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    Is the Nation's Vaccine Program in Trouble?


    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.

    The proposed remedy by the IOM panel is the $1.5 billion investment over the first five years, with an annual increase of $175 million over current spending. The report also says Congress should spend $50 million more to buy vaccines for needy adults and states should kick in another $11 million.

    On Capitol Hill, the FDA and CDC were under attack at a hearing of the House Committee on Government Reform. The concern, expressed by Chairman Dan Burton (R-Ind.), is that there are possible conflicts of interest issues that unduly influenced the approval of the rotavirus vaccine.

    The vaccine, RotaShield, was approved by the FDA in 1998 to prevent infant diarrhea and recommended for universal use by the CDC in March of 1999. However, it was pulled off the market last October after some children developed serious bowel complications.

    Burton says that three out of the FDA advisory committee members who voted for the vaccine had financial ties to drug companies that were developing different versions of the product. He also notes that four of the eight CDC part-time experts who gave their OK for using RotaShield also had interests in firms working on similar vaccines. Both the FDA and CDC rely heavily on a system of freelance experts to help them reach decisions about putting pharmaceuticals on the market.

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