Good intentions abound in the Clinton administration. But some critics say blind devotion to a well-intended campaign pledge is earning the administration an embarrassing black eye.
Auditors for the General Accounting Office have concluded that critics are right in their charges against the administration's program to provide free vaccines to millions of pres-school children.
In a new report, the GAO says the program is behind schedule and riddled with organizational problems that could threaten vaccine safety and public health. What's more, the GAO says, the entire effort is based on flawed assumptions about the effect of the vaccine costs on immunization rates.
This saga began with the admirable desire to boost childhood vaccination rates, which during the 1980s dropped to among the worst in the hemisphere. While war-torn nations like El Salvador were summoning the will to stop their hostilities periodically in order to immunize young children against preventable diseases, the United States was lagging behind in one of the simplest and most basic tenets of public health.
One result was the national measles epidemic that popped up in Baltimore and other parts of the country between 1989 and 1991, with more than 55,000 reported cases of the disease, including 11,000 hospitalizations and more than 160 deaths.
President Clinton is right: There is no excuse for low childhood immunization rates.
But critics say his solution -- heavily weighted toward free vaccinations -- targets the wrong culprit. And, the GAO says, the system the administration is devising to help states buy and distribute vaccines is cumbersome, untested and potentially unsafe.
Currently, private doctors or state agencies order vaccines directly from the manufacturers. But the administration has devised a plan in which orders for vaccines will be collected by states and forwarded to the Centers for Disease Control. From there, the orders will be transmitted to manufacturers or to a federal warehouse in New Jersey operated by the General Services Administration, another federal agency. Vaccines can then be shipped either directly from the manufacturer or from the federal warehouse.
The GAO report has pointed out a couple of problems, however.
* The General Services Administration knows how to store and ship office supplies, hardware, paints and several thousand other commodities. But it has no experience with temperature-sensitive vaccines.
* At the time of the report, the Public Health Service had not tested the procedures for ordering vaccines or the containers and procedures for shipping them.
* Despite the administration's concern with the cost of vaccines to families, the program will allow physicians to charge as much as $15 for giving the shots, much more than allowed by the legislation that authorized the program last year.
Donna Shalala, secretary of Health and Human Resources, maintains that the administration's goal is to build a strong, comprehensive immunization system using both public and private elements of the health-care system. Currently, the cost of vaccines forces many low-income families to depend on crowded, understaffed public-health clinics. Secretary Shalala says that the plan would allow these same families the convenience of getting immunizations from private doctors.
She also notes that the plan helps states begin building a record-keeping system to aid parents in keeping track of immunization schedules. For many parents, the lack of convenient access to immunizations and the complexity of the immunization schedule are far bigger headaches than cost.
And what about cost? In 1991, the average price of immunizing a child through a private physician was $196.43, more than eight times higher than in 1982. The same vaccines were available for $90.55 through public-health clinics.
Drug companies point out that the cost includes two new vaccines, plus an additional dose of another vaccine. Liability costs and federal excise taxes to provide compensation for children damaged by vaccines have also inflated the price tag. Cost is a factor in immunization rates, but probably not as important overall as convenience, access to immunizations and better record-keeping. For many children, immunizations are covered by Medicaid or private insurance. But even when families have to foot the entire bill, the cost is spread over a couple of years -- unlike car seats, another necessary expense for parents.
At last we have an administration that knows the value of paying attention to children's health. Let's hope good intentions get translated into good results, not bureaucratic chaos.
Sara Engram is editorial-page director of The Evening Sun.