    [Public Papers of the Presidents of the United States: William J. Clinton (1993, Book I)]
    [February 12, 1993]
    [Pages 97-100]
    [From the U.S. Government Publishing Office www.gpo.gov]

    Remarks and an Exchange With Reporters on Child Immunization at the
    Fenwick Center in Arlington, Virginia
    February 12, 1993

        The President. Thank you. We are delighted to be here today. I want
    to thank all of you for hosting us and coming out in such wonderful
    numbers, and I want to especially thank the young people who are here.
        I want to begin my introducing the First Lady, my wife, Hillary. As
    many of you know, she is the chair of the President's Task Force on
    Health Care and came today to review the work of this wonderful clinic
    in anticipation of our presenting to the Congress a program to provide
    affordable health care for all Americans in the next several weeks.
        We've had a wonderful time here today. And I want to introduce the
    person to my left who will speak in a moment, the Secretary of Health
    and Human Services, Donna Shalala. I also want to introduce two United
    States Senators who came with us today: first, the chair of the Senate
    Committee on Labor and Human Resources, Senator Edward Kennedy of
    Massachusetts; and Senator Don Riegle of Michigan.
        I'd like to thank Jim Hunter, the Arlington County Board chair, for
    meeting us here. I know we have members of the Virginia Senate and House
    here, and the school board chair, Frank Wilson. I thank all of them for
    being here. But the two people I'd like to thank most today are the two
    fine public servants who showed us around. I'd like to ask them to stand
    and be recognized: Dr. Susan Allan, the Arlington County health
    director--where is Susan?--and Sue Adams, the Family Health Bureau
    chief. Thank you, Sue.
        We've had a wonderful time today. We got to walk through the process
    of what it was like for a parent to have a child immunized here. We saw
    the good news, which is that this place is doing a wonderful job of
    reaching people. We also saw some of the bad news, which is it's still
    pretty cumbersome to have a child immunized. And we did get to see a
    young woman of 20 months, get her a polio vaccine, which is an oral
    vaccine. So it was nice to see someone be vaccinated without pain.
    [Laughter]
        We came here today to make this day a landmark and to fight to
    protect the health of millions of our children. I can think of no better
    place to announce a new immunization policy than right here on the front
    lines of the fight to provide accessible, affordable health care to
    every family in this area.
        I'm pleased to be joined here by the children's advocates whom I
    have introduced. And I do want to say again our thanks to Sue Adams, the
    director of this clinic, and all the wonderful staff that came out and
    said hello to us and encouraged us along the way.
        This week I was startled to read of the case of a young boy named
    Rodney Miller, a 20-month-old child who lives in Miami, currently being
    treated for meningitis in the Jackson Memorial Hospital. He's there
    because he did not receive a meningitis vaccine that cost $21.48. The
    bill for his stay in the hospital has already topped $46,500.
        In the health care policy that our national task force is
    developing, nothing will be more important than preventive care. Today,
    American taxpayers are being hit with $10 in avoidable health care
    costs, avoidable health care costs, for every $1 we could be spending on
    immunizing our young people. The recent resurgence of measles in our
    country afflicted over 55,000 people, most of whom were children. The
    epidemic cost this country $20 million in avoidable hospital costs
    alone. Prevention would have cost $1 million. And those figures don't
    begin to take into account the terrible human cost, the agony of a young
    man like Rodney Miller with his joints swollen, with his ankles so
    swollen they have to be relieved with needling to get the pus out, that
    the pain and problems that he and many others will take

