Washington.--Avaccine against measles has been available since 1963. By the early 1980s the disease was practically wiped out in the United States. But since 1989 we've suffered a measles epidemic: more than 70,000 cases and 100 deaths. Half the deaths were of young children and the cause was their failure to be vaccinated.
Fewer than half of all inner-city children get the vaccinations recommended for them by their second birthday. In polio vaccinations of one-year-olds, the U.S. ranks 17th in the world, behind places like Albania, China, Pakistan, Mexico and Poland.
George Bush mocks Bill Clinton's notion of government spending as an investment. But childhood vaccination clearly is a social investment -- not just in the goody-goody sense that nobody wants children to die, or even in the sense that shots are a health-care bargain compared to the price of treating the disease. Immunization of individuals protects all of us from catching the disease. And yet, like so many other social investments, our vaccination infrastructure has been crumbling.
There are various causes. The price of vaccines has skyrocketed -- part of the larger health-care cost explosion. A dose of measles-mumps-rubella vaccine that cost $2.71 in 1980 is over $15 today. Meanwhile, fewer families have health insurance and fewer insurance plans cover vaccinations. Along with the growth of childhood poverty, this has put increased pressure on community health centers and public health clinics, whose budgets have not kept up.
So children dying needlessly of preventable diseases is another aspect of the general decline of national well-being that sneaked up on us while we were partying in the 1980s. And the vaccination scandal is characteristic of the Reagan-Bush years in a second way: We have been led by people with no faith in the power of government to do good. They believe their own rhetoric about government not being the answer. They don't believe it enough to prune entitlements for the middle class. But that's cynicism, not faith. They do believe their rhetoric enough to sit on their hands when a new social problem cries out for action.
The Bush response to the childhood vaccination crisis will be familiar to students of the president's approach to other problems. As with the S&Ls;, as with the deficit, as with Saddam Hussein, there were people who issued warnings early on that were ignored. As with health-care reform and parental leave, Mr. Bush's own proposals have only come in response to goading from the Democrats. As with drugs, Mr. Bush's approach has featured occasional public-relations frenzies alternating with periods of calm.
In his first budget (fiscal 1990), President Bush actually proposed a small cut in child-immunization funds, from $142 million to $138 million. After Congress got through, the figure was $158 million. The next year, Mr. Bush tried for another cut to $152 million but Congress insisted on an increase to $217 million. The next year the president saw the light and proposed $257 million; Congress appropriated $297 million. For fiscal '93, with the election approaching, the president bid $349 million and Congress actually sliced that by a few million (because Mr. Bush wanted to take the money from other programs, such as low-income heating assistance).
In June 1991, the president invited an audience of children into the Rose Garden to hear him declare that he was sending "SWAT teams" to six cities to study the vaccination problem. This was odd, since his own Department of Health and Human Services had just sent him a report analyzing the problem and proposing a $90 million emergency solution to it. Mr. Bush decided against that. In fact, at the time of the ceremony he was proposing to spend less on vaccinations than both houses of Congress had already cleared.
Eleven months later, last May, Mr. Bush was back in the Rose Garden announcing a new nationwide campaign for immunizing 2-year-olds. This is more than three years into his term and about as long into the measles epidemic (which is already waning).
I don't begin to know what is the "right" amount our government should be spending on child vaccinations. (The American Academy of Pediatrics says it's $487 million.) And I don't pretend to suppose that throwing money at the problem is the entire answer. But I do feel, as a citizen of the richest country in the world, that this is a problem I shouldn't have to worry about. And I wish we had a president who would take whatever action, and spend whatever money, is necessary to solve it. Quickly, not after years of prodding. Perhaps that makes me a Democrat.
Is there anyone who thinks that poor kids shouldn't get vaccinated? Is there anyone sick and tired of seeing his tax dollars going to wasteful, overpaid bureaucrats who fritter away their days inoculating children against disease? Is there anyone who believes this is a matter best left to the private sector? That tax cuts can take care of it? That "a thousand points of light" will shine it away? That giving shots to 2-year-olds only encourages welfare dependency? That preventing the spread of measles and polio is European-style "social engineering"?
Let those people vote for George Bush.
TRB is a column of The New Republic, written by Michael Kinsley.