Money Gap Could Deprive Many Children of Vaccines

Thousands of children nationwide could go unvaccinated later this year against such diseases as measles, mumps and whooping cough because public funding for immunization programs has failed to keep up with the skyrocketing cost of vaccines.

Public health officials anticipate up to a $20-million shortfall in money available to states to buy vaccines. A new federal surcharge and continued concerns about vaccine manufacturers’ liability have contributed to a cost rise of as much as 50% this year.

If no new money is allocated, officials fear that children will be turned away from public clinics and vaccinations will have to be postponed--a policy that they said would permit chinks in the fragile armor of immunity considered crucial to averting epidemics.

“For the first time ever, the whole vaccine program is threatened by the unavailability of vaccine to the children who need it,” said Dr. Richard M. Narkewicz, president of the American Academy of Pediatrics. “. . . We know for a fact then that we are going to have an increased number of cases of preventable disease.”

In California, the chief of the state immunization unit warned county health officers late last week that vaccine supplies could run out after September. Thousands of children could be affected if federal or state officials fail to come up with the estimated $1.6 million needed to pay for the state’s increased vaccine costs.

“What it translates into is we’re going to run out of vaccine in the last quarter of this year,” said Dr. Loring Dales, chief of the immunization unit in the California Department of Health Services. “We may have up to a three-month period where there will be no measles-mumps-rubella or diptheria-tetanus-pertussis vaccine.”

In Orange County, health officials said that enough vaccine is available for the immediate future. But as demand increases costs, which already have doubled in some cases with the new federal surcharges, the county may have to divert funds in already-strained health-care budgets to ensure a sound immunization program.

“Every year, there is concern about funding for vaccine, and it’s become critical in the last two years,” said Dr. Gerald Wagner, medical director of Orange County’s immunization program.

“We have enough vaccine for the moment. But as state supplies decrease, we will have to go to the Board (of Supervisors) to (get approval for) purchase of the doses individually. That means we will have to look at what we have to give up” in the way of other programs, Wagner said.

The shortfall stems from the steady rise in vaccine prices in recent years because of increased litigation over vaccine-related injuries. Vaccine manufacturers say they have had to raise prices in order to cover the costs of lawsuits and judgments.

To try to control those price increases, Congress passed a law last year creating a federal vaccine injury compensation system under which people claiming to have been injured may avoid lengthy court suits by applying for compensation from a federal fund.

But the new federal surcharges placed on vaccines to support the federal fund total up to $4.56 per dose. Vaccine manufacturers say the surcharge more than wipes out any price cuts they have been able to make in return for the reduction in liability.

As a result, the overall price of a dose of vaccine for diphtheria, tetanus and pertussis (DTP) has risen 25% since Dec. 31, 1987, officials say. The overall price of a dose of vaccine for measles, mumps and rubella (MMR) has risen 50%.

“From the public health point of view, it’s an emergency situation,” Dr. William B. Walker, president-elect of the California Conference of Local Health Officers, said Thursday. “We cannot afford to be without the vaccine . . . without running the risk of significant epidemics.”

Dozens of other states are anticipating similar financing shortfalls, according to a preliminary survey by the Assn. of State and Territorial Health Officers. California, Florida and Massachusetts were among those reporting the largest anticipated shortfalls.

“There will be pockets where people can’t get the vaccine, no matter what we do,” said Narkewicz, who has appealed to Congress for extra money. “Even if the legislators do act . . . there are still going to be some children who should have gotten it and (will get) sick.”

During the first five years of life, children entering school are required by law to receive several series of vaccinations. Those include one dose of MMR, five doses of DTP and four doses of oral polio vaccine, administered at prescribed intervals to build immunity.

Without those doses, children are susceptible to diseases that can be devastating at a young age. Diseases such as measles, mumps and pertussis, or whooping cough, which are often mild in adults, can cause brain damage or even death in children.

“These are very contagious diseases,” said Dr. Shirley Fannin, who is in charge of communicable disease control for Los Angeles County. “They are kept under control by a high level of immunity: If the disease gets introduced, it doesn’t go far.

“But if you allow your susceptible population to grow, you will have sizable outbreaks,” said Fannin, who oversees an immunization program serving about 90,000 children a year. “That’s why we don’t like to face lags in the program.”

“With any luck, you would notice very little effect in the first few months,” said Dr. Donald Ramras, public health officer in San Diego County. “But as fewer and fewer kids are immunized, we’re going to be back where we were in earlier days, with outbreaks of communicable diseases.”

So far, Orange County has been waging a successful immunization battle, said Wagner, director of the county’s immunization program.

Annual surveys in Orange County, for example, show that of the 26,000 children who are entering kindergarten in Orange County, more than 95% of them are immunized.

But as costs go up and vaccine supplies dwindle as demand increases, “We have a real fear that those immunization rates will lower and it will lead to a spread of disease that could be easily prevented,” Wagner said.

Nationwide, more than half of all children are vaccinated through publicly financed programs at little or no charge. Because many private insurers do not cover the cost of immunization, the percentage dependent upon public clinics appears to be rising, officials said.

Congress may increase federal funding for immunizations from $98 million to approximately $140 million next year, health officials said. But Congress has not yet considered whether it will approve a supplemental appropriation for the remainder of this year.

Meanwhile, state and county health officials in California and elsewhere are pessimistic about their prospects of increased money from state and local sources. In California, two-thirds of the immunization funding is federal and one-third is from the state.

Several county health officers and state health officials in California said they are preparing to present the problem to county supervisors and state legislators. They said they are also making contingency plans in case no additional money is forthcoming.

Some said they would give priority to young children needing initial vaccinations, postponing adults and older children needing final booster shots. That way, they said, they might create partial immunity and not leave young children completely unprotected.

Times staff writer David Reyes contributed to this report from Orange County.