WASHINGTON -- The federal and state governments could buy childhood vaccines and distribute them free under a plan being considered by the Clinton administration to ensure virtually all U.S. children are vaccinated.
At present, the government says, only 40 percent to 60 percent of preschool children get the recommended shots, and in some inner-city neighborhoods the number is just 10 percent. Health officials say the low level of immunization is one reason for outbreaks of measles and other diseases in the last few years.
The administration says its plan will lead to virtually universal immunization because the cost of vaccines, which has increased greatly in the last decade, would no longer be a barrier.
The idea is supported by leading pediatricians and child-advocacy groups, including the Children's Defense Fund, but it is opposed by drug companies, which say it will make the manufacture of vaccines unprofitable and may force them to slash spending for research to develop new, more effective vaccines. Moreover, they say it will not necessarily increase rates of immunization, because price is far less a barrier than the lack of education and accessibility for inner-city residents.
"Universal purchase would just kill innovation because the government would control the market," says Thomas L. Copmann, assistant vice president of the Pharmaceutical Manufacturers Association.
Under a program of universal purchase, vaccines would be treated as a public utility, with a guaranteed market and negotiated prices, including profits for manufacturers.
"Under our current system, with limited access to vaccine, immunization has become a privilege," says Dr. Kenneth J. Bart, director of the National Vaccine Program Office at the Department of Health and Human Services. "We believe that every child has a right to be vaccinated, just as everybody has a right to clean water."
Several states, including Connecticut, Massachusetts and Washington, have programs to distribute vaccines to private doctors at no charge. The programs vary, but state officials say they significantly increase immunization rates.
In general, these states buy enough vaccine for all children, using a combination of state money and federal grants. Doctors may charge a small fee, up to $5 or $10, for their services, but may not charge for the vaccine itself. State officials say these programs help them measure immunization levels because doctors must report how the vaccine is used.
Such systems of universal purchase and distribution are used "in nearly every other country," the Children's Defense Fund says.
In the United States, vaccines are now distributed through a hodgepodge of arrangements. Federal officials say these arrangements reflect basic problems in the nation's health-care system. About half of employer health plans do not cover childhood vaccines, regarded as a cornerstone of preventive medicine, the officials say.
Right now, the federal government pays for one-fourth to one-third of all childhood vaccine bought in the United States, while state and local governments buy one-fourth or less. The federal government estimates that private doctors and other private health-care providers buy half of all vaccine, which is paid for by their patients and their insurance companies.
The plan would cost the government $300 million to $500 million a year, in addition to the $175 million it already spends to buy vaccine. Federal officials said they had not decided how to pay for the program.
When the federal government buys vaccine in bulk, it gets a big discount.