Worth a Pound of Cure F

SARA ENGRAM

February 07, 1993|By SARA ENGRAM

Folk wisdom says where there's a will there's a way. Here's some evidence:

* During the bloodiest days of El Salvador's civil war, the opposing sides agreed on one priority -- immunizing young children against preventable childhood diseases. They scheduled periodic truces to accomplish that goal. Now, as in most other Western hemisphere countries, 80 percent or more of El Salvador's children aged 2 and over are fully immunized.

* When a health minister in Great Britain decided the country could do better than a 60 percent immunization rate, he offered physicians bonuses for seeing to it that their young patients got their vaccinations. There was much griping about the reward system, but it worked. Immunization rates soared to 80 percent. Further bonuses pushed the rate past 90 percent.

Rich or poor, troubled or tranquil, countries that want to protect young children from preventable diseases can do it. Apparently, the United States hasn't really wanted to.

Among this country's pre-school population, immunization rates hover between 40 percent and 60 percent. (School-aged children are required by law to be vaccinated.) Worse, in many inner-city areas, where population density is greatest, rates drop as low as 10 percent -- equivalent to, say, Mongolia.

That poor performance places the United States in less-than-stellar company. In the Western hemisphere, only three countries fail to immunize 80 percent of pre-school children -- Haiti, Bolivia and the United States.

The Clinton administration says it wants to change this, and it is ++ exploring ways to do so. That really shouldn't be big news. Any health care reform effort worth its salt would begin with the basic building blocks of cost-effective care -- and that means implementing the simple, common-sense wisdom that

prevention is always better than cure.

It's cheaper as well. Every dollar spent to immunize a child saves $10 down the line -- in hospital costs or side effects.

Measles, for instance, may strike many people as one of childhood's rites of passage, something to be taken in stride. But when measles epidemics broke out in 1990 (a direct result of poor immunization rates), 89 Americans died.

Those outbreaks struck 13,000 pre-schoolers. Measles can cause severe pneumonia and hearing loss. Even with no lasting effects, a disease that produces temperatures of 104 or 105 degrees is scary. What kind of health care system wouldn't do everything possible to spare children -- and parents -- unnecessary suffering, discomfort and fear?

Dr. D. A. Henderson, former dean of the Johns Hopkins School of Hygiene and Public Health and now White House adviser on life sciences, led the successful effort to eradicate smallpox. So he knows first hand the importance of a comprehensive immunization program for any society.

"This is the simplest, most cost-effective medical procedure we do," he says. "We [in the United States] can do it, we just can't deliver it."

And that's the problem. A number of obstacles stand in the way, from the rising cost of vaccine to inconvenient hours and locations of public clinics where shots are available for free or at reduced cost. And in this mobile society, it can be difficult for parents to keep track of each child's immunization record. Most countries have some kind of national registry for immunizations.

Cost, convenience, tracking -- all of these barriers help keep U.S. immunization rates lower than they should be. But these are removable obstacles -- if the country wants to remove them.

For instance, drug companies have complained that proposals for the government to buy up all vaccines and distribute them for free would cut into profits crucial to support further research and development. But there's no reason R&D costs can't be factored into a fair price from the government. That is routinely done by the Department of Defense.

As Dr. Henderson notes, the problem goes beyond cost or any other single barrier. Neither can it be blamed on "those dumb parents," who don't take proper care of their children. The problem lies in a system that turns a simple procedure into an obstacle course.

"It's a strange monster of a system," Dr. Henderson says. "It's not a system -- it's chaos."

Getting kids immunized should be convenient and free, as it is in most countries around the world. The benefits would far outweigh the costs.

All it would take is the decision to make the health of children a national priority.

L President Clinton promises to do this. Let's hold him to it.

Sara Engram is editorial-page director for The Evening Sun. Her column appears here each week.

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