WASHINGTON -- Republican members of Congress say they intend to dismantle a federal program that distributes free vaccine to millions of children in view of a new report from congressional auditors who found that the program was misconceived and mismanaged.
Even congressional Democrats say the program known as Vaccines for Children -- which had its share of skeptics when it was unveiled in 1993 -- must be radically changed or it will not survive.
President Clinton and his wife, Hillary Rodham Clinton, have cited the vaccine program as a prime example of what the government should be doing to promote public health.
But the report prepared by the General Accounting Office says the administration incorrectly assumed that vaccine costs were the major barrier to immunization and underestimated the complexity of delivering vaccine to doctors and clinics around the country.
After reading the report from the GAO, Sen. Dale Bumpers, an Arkansas Democrat, said in an interview: "I would be perfectly willing to abolish the Vaccines for Children program and start all over again. It's been an unmitigated disaster from its inception. It proceeded on an absolutely false assumption, that cost was the big barrier to immunizations."
Mr. Bumpers and his wife, Betty, have been working to increase the immunization of children since he was governor of Arkansas in the early 1970s.
The audit by the GAO, the investigative arm of Congress, was requested by Mr. Bumpers and by Reps. Scott L. Klug of Wisconsin and Ron Wyden of Oregon.
Mr. Clinton persuaded Congress to establish the program in 1993 by arguing that vaccine manufacturers were pursuing "profits at the expense of our children."
The program provides free vaccine against such diseases as measles, mumps, polio and whooping cough to children 18 and younger who are eligible for Medicaid, have no health insurance or have private insurance that does not cover vaccine. The government expects to spend $457 million this year.
From the earliest days of the program, drug companies and other critics said that it was based on faulty assumptions and that the government was ill-prepared to run such a huge enterprise.
After a yearlong study, the GAO said it "did not find sufficient evidence to conclude that the cost of vaccine for parents has been a major barrier to children's timely immunization."
"The problem of under-immunization is limited to certain population groups and areas often referred to as pockets of need," the report said. But by trying to increase immunization for the population at large, it said, the Vaccines for Children program squanders resources.
The auditors recommended that Congress refocus the program to achieve "higher immunization rates in pockets of need, where conditions are ripe for disease outbreaks."
The Children's Defense Fund, the American Academy of Pediatrics and some state officials are fighting to preserve the vaccine program.
Dr. David Satcher, director of the Centers for Disease Control and Prevention, said, "We are not in agreement with most of the criticisms in the GAO report." He acknowledged that the program had had problems but said, "We are well on our way to surmounting every hurdle."
Mr. Klug and the chairman of the House Commerce Committee, Rep. Thomas J. Bliley Jr. of Virginia, said Republicans were planning to replace some health programs for low-income people with direct cash payments to the states. Money now earmarked for vaccines could be included in the grants, they said, and states would have much more freedom in deciding how to spend it.