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    throughout their lives simply because we don't immunize our children.
        Lest you think that this is a problem that every country has, I want
    you to know in this beautiful health care building that the United
    States has the third worst immunization record in this hemisphere. Of
    all the nations in this hemisphere, only Bolivia and Haiti have lower
    immunization rates for their children than the United States of America.
        Over the past 10 years, while immunization rates have been declining
    in many important areas, the price of vaccine has risen at 6 times the
    rate of inflation. Immunizing a child cost about $23 10 years ago; it
    costs more than $200 today. In a public clinic, the cost of fully
    immunizing a child has leapt from $7 to more than $90. Manufacturers of
    these vaccines cite the cost of research and development to defend the
    rising prices. Well, nobody wants research to slow down, but let's look
    at what's really happening.
        The pharmaceutical industry is spending $1 billion more each year on
    advertising and lobbying than it does on developing new and better
    drugs. Meanwhile, its profits are rising at 4 times the rate of the
    average Fortune 500 company. Compared to other countries, our prices are
    shocking. Listen to this: The polio vaccine in the United States
    currently costs close to $10. In England, the same drug is available for
    $1.80. In Belgium, it costs 77 cents. The problems of having an adequate
    delivery system, plus the spiraling costs, are putting America's
    children and America's future in jeopardy.
        To make matters worse, the makers of these vaccines have refused to
    make their products available to States at more affordable cost. I
    should tell you, those of you who don't know, that the Federal
    Government buys vaccines from the manufacturer and distributes it
    through the States and ultimately the people through the Center for
    Disease Control. We buy the vaccines at a much lower cost than a doctor
    can. The States often directly buy vaccines. They buy the vaccines at a
    higher cost than the Federal Government, but still at a lower cost than
    doctors. States can order large quantities and therefore should receive
    lower prices.
        But listen to this: While 10 States have succeeded in negotiating
    agreements with the vaccine manufacturers that allow them to immunize
    all the children they can reach, manufacturers are now balking at
    starting talks with other States. In fact, just recently Texas, South
    Carolina, and Hawaii were all turned away. They were told that their
    efforts to get cheaper vaccines for their children were against public
    policy.
        Today we must tell the drug companies to change those priorities. We
    cannot have profits at the expense of our children. These practices have
    got to stop.
        But I want to make it clear: Dealing with the cost of vaccines will
    not be enough. We also have to improve the delivery of preventive care.
    I want to say to the members of the press and to all the people who are
    here, we should be under no illusion that every family and every child
    in America has access to a health clinic as good as this one. We should
    be under no illusion that every family and every child in America has
    access to a health clinic that opens at 7 a.m. in the morning and closes
    at 7 p.m. at night so that working families can bring their children.
        Even here, where there has been a dramatic increase in the number of
    children immunized, we are still seeing rates of 70 percent immunization
    when the national goal, and what is necessary to assure that there will
    be no outbreak of communicable diseases, is 90 percent. Without an
    outreach program to go out and reach people where they are, in the
    languages they speak, in the homes and in the neighborhoods and in the
    organizations that they frequent, we will not be able to reach this
    goal.
        So today I am announcing a three-part policy to protect our
    children's future and to save the taxpayers millions of dollars. It will
    require changes on the part of all of us. And as I have in the last 3
    weeks, I want to begin with the Government so that we do our job first
    before we ask anyone else to change what they are doing.
        I am pleased to announce that the job stimulus program that I will
    outline on Wednesday evening to the Congress will include $300 million
    to make vaccination services more widely available to all Americans.
    These funds will help public programs buy more vaccines. They will
    improve community services and personal outreach efforts. They will mean
    extended clinic hours all across America, more staff, and increased
    education efforts in conjunction with the Department of Education and
    the Department of Health and Human Services, and the resources necessary
    to create a national tracking

