By ROBERT PEAR,
Published: August 23, 1994  Archived New York Post

THE HEALTH CARE DEBATE: IMMUNIZATIONS; Clinton’s Plan for Immunization Of Children Suffers a New Blow

In a sudden reversal, the Clinton Administration has abandoned plans for a national vaccine warehouse, which was to store and distribute vaccine as part of a campaign to immunize children across the country starting Oct. 1.

The demise of the warehouse is the latest in a series of setbacks to a Clinton initiative that, when first proposed in 1993, called for providing free, Government-subsidized vaccines to all children. The program has since been scaled back several times and, with cancellation of the plan for a vaccine warehouse, even less of the President’s proposal survives.

Administration officials said today that they still wanted to see all children immunized and hoped to raise immunization levels by having manufacturers make bulk shipments of vaccine to state health departments and public health clinics. Such shipments are already common practice.

But under pressure from the drug industry and Congress, the Administration has scrapped plans to use a Federal warehouse in Burlington, N.J., for the storage and distribution of vaccine.

Congress established a new program to provide free vaccines to low-income and uninsured children last year, but did not specify how the vaccines would be distributed. The Administration chose to use a Federal warehouse.

The Government has already spent more than $700,000 to buy freezers and other equipment needed to keep vaccine in the warehouse. Critics said the money would have been better spent on efforts to educate parents and find children who had not received their shots.

The vaccine distribution program, described by Administration officials as a dress rehearsal for efforts to restructure the entire health care system, was to begin on Oct. 1.

Federal and state health officials said the Government’s effort to store and distribute vaccine offered two lessons relevant to the larger debate: The health care system as it exists in 50 diverse states is far more complex than many people in Washington assume, and the Government needs cooperation from the health care industry if it wants to guarantee health care for all Americans.

Administration officials, who have defended the warehouse for the last eight months, changed course after members of Congress, drug company executives, Federal auditors and many state officials concluded that the Public Health Service did not have the ability to distribute vaccine to tens of thousands of private doctors on schedule.

As recently as last month, President Clinton and Donna E. Shalala, the Secretary of Health and Human Services, said they were confident that the Government could do the job with help from another Federal agency, the General Services Administration, which runs the warehouse in New Jersey.

But Dr. Walter A. Orenstein, director of the national immunization program at the Federal Centers for Disease Control, said today: “The G.S.A. delivery system will not be used. We are in the process of looking for alternative ways to get vaccine delivered.”

The alternatives, he said, call for vaccine to be shipped by drug companies or commercial distributors, not by the Government. Clinton Administration officials had argued that the Government could distribute vaccine more cheaply and efficiently than private companies, but members of Congress said that assertion was never proved. With the warehouse eliminated as an option, Congress may need to pass a separate bill to pay private companies for distribution.

“It has clearly hurt implementation of the vaccine program to have so much controversy,” said Dr. Orenstein. “That’s one reason for abandoning the G.S.A. distribution system, so we can have something acceptable to more people.”

Senator Dale Bumpers, Democrat of Arkansas, a close friend of President Clinton and his wife, Hillary, said the Administration’s plans for ordering, storing and distributing vaccine were “indescribably complicated.”

“A fairly simple law, designed to benefit a relatively small group of uninsured children, was transformed into a bureaucratic nightmare that put the safety and availability of a third of our nation’s vaccine supply at risk,” Mr. Bumpers said. He asserted that the Administration’s plan “took us dangerously close to nationalizing the pediatric vaccine market,” a result he said Congress never intended.

Senator Dan Coats, Republican of Indiana, asked, “If we cannot run a vaccine for children program, how are we going to run health care for everything else?” States Left in the Lurch

The decision to scrap the warehouse leaves many states in the lurch. Dr. F. Edgar Thompson Jr., the state health officer of Mississippi, said today, “We can distribute vaccine to the 120 State Health Department clinics here, but we have no means of distributing vaccines to hundreds of private physicians.”

The vaccine program originated in President Clinton’s desire to protect children against diseases like measles, mumps, diphtheria, polio, whooping cough and spinal meningitis. Less than a month after the President took office, Mrs. Clinton assailed drug companies as price gougers, and Mr. Clinton said children went without vaccine because the manufacturers were pursuing “profits at the expense of our children.”

Mr. Clinton first proposed that the Government distribute free vaccine to all children. But in 1993, Congress adopted a more modest program making vaccine available to children who were uninsured or eligible for Medicaid, the Federal-state program for low-income people.

Lawmakers were stunned when they learned last spring that the Government intended to set up a Federal vaccine warehouse. Senator John C. Danforth, Republican of Missouri, summarized Congressional reaction in May: “This program is getting bollixed up. The Government is taking over the vaccine distribution system. That’s crazy.”

In a letter to House members in June, Marian Wright Edelman, president of the Children’s Defense Fund, said the Federal warehouse was the only way to guarantee that delivery of publicly purchased vaccine would start on schedule Oct. 1. “There will be at least a nine-month delay in implementation if the Federal warehouse is scrapped at this late date,” she said then. Moreover, Mrs. Edelman wrote, “The storage and delivery of vaccines is not a difficult task.”

Debate over the warehouse diverted attention from the goal of immunizing all children. “Critics used concerns about the distribution system to cast the entire vaccine program in a negative light,” said James D. Weill, general counsel of the Children’s Defense Fund. “That’s like saying the Pentagon paid too much for hammers, so the Pentagon shouldn’t have any budget.”

The General Accounting Office, an investigative arm of Congress, suggested last month that the cost of vaccine was not an important barrier to immunization. Most children inadequately vaccinated are already eligible for free shots, it said. But the Administration says cost is an important consideration for poor families.

Clinton Administration officials say that drug companies have resisted the Government’s efforts to buy and distribute vaccine because of concern about their profits. Under the 1993 law, Federal and state governments, which now buy about half of all childhood vaccine, would have increased their share of the market to 80 percent, leaving 20 percent in sales to private doctors and clinics. Drug company revenues would have declined because the Federal Government and many states get deep discounts.