[Congressional Record Volume 140, Number 85 (Wednesday, June 29, 1994)]
[Extensions of Remarks]
[Page E]
From the Congressional Record Online through the Government Printing Office [www.gpo.gov]


[Congressional Record: June 29, 1994]
From the Congressional Record Online via GPO Access [wais.access.gpo.gov]

 
                 GANG THAT COULDN'T GIVE SHOTS STRAIGHT

                                 ______


                        HON. JOHN J. DUNCAN, JR.

                              of tennessee

                    in the house of representatives

                         Tuesday, June 28, 1994

  Mr. DUNCAN. Mr. Speaker, the column below shows how big government 
can screw up almost anything, and how even programs that sound good on 
the surface can end up hurting the very people who were supposed to be 
helped.
  I call this column by Robert Goldberg to the attention of my 
colleagues and other readers of the Record.

             [From the Wall Street Journal, June 20, 1994]

                 Gang That Couldn't Give Shots Straight

                          (By Robert Goldberg)

       By its own account the Clinton administration regards 
     carrying out the Vaccine for Children program as a ``dress 
     rehearsal'' for health care reform. If so, the show will 
     close before it ever opens.
       There has not been a social program in recent history so 
     badly flawed as Vaccine for Children. The administration's 
     initiative is based on misleading information about 
     immunization levels in the U.S. It is determined to create an 
     entitlement even though immunization rates are at record 
     levels. At a time when local health officials have more free 
     vaccine than they can use, it is spending money to set up a 
     government-run delivery service of unknown cost and 
     questionable utility. Ignoring calls to delay the program, 
     the administration has arrogantly dug in its heels to carry 
     out a campaign pledge that borrows against our children's 
     future and spends against their needs.


                            sin of omission

       Originally the administration proposed buying up all 
     childhood vaccines. Health and Human Services Secretary Donna 
     Shalala told Congress that immunizations should be a right, 
     just as access to water and other public services is a right. 
     There were only three problems with Ms. Shalala's statement: 
     Water is not free; immunizations, with rare exceptions, are 
     affordable; and vaccination rates are high. Of course, Ms. 
     Shalala never mentioned that a $200 million federal program 
     already allows any child to receive free vaccines at local 
     health clinics.
       The administration maintained Vaccine for Children was 
     necessary to meet a goal of immunizing 90% of all 
     preschoolers with DPT (diptheria, pertussis, tetanus), polio 
     and measles vaccines by the year 2000. At a congressional 
     hearing the secretary said: ``The United States has one of 
     the lowest immunization rates for preschool children compared 
     to European countries.'' Yet Ms. Shalala used 1985 
     immunization measures for DPT, polio and measles even though 
     1992 information was available.
       While the outdated survey showed that slightly over half of 
     all preschoolers were immunized, the 1992 immunization survey 
     in Ms. Shalala's possession showed rates of nearly 80%. And 
     1993 data showed that the nation had largely met the goal of 
     a 90% immunization rate. In fact, Walter Orenstein, the 
     director of the Centers for Disease Control and Prevention's 
     National Immunization Program, noted at a recent Senate 
     Appropriations Committee hearing: ``Immunization levels among 
     preschool children are the highest ever.''
       Congress killed the Clinton plan to buy up all childhood 
     vaccines and provide them to rich and poor alike. Instead 
     Vaccine for Children will cover the poor, Medicaid patients, 
     the uninsured and the ``underinsured''--an amorphous category 
     that includes anyone whose health insurance does not cover 
     shots. To get the free vaccines, all people need to do is 
     show up at public health clinics and ``assert'' they have no 
     coverage. Further, Vaccine for Children would go out of 
     existence when health care reforms added immunization to a 
     standard benefits package. Citing these assumptions, the 
     Congressional Budget Office estimated that the program would 
     cost $430 million over five years.
       Congress assumed and the administration said that private 
     vaccine companies would distribute the government-supplied 
     vaccine. But the price controls the government imposed on 
     vaccines to meet the CBO estimate left no margin for paying 
     delivery costs. Therefore, the Department of Health and Human 
     Services decided to set up its own distribution system. The 
     rush to fulfill a campaign pledge now threatens to compromise 
     the nation's vaccine supply.
       First, HHS wanted the Veterans Administration and the 
     Defense Department to operate a vaccine depot system for the 
     program. The offer was rejected: Both agencies were getting 
     out of the vaccine and medical distribution business; two 
     government studies showed that private companies distributed 
     health care products more cheaply and efficiently.
       With only two months remaining before vaccines are supposed 
     to be shipped, HHS has gotten the General Services 
     Administration to create a new distribution system. However, 
     GSA lacks both the infrastructure and experience to move 
     hundreds of millions of fragile and highly sensitive 
     biological products safely on a tight schedule and under 
     strict Food and Drug Administration requirements. What GSA 
     does have is space in a New Jersey warehouse now used for 
     storing paint solvent, where the administration plans to 
     store up to 40% of the nation's entire childhood vaccine 
     supply.
       The warehouse lacks the private vaccine industry's state-
     of-the-art distribution systems, computer equipment and 
     managerial expertise for handling and accounting for every 
     single dose of vaccine according to complicated FDA safety 
     guidelines. For example, the Centers for Disease Control 
     states that it will save time and money by packing different 
     vaccines in the same container. The problem is, different 
     vaccines can't be shipped and stored in the same way without 
     jeopardizing their safety. Oral polio vaccine must be shipped 
     frozen, while others must be kept at temperatures between 2 
     degrees and 8 degrees Celsius. Not even the Clinton 
     administration can change the laws of physics.
       Further, by creating another level of bureaucracy, HHS is 
     adding to the already significant amount of waste and 
     spoilage that already results from the handling of vaccines 
     by state and local public health programs. HHS is in such a 
     panic to distribute the vaccines that it is discouraging 
     states from tracking and accounting for vaccine deliveries, 
     despite the fact that the FDA would shut down a private 
     company that neglected those duties. States are planning 
     accordingly: Recently Illinois told the Centers for Disease 
     Control that it was ordering 25% more vaccine in anticipation 
     of waste under Vaccine for Children.
       There is a real danger in storing so much vaccine in one 
     place. A catastrophe is not out of the question. In May 1992, 
     the Illinois public health service's supply of Hepatitis B 
     vaccines was stored in a meat locker with carcasses. Blood 
     and other matter was found dripping over the vials, 
     contaminating the entire lot. In Washington, D.C., 
     refrigeration in the District government's central vaccine 
     warehouse broke down. The warehouse lacked a backup system, 
     and 23,000 doses of measles vaccine--a year's supply for the 
     entire District--was lost.


                            `we have enough'

       Worst of all, the administration is diverting funds to the 
     warehousing scheme at a time when public health officials 
     insist they have plenty of free vaccine. State and local 
     health officials such as F.E. Thompson of the Mississippi 
     State Department of Health note: ``We have enough vaccine. . 
     . . What we do not have enough of is nurses to give it, 
     clerical staff to track the children, and outreach workers to 
     bring them.''
       In fact, a number of states, including Arkansas, have told 
     the Centers for Disease Control that the Vaccine for Children 
     program will actually hurt immunization efforts by taking 
     time and staff away from their own vaccine initiatives. The 
     Centers for Disease Control is understaffed and cannot keep 
     up with the state and local health officials' demand for 
     technical assistance.
       Appeals to delay or scrap Vaccine for Children have been 
     ignored. Instead, HHS is working overtime to get deliveries 
     going by August. The Clinton administration will probably 
     throw some operation together so it can claim victory. But in 
     fulfilling a campaign pledge, it will fail to improve the 
     lives of children.

                          ____________________