It's Mrs. Clinton's shot at an inoculation cure - Hillary Rodham Clinton's effort to supply childhood vaccines to every pre-school child

0 Comments | Insight on the News, Feb 22, 1993 | by Elena Neuman

"There are a host of reasons that we shouldn't lessen the restrictions. We should, in fact, tighten them up," she says. "The intent of the National Childhood Vaccine Injury Act was to make vaccines safer, so these standards really fly against Congress's intent in passing that law, which still now should form the basis of any federal policy about immunization campaigns."

Erickson is referring to a law passed in 1986 in response to a number of serious neurological reactions and deaths from the whooping cough vaccine. A slew of lawsuits against the manufacturers of the vaccine threatened to put them out of business and jeopardized the nation's vaccine supply. They also sent the prices of most vaccines skyrocketing. The price of the DTP vaccine, for example, has risen 5,147 percent from its low of 19 cents a dose in 1977 to $9.97 in 1992. The 1986 law partially rectified the crisis by legislating medical precautions for administering vaccines as well as a publicly financed vaccine injury compensation fund to eliminate the need for outside litigation against the companies.

"The at-risk indicators for a vaccine adverse reaction are if there has been a history in that family among siblings or very close relatives of having had an adverse reaction," says Erickson. "So the recommendation of giving siblings simultaneous vaccinations seems misguided. Having some sort of sequenced pattern to having siblings receive vaccinations makes a lot more sense. But really the most risk is introduced by not having competent medical professionals do the exams, the screening and admininistering of the vaccinations. Doctors are not well-trained enough to diagnose adverse reactions, and if doctors aren't well-trained enough, you can certainly imagine that other persons without the professional training, what their deficiencies would be in recognizing adverse reactions,"

The National Vaccine Information Center, an advocacy group for families of children injured by vaccines, has tracked 360 deaths and 17,221 other serious adverse reactions due to vaccinations in the 20 months leading up to July 1992. This, they say, represents only a fraction of the number of adverse reactions. (The CDC and many pediatricians and neurologists, on the other hand, question whether vaccines are the true cause of all these injuries and deaths.)

Erickson, Orenstein and other immunization professionals further question the universal vaccine purchase program promoted by the Children's Defense Fund, the American Association of Pediatrics and other heath care organizations. While Orenstein concedes that universal purchase would prevent fragmentation of care while also stopping the overuse of public clinics by children who are normally treated by private physicians, he says he wonders whether such an expensive solution would solve the problem of low vaccination rates in the inner cities.

"We still will need to improve our health care delivery capacities in the inner cities," he says. "We shouldn't think that buying the vaccines will somehow get a kid in Harlem vaccinated. Moreover, will vaccine manufacturers drop out of the market as a result of universal purchase? That is a potential threat. Will they invest the same amount of money in research? That is not clear." Vaccine manufacturers expressed just these concerns upon receiving word of Clinton's universal purchase plans, and the CDC is currently funding a study to determine the benefits and risks of universal purchase.