Shots in the Dark


When President Clinton took office in 1993, one of his priorities was to reverse a slide in childhood immunization rates. In the 1980s, immunization rates among pre-school children had sunk so far they ranked among the worst in the hemisphere. But in devising a way to vaccinate more young children against common childhood diseases, the White House targeted the wrong enemy.

The administration decided cost was the problem. It set out to provide shots free of charge to as many children as possible, downplaying evidence that other factors played an equal or greater role and that low-income children on Medicaid already have access to free immunizations. As a result, the Clinton program has drawn scathing audits from the General Accounting Office.

Last year, as the program was getting off the ground, the GAO examined the system the administration was devising to help states buy and distribute vaccines and described it as cumbersome, untested and potentially unsafe. Now, another critical report from the GAO charges that the administration was wrong in focusing on providing free vaccines and that it underestimated the complexity of setting up a system of delivering vaccines to doctors and clinics.

After reading the report, even an administration ally like Sen. Dale Bumpers, D.-Ark., described the program as an "unmitigated disaster." It is hardly surprising, then, that the Republican response is to try to do away with the program altogether. What is surprising is that the administration got itself in this fix in the first place.

Childhood immunization should be an easy issue to champion. Yet somehow the administration set about spending money in all the wrong places. Yes, cost is a problem for some families, but it's not the overriding cause of low immunization rates. Unlike car seats, the cost of vaccinations is spread over two years.

Some states pay for all children's vaccines, but while their immunization rates are better than other states, they still don't approach the levels in most other Western hemisphere countries. Access to clinics, difficulty of keeping track of immunization schedules (especially when families move frequently), the lack of effective public education on the importance of vaccinations -- all these factors seem to weigh more heavily on families than cost.

Despite that evidence, the Clinton administration focused its efforts on a vaccine-purchasing approach that will cost $457 million this year -- a nice target for budget-cutting Republicans. And, no doubt, a prime candidate for a horror story about government's penchant for taking a good issue and producing a bureaucratic nightmare.

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