccine. Less than 50% of American children have received this vaccine, even though the CDC recommends it.

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