Budget Cuts Limit Prospect of Measles Vaccine for Needy

San Diego County cannot give children a second measles vaccination as recommended by a federal agency because it lacks the vaccine to give the first inoculation.

More than 8,000 children might have to go without the needed first vaccination next year, despite a fivefold increase in measles cases over the past year, county health officials say.

“If we haven’t got the vaccine, we’re obviously not going to immunize,” said Donald Ramras, county health officer. “If things don’t change, my prediction is that some people won’t get it.”

The problem is a money crunch in the state Department of Health Services, where officials are expecting a shortage next year of 500,000 vaccines against measles, polio and mumps, among others, because of a 25% to 30% cut in funding and a rise in vaccine prices.

The health department’s shortfall trickles down to the counties, to whom it distributes the vaccines.

“It’s been kind of a desperate situation for the last part of the year,” said Loring Dales, chief of the immunization unit of the state health department.

Dales said that people who can afford a private clinic, where the cost of a measles vaccination is $30, will be able to find the vaccine. However, for more than 35,000 children--almost 25% of the 150,000 children in California that receive immunizations at public facilities every year--”it’s just not going to happen.”

Already this year, clinics in several counties have sporadically had to turn away children needing a variety of vaccines, Dales said. Without more funding, more children will be turned away from public clinics in the second half of next year, when funds for vaccines against measles, polio and the mumps, to name a few, run out.

“This is the first time that it has ever been this bad,” Dales said.

Vaccines are purchased with a combination of state and federal funds, with the state picking up 20% of the tab.

San Diego County, which administered almost 33,000 measles vaccinations in 1989, expects the funding cut to mean 8,000 fewer available first vaccines, a shortage that Ramras predicted will be felt by July or August.

“Our bottom-line projection is that the county will need about $350,000” more to be able to vaccinate the children who need it, Ramras said.

The county has had 182 cases of measles this year, contrasted with 34 cases last year, he said.

Compounding the budget problems is a recommendation, to be published Friday by the Centers for Disease Control in Atlanta, that all children receive two doses of measles vaccine--the first at 12 to 15 months of age and the second upon entry to kindergarten or elementary school, or 4 to 6 years of age. The centers also recommend a second dose for college students and those in the health-care industry.

The county would need $835,000 more to comply with the recommendation as well as meet the current need, Ramras said. He also predicted that the price of vaccines will rise moderately.

Despite the cost of a second dose, the recommended has been long overdue, said James Connor, professor of pediatrics at the School of Medicine at UC San Diego. The American Academy of Pediatrics issued a statement in July that is similar to the upcoming CDC report, recommending that children receive a second measles vaccine upon entering middle or junior high school.

The CDC recommendation is prompted by vaccine failure, a problem that has become apparent in the past two to three years, according to Dr. William Atkinson, a medical epidemiologist at the centers’ division of immunology.

Atkinson said that about 40% of measles cases in the United States involve patients who have already received vaccinations.

The vaccine’s fragility leads to its failure, he said.

“If left in the light or in room temperature too long, or if it’s given too early, certainly before 12 months, there is a possibility of vaccine failure,” Atkinson said.

He called the measles vaccine “one of the better ones we have” in that it has been 95% effective.

“But 95% is not enough. We believe that about 75% of individuals who do not respond to the first dose will respond to a second dose.”

Stanley Plotkin of the American Academy of Pediatrics said money should not be an issue in the case of vaccinations.

“It’s regrettable because vaccinations are probably the most cost-effective things we can do in medicine,” Plotkin said.

The measles vaccine alone saves $10 to $15 in health-care costs for every dollar spent on immunization, according to Dales.

“Even though prices have gone up, they still save more than they cost,” he said.

California’s situation has become so critical that the state has had to borrow $70,000 worth of vaccines from Oregon, Texas, Arizona and Utah, Dales said.

“We have had to respond less aggressively to epidemics than we would like to have,” he said. “The picture has been unfolding for about two years, and it’s about to get worse.”

In Southern California, the largest single problem in the measles epidemic is children not being vaccinated in time, Dales said. While children entering school are required to have the vaccinations, more than half the measles cases in California this year were among preschool children who had not been vaccinated, he said.

Southern California has seen an ongoing measles epidemic for the past 2 1/2 years, Dales said. There were 17 deaths due to measles and 2,648 cases of the illness reported in California this year--the most since 1977, the year before the state required children entering school to have the vaccination. In 1983, the state enjoyed an all-time low of 176 cases of measles.

MEASLES EPIDEMIC

After six years of relatively few measles cases, San Diego County’s measles caseload quintupled this year, mirroring a statewide epidemic. Even so, health officials said, they lack the money to provide measles vaccinations to all the children who need them.

San Deigo County: 1980: 294 1989: 182

California: 1980: 960 1989: 2,700 Source: San Diego County and California health departments