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    system so we know what is happening to these children. These folks here
    are having a terrible time getting good and accurate records because we
    don't have a national tracking system.
        These are the kinds of things that the National Government owes the
    American people and owes these fine public health professionals if we're
    going to do what we should be doing to help protect our children. And we
    will begin with that.
        Second, I'm directing Secretary Shalala to begin negotiations with
    our drug manufacturers to assure that other States who do not have the
    arrangements that 10 do can buy the vaccines they need at affordable
    prices. There is no reason in the world why a child in Texas is unable
    to receive vaccination while a child in Massachusetts can. We can't
    stand this kind of inequality simply because of the economic priorities
    of the manufacturers of the vaccine. It's wrong.
        Finally, the administration will prepare an initiative for my
    review, in cooperation with key congressional health leaders such as
    Senator Kennedy, Senator Riegle, Senator Bumpers, Senator Pryor,
    Congressmen Dingell, Waxman, and others, that will guarantee the
    immunization of every child in America.
        And I want to challenge the manufacturers of these vaccines to work
    with us. We cannot possibly justify financing research and development
    in future vaccines based on prices that will assure that children will
    not receive the vaccines that are available today. We can do better than
    that, and we have to.
        Our Nation is the only industrialized nation in the entire world
    that does not guarantee childhood vaccination for all children. It ought
    to be like clean water and clean air; it ought to be a part of the
    fabric of our life. Look at these children. We should not risk losing
    one of them, and we should not waste one dollar on our already over-
    bloated health care system that we could do away with vaccinations.
        The cruel irony is that we are the Nation that develops and produces
    the majority of the world's vaccines. But we don't have an effective or
    an affordable mechanism for distributing them, and we charge more for
    vaccines in this country than are charged in other countries for the
    same vaccines that are manufactured here. That is an irony that we
    cannot permit to continue.
        So the steps we're taking today will go a long way towards solving
    that dilemma. We'll make sure that excessive profits do not stand in the
    way of children's health. And I want you to know that we will not stop
    until preventable childhood diseases no longer threaten the families,
    the children, and the future of the United States.

    [At this point, Secretary of Health and Human Services Donna E. Shalala
    made brief remarks.]

        The President. Thank you very much. Thank you very much. We're going
    to shake hands, but I promised the press we'd answer a couple of
    questions. Does anybody have one? Where are they? I was listening for a
    familiar voice. Go ahead.
        Q. Mr. President, can you tell us what you hope to achieve? What
    makes you think that the health costs----
        The President. Well, for one thing, the drug companies are used to
    selling drugs on a bulk basis at a discount rate to the Federal
    Government and to some of the States. I think that the position they
    have taken, that we should continue the status quo, is untenable. But if
    they have legitimate arguments on research and development, maybe
    there's some other ways we can try to address those.
        I think we ought to let Secretary Shalala and the White House folks
    meet and deal with them and see what position they take. I cannot
    believe that anyone seriously believes that America should manufacture
    vaccines for the world, sell them cheaper in foreign countries, and
    immunize fewer kids as a percentage of the population than any nation in
    this hemisphere but Bolivia and Haiti. I can't believe that that is
    their position. But that is the inevitable consequence of what we have
    not done.
        Yes?
        Q. [Inaudible]--Congress is going to go along with any----
        The President. Well, I'm going to present a program to the Congress
    to provide for the immunization of all children at a reasonable price. I
    hope they will be a part of developing that program. Whether they are or
    not is up to them. But this is unconscionable. We are running the risk
    of new epidemics spreading out in this country. We cannot do it. We were
    supposed to have 90 percent of our kids immunized in 1990. That's what
    Dr. Koop wanted when he was Surgeon General. We missed the deadline.
    They put it off to the year 2000. And unless

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    we do something about the delivery system and the price, we're not going
    to get there in the year 2000. I want to get there sooner, and I think
    we can. I believe they'll be a part of this. I think the public
    outpouring on this is going to be so strong that they'll come along and
    do it.
        I'm still going to try to pass a bill that will permit us to
    immunize all the children of the country.
        Q. [Inaudible]
        The President. Well, let me say, in my State the public health
    department does 85 percent of the immunizations done. I'm very proud of
    that. And there are a lot of Southern States that, because of our legacy
    of poverty, have had to develop very elaborate public health networks.
    So this is something that we've been sensitive to for a long time.
        I've also been interested in buying the vaccinations. But everything
    that I've done on public health since--well, ever since we got into
    public life, Hillary's been a part of. So she's been pushing this, but
    so has Secretary Shalala. I don't know who to give credit to. But I
    don't care who you give credit to, as long as we get it done.
        Thank you very much.

    Note: The President spoke at 11:07 a.m. at the Arlington County Career
    Center.