Dr. Donald A. Henderson knows something about immunizing the masses against disease, having directed a campaign for the World Health Organization that accomplished nothing less than the eradication of smallpox from the globe.
These days, the Baltimore doctor is preparing to carry out one of President Clinton's chief goals: reversing the nation's abysmal record of immunizing children.
Less than 60 percent of U.S. children under 6 are fully immunized against such diseases as measles, mumps, rubella, whooping cough and polio. In many inner-city areas, the rates drop as low as 10 percent.
Dr. Henderson, 64, is the deputy assistant secretary for science at the U.S. Department of Health and Human Services. He served as dean of the Johns Hopkins School of Hygiene and Public Health from 1977 to 1989 after a decade as chief of the global war on smallpox.
QESTION: Why is this country doing such a terrible job vaccinating its children -- ranking with Bolivia and Haiti as having the lowest immunization rates in the Western Hemisphere?
ANSWER: One piece of it is that health-care providers are not according immunization a high level of priority. Perhaps it's understandable. When we introduced the polio vaccine, we had to ration because we did not have the supply to meet the demand. We did that so well, we don't see polio.
Measles and mumps are comparatively rare [so] there's a complacency: It doesn't make that much difference if we don't get the kids vaccinated until they get to school. But as we learned from the 1989-'91 period, we had major epidemics of measles. The point is, the risk of acquiring these infections remains high. Once we stop vaccinating, we're going to have the resurgence of these diseases.
Q: Does the blame fall mostly on parents, or on the pediatricians and family doctors?
A: There are those who are saying it's the parents who are ignorant. In fact, there are many many instances where children are being seen by health-care providers and not being immunized; for example, children coming into emergency rooms. Many children in the inner city depend on emergency rooms for their health care -- and the doctors are busy with other things.
Q: What should we be doing to help parents?
A: All parents should make a real point of insisting their children be vaccinated.
But we should also make it easy for them. The times the clinics are open should be convenient to working parents. A number of clinics at this point say the child cannot be immunized unless they have a full physical exam. That's not necessary. The child does not need a full physical examination to be vaccinated.
Q: Where does the federal program stand now? Is there a timetable? How much is it going to cost?
A: The president has asked for a major increase in funding for immunization for the fiscal 1994 budget, which would commence Oct. 1. It would bring funding up to $667 million . . . from around $330 million or $340 million. At the moment it's working its way through Congress.
Immunization is clearly the most cost-effective and simplest of all medical procedures that we perform. Not to be able to deliver this in an effective way to children throughout the country really is a crime.
Our efforts are several. One is to work with states and local agencies to try to provide a user-friendly system -- more convenient in terms of hours, less waiting, more convenient all around.
Q: What else should we do to make sure everybody gets vaccinated?
A: One thing we would do is start a system to register children in a computer system at the time of birth. Then, when the child is due for a vaccination, the computer would kick out a letter to the parents saying their child is due for a vaccination. Then, everyone who provides an immunization can enter it into the system. And a doctor who sees a child can immediately access it.
It's been used very effectively in Britain and Holland.
Q: If our vaccination levels are so low, why haven't we seen resurgences of preventable diseases other than measles, such as polio, rubella, diphtheria?
A: We have seen resurgences of some of these diseases. Rubella has began to come back. Whooping cough began to come back.
Why didn't we see a resurgence of polio? In fact, the potential is there. If we had wild polio virus introduced into these areas, one could expect a resurgence or a major outbreak.
Q: Is there wild polio circulating?
A: We are feeling increasingly confident that wild polio virus is not circulating in the Western Hemisphere. But the risk is there.
As recently as January in Manitoba, they isolated a wild polio virus in quite a number of kids in a religious community that refused vaccination. We did not see further spread. Had that gotten into our inner cities . . . well, we know you have major epidemics with 50 percent of the children vaccinated.
Q: Many traditional insurance plans do not cover immunizations, so parents are forced to pay out of pocket. Is this part of the reason children are not getting immunized?
A: Yes. In fact, about half of the children covered by insurance do not have coverage for immunizations. We'd hope to see all policies cover immunization. I've talked to the insurance people. I said, "You cover in-grown toenails and acne and what have you."
They say, "Immunization is an expected cost and insurance is supposed to cover unexpected costs."
It's well documented: Many pediatricians see parents who don't have a lot of money, and what they do is refer them to the public clinics. This is for the poor, harassed mother who has dragged her kids in to see the pediatrician for regular visits, and now has to make two visits. It's inevitable she doesn't make it. It's been estimated that to add immunization, to provide it in insurance policies, would probably cost a penny a day for a family.
"Here's something that prevents illness," I've said to our insurance-agency colleagues. "I don't know what you're selling. It sounds like you're selling sickness insurance. If you're going to sell health insurance, then provide the immunization."