[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

[[Page 98]]

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.