[Public Papers of the Presidents of the United States: WILLIAM J. CLINTON (2000-2001, Book III)]
[December 11, 2000]
[Pages 2680-2681]
[From the U.S. Government Publishing Office www.gpo.gov]



Memorandum on Improving Immunization Rates for Children at Risk
December 11, 2000

Memorandum for the Secretary of Agriculture, the Secretary of Health and 
Human Services

Subject: Improving Immunization Rates for Children at Risk

    In 1992, less than 55 percent of children under the age of 3 
nationwide had received the full course of vaccinations. This 
dangerously low level of childhood immunizations led me to launch, on 
April 12, 1993, the Childhood Immunization Initiative, which helped make 
vaccines affordable for families, eliminated barriers preventing 
children from being immunized by their primary care provider, and 
improved immunization outreach. As a result, childhood immunization 
rates have reached all-time highs, with 90 percent or more of America's 
toddlers receiving the most critical vaccines by age 2. Vaccination 
levels are nearly the same for preschool children of all racial and 
ethnic groups, narrowing a gap estimated to be as wide as 26 percentage 
points a generation ago.
    Despite these impressive gains, immunization levels in many parts of 
the country are still too low. According to the Centers for Disease 
Control and Prevention, low-income children are less likely to be 
immunized than their counterparts. In fact, immunization rates in 
certain inner-city areas are as low as 65 percent, placing them at high 
risk for potentially deadly diseases such as diphtheria, pertussis, 
poliomyelitis, measles, mumps, and rubella. These diseases are 
associated with birth defects, paralysis, brain damage, hearing loss, 
and liver cancer. In addition, children who are not fully immunized are 
proven to be at increased risk for other preventable conditions, such as 
anemia and lead toxicity. Clearly, more needs to be done.
    Today, I am directing you to focus your efforts to increase 
immunization levels among children at risk in a place where we clearly 
can

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find them: the Special Supplemental Nutrition Program for Women, 
Infants, and Children (WIC). This program, which serves 45 percent of 
infants nationwide and more than 5 million children under the age of 5, 
is the single largest point of access to health services for low-income 
preschool children who are at the highest risk for low vaccination 
coverage. State data indicates that in 41 States, the immunization rates 
for children enrolled in WIC are lower than the rates for other children 
in their age group--in some cases, by as much as 20 percent.
    Therefore, I hereby direct you to take the following actions, in a 
manner consistent with the mission of your agencies:

       (a)   Include a standardized procedure as part of the WIC 
            certification process to evaluate the immunization status of 
            every child applying for WIC services using a documented 
            immunization history. Children who are determined to be 
            behind schedule on their immunizations or who do not have 
            their immunization records should be referred to a local 
            health care provider as appropriate;
       (b)   Develop user-friendly immunization materials designed to 
            ensure that information on appropriate immunization 
            schedules is easily accessible and understandable for WIC 
            staff conducting nutritional risk assessments. WIC staff 
            should be trained to use these materials by State and local 
            public health authorities;
       (c)   Develop a national strategic plan, within 60 days, to 
            improve the immunization rates of children at risk. In 
            developing the plan, the Departments of Agriculture and 
            Health and Human Services should: consult with 
            representatives from the Office of Management and Budget to 
            ensure consideration for the FY 2002 budget; include input 
            from provider, health care consumer, and nutrition 
            communities, and develop a blueprint for action to:
        1.   expand the availability of automated systems or computer 
            software to provide WIC clinics with information on 
            childhood immunization schedules, with the eventual goal of 
            providing this service in every WIC clinic nationwide, to 
            provide more accurate and cost-effective immunization 
            assessment, referral, and follow-up, in a manner that 
            addresses cost-sharing concerns by both agencies;
        2.   disseminate a range of best practices for increasing 
            immunization rates for low-income children to WIC State and 
            local agencies, as well as immunization programs nationwide, 
            including developing efficient and effective ways to educate 
            WIC staff about the importance of immunization, appropriate 
            immunization schedules, and the information necessary to 
            make a meaningful referral;
        3.   foster partnerships (through written guides and/or 
            technical assistance) between WIC offices and health care 
            providers/advocates who can assist with immunization 
            referrals and conduct appropriate follow-up with families;
        4.   include information on the importance of immunizations and 
            appropriate immunization schedules in standard WIC efforts 
            to educate families about breastfeeding, anemia, lead 
            poisoning, and other health-related topics; and
        5.   evaluate whether other Federal programs serving children 
            should require a standard question on immunizations as part 
            of their enrollment process, and if deemed appropriate, 
            develop a plan for implementing that requirement.

    The actions I am directing you to take today, and any further 
actions developed as a result of interagency collaboration or public-
private partnerships, should not create barriers to WIC participation. 
Immunization outreach and assessment procedures should never be used as 
a condition of eligibility for WIC services or nutritional assistance. 
Rather, activities to improve immunization rates for children 
participating in WIC should be complementary, aggressive, and consistent 
with my Administration's overall initiative to increase immunization 
rates for children nationwide.

                                                      William J. Clinton