U.S. would track child vaccinations Monitoring linked to free-shot plan

April 02, 1993|By John Fairhall | John Fairhall,Washington Bureau

WASHINGTON -- If your young child isn't vaccinated, the government is going to come calling.

Immunization legislation announced yesterday by the Clinton administration would provide free vaccines to every American child and authorize a national tracking system to make sure that all children are protected against disease. Beginning at birth, a child's immunization history would be entered into a state-based, nationally linked computer system, enabling authorities to monitor vaccinations.

Parents of pre-schoolers who haven't had their shots would be reminded by public health officials, who could send a letter, drop by, or call.

But the legislation contains no enforcement provisions. And the bill was vague on the question of how the government would negotiate a price for the vaccine it would buy from drugmakers.

Under the Clinton measure, the federal government would be the sole purchaser of vaccines, providing them at no cost to private doctors and public health clinics. In drafting the bill, congressional and administration officials discussed creating a board that would negotiate prices, but the measure presented yesterday left that up in the air.

BTC Federal officials said they hoped parents would want to take advantage of the immunization program, which would cost up to $1.5 billion a year beginning in 1995 and would provide free vaccine to all children, regardless of family income.

Many American children do not receive their shots before their second birthday, and the immunization rate for poor children in some big cities is as low as 10 percent.

While hardly anyone of either political party disagrees with the need to reverse this trend, there is an ideological split even within the Clinton camp over the idea of making vaccines free to all children.

On one side are generally liberal thinkers like Marian Wright Edelman, head of the Children's Defense Fund and a close friend of the Clintons. She strongly pushed the idea of universal, government-sponsored vaccinations, and was the only official of private group invited to join Health and Human Services Secretary Donna E. Shalala at yesterday's news conference outlining the legislation.

Acknowledging Ms. Edelman's role, Ms. Shalala said to her: "This keeps a promise that we made to you."

On the other side are moderate Democrats such as Will Marshall, president of the Progressive Policy Institute, an arm of the Democratic Leadership Council, which Mr. Clinton formerly headed. Mr. Marshall supports free vaccines for poor children and the administration's plans for restraining vaccine prices but

doesn't believe the government should be doing for middle-class families what they can afford to do for themselves.

Mr. Marshall recalled that during his campaign for president, "Bill Clinton made much of the idea of reciprocal responsibility," of a "compact" between government and citizens delineating each of their responsibilities.

"I'm skeptical that the government needs, in effect, to substitute for the individual responsibility of parents," Mr. Marshall said.

But a Clinton political adviser, Paul Begala, defended the no-charge approach. One of the beauties of the Social Security program is its universality, he said. "Everybody pays, but everybody gets it."

Congressional supporters of the legislation, who joined Ms. Shalala at the news conference, also defended the idea.

Democratic Sen. Edward M. Kennedy of Massachusetts said "it has to be universal; otherwise you create all kinds of gaps and restrictions, and it adds to the bureaucracy" to devise a program with distinctions based on income.

Either a board, or a "permanent procurement panel" might be formed, said Dr. Alan R. Hinman, assistant surgeon general and director of the National Center for Prevention Services. Ultimately, the vaccine program will be absorbed under health care system reforms that the administration is now planning, Mr. Hinman and other officials said.

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