Clinton to seek free vaccines for all children Government would buy shots, oversee immunizations

April 01, 1993|By John Fairhall | John Fairhall,Washington Bureau

WASHINGTON -- In a controversial move to ensure that all children are immunized against disease, the Clinton administration plans to announce legislation today that would enable the government to buy all vaccines and make them available to every child free of charge.

The legislation faces fierce opposition from drug companies fearful that it would cut their profits. The bill would require them to sell vaccines to one buyer, the government, at a discounted price to be determined by a new national board, congressional and administration sources said yesterday.

President Clinton may also encounter criticism from conservative Democrats, who have cautioned him against free vaccines to children of well-to-do parents.

Although the legislation applies only to vaccines, it could foreshadow how the administration will deal with drug prices in general when it announces a health care reform plan in May. Administration officials have repeatedly warned that price controls will be required.

The vaccine program would begin in 1995. How much it would cost the government would depend on the price paid to drug makers. To ensure that children get their shots, a national tracking program would follow up.

Mr. Clinton has made universal immunization a top priority, and in a speech Feb. 12, he chastised drug companies for pursuing "profits at the expense of our children." Only about half of the country's 2-year-olds are fully vaccinated, and the president made it clear he wanted vaccine prices lowered to remove any financial barrier to immunization.

The average cost paid by a private doctor for a complete series of vaccines -- including polio, mumps, rubella, whooping cough, measles, tetanus and diphtheria -- increased dramatically from $23 in 1982 to $244 last year. Drug companies say, however, that government excise taxes have contributed to the increase.

In mid-February Mr. Clinton directed Health and Human Services Donna E. Shalala to begin negotiations with drug companies. But the effort failed, according to a departmental source, who said: "We didn't make any headway in that approach."

The proposed Comprehensive Childhood Immunization Act of 1993, which Ms. Shalala will discuss at a news conference, vastly expands the government's role and financial obligation in child vaccines. Although the government now buys vaccine at a discounted bulk rate for distribution to public health clinics, under the bill the government would buy all vaccine and make it available not only to clinics, but private doctors as well.

Doctors could not charge for the vaccine, but would be permitted to charge an administration fee, which could be waived for low-income people.

Critics of the present immunization system say price is a major hindrance and that more and more private doctors have simply stopped offering vaccinations. Often, a doctor will tell parents to take their child to a public clinic where vaccinations are free. But many parents don't want the trouble of going to a clinic, which might not have convenient hours or not be located near their homes.

Drug company executives argue that price isn't the major barrier to vaccinations. They recommend that the government spend more time and money opening more clinics, expanding clinic hours and educating the public on the need for immunization. Ms. Shalala is expected to address some of these issues.

The impetus for the legislation comes in part from the nonprofit Children's Defense Fund, a leading advocacy group. The head of the organization, Marian Wright Edelman, is a close friend of the president and his wife, Hillary Rodham Clinton, who served more than two decades on its board of directors.

Ms. Edelman will be at the news conference, along with leading congressional advocates of immunization reform, among them Rep. Louise M. Slaughter, a New York Democrat who introduced a bill last year that is in many ways a model for the administration's proposed legislation.

Drug companies were not consulted in drafting the legislation, and as word of the administration's action spread last night they began to prepare for a fight. They are bitterly opposed to having just one buyer, and to the idea of a national price board.

It wasn't immediately clear how the board would function or who would run it. Congressional sources said generally the board would look at drug companies' research and development costs and other factors in determining a fair price for vaccines.

Craig Engesser, a spokesman for one manufacturer, Lederle-Praxis Biologicals, said the legislation would create uncertainty about the vaccine market, leading to reduced research and development. "We don't know what prices they're going to give us," he said.

"I don't know that newspapers would want to have their profit margins determined by people outside the business," he added.

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