No Shots, No School

April 29, 1991

They're ba-a-a-ck! Those childhood diseases -- measles, rubella, whooping cough -- were supposed to have been wiped out by vaccination programs. But children increasingly are not getting the vaccinations. D.A. Henderson, of the Johns Hopkins School of Public Health, who led the World Health Organization's successful effort to eliminate smallpox, estimates that only Haiti and Bolivia, among 38 countries in Latin America and the Caribbean, vaccinate fewer of their 2-year-olds than does the United States.

And so the infections return. The federal Centers for Disease Control reported 26,520 cases of measles last year, 18 times more than in the early 1980s, when the annual numbers hardly exceeded 1,000. Cases of whooping cough rose from 2,823 in 1987 to 4,138 last year. In 1988 only two babies damaged by rubella were reported; last year 11 were. Dr. Henderson warns that polio could be the next disease to stage a comeback.

Many states, including Maryland, require that children be immunized against such diseases before they are admitted to school, yet Dr. Henderson guesses that only about 70 percent of American preschoolers have been vaccinated -- and as few as half of inner-city preschoolers. More than half of American children are immunized in public clinics, but federal funding for these programs has not kept pace with the rising costs of the vaccines needed -- from $6.69 in 1982 to $91.20 last year. The money squeeze shows up in leaner staffing and shorter hours at some clinics. Dr. Henderson says the medical profession throws up its own administrative barriers -- requiring children to have a physical examination before immunization, or refusing to vaccinate a child who has a cold.

The Bush administration wants $40 million to increase funding for immunization programs, including $10 million to test a plan that would deny welfare, Medicaid or other benefits to families unless they can prove their children have been vaccinated. William L. Roper, director of the Centers for Disease Control, defends the scheme as consistent with laws requiring immunization of children attending schools or licensed day-care centers.

Encouragement may help, but it must be combined with measures to make immunization easily available. Roland Park Elementary-Middle School showed how the other day when it sent home 280 students who couldn't prove they had had a measles booster -- after city health officials had run four free clinics at the school. Then a follow-up clinic gave the youngsters another chance to get the booster. With such concerted efforts, we can put measles and other childhood diseases back on the list of endangered bugs.

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