San Diego Chosen for Vaccination Pilot Plan : Health: It is one of six U.S. cities participating in effort to increase immunization against such diseases as measles, polio and diphtheria.

Still reeling from the measles epidemic that killed 51 children in California in 1990, county public health authorities here plan to unveil an aggressive new immunization program during President Bush’s visit this week.

San Diego is one of six U.S. cities, and the only one in California, chosen to launch a national pilot immunization program, aimed not only at measles but also at diseases such as polio, diphtheria, tetanus and whooping cough.

Already touting it as a potential model, health officials hope the program will meet the goal of fully immunizing at least 90% of all children by age 2 before the year 2000.

The goal, experts concede, is ambitious. Statewide and nationwide, 51% of children under 2 lack recommended immunizations. In San Diego, the figure is 52.3%. California led the nation in measles cases during the 1990 epidemic.

“Immunization levels were grossly inadequate in the mid-’80s and they are grossly inadequate now,” said Dr. Walter Orenstein, director of the immunization division at the federal Centers for Disease Control in Atlanta. “We have got to do better. We cannot tolerate that low a level.”

Last June, Bush and health officials announced stepped-up efforts to immunize youngsters. To find ways to improve immunization rates, “SWAT teams” from the Health and Human Services Department will visit six cities: San Diego, Philadelphia, Detroit, Phoenix, Dallas and Rapid City, S.D.

Bush immediately came under fire, as critics said low immunization levels reflect the plight of the poor in the health care system.

“We don’t need a six-city road show to study the problem. We need a genuine federal commitment to see that every child is immunized,” said Sen. Edward M. Kennedy (D-Mass.), chairman of the Senate Labor and Human Resources Committee.

Mindful of that criticism, planners formulated what they hope will be seen as more than a dog-and-pony show. And California officials intend to monitor the San Diego program.

“We’re going to be watching very closely. We’re going to try to measure and see where we can get the biggest bang for the buck,” said John Dunajski, assistant chief of the state Department of Health Services’ immunization unit. “I can’t say all will work but I think some will.”

Funding for federal vaccine programs increased from $98 million in 1988 to $218 million in 1991. Health officials here expect that they will soon know how much federal money will be coming their way to assist them in carrying out the program, which is expected to cost about $4 million a year here.

California receives about $17 million worth of vaccines annually, and another $1.4 million in cash to help local immunization programs.

Every dollar spent on immunization can save up to $15 in health care, according to CDC estimates.

About 60% of the 12,587 California measles cases in 1990 were among children too young to attend school. By law, children entering California schools must be vaccinated against a variety of diseases, including polio, diphtheria, tetanus, measles and pertussis (whooping cough). The no-shots, no-school law has already ensured that most school-age children are immunized, but younger ones appear to be the most vulnerable and most unprotected.

“We have to motivate parents, convince parents that it is in the best interests of the child not to wait until they are ready for kindergarten,” said Dunajski.

“It’s much more difficult because it isn’t compulsory,” he said. With toddlers, “we don’t have the stick like we do with the school immunization law.”

Why don’t parents get their youngsters immunized early? The reasons are varied, and health officials here explored them as they planned the county’s new program.

Sometimes they are not aware that they should. Sometimes it is too costly or time-consuming.

“There are so many need-to-do things in our society that the ones you do are the ones that are yelling the loudest,” said Sandy Ross, immunization coordinator for the county.

“If you are having trouble putting food on the table you are going to worry about eating. If you don’t have time off from work to take the child to the doctor, are you going to do it?”

So San Diego officials want to offer immunizations at more facilities, and to expand the hours they are open. They also want a mobile immunization unit that can go to such places as welfare offices. County health officials will also increase the number of immunization clinics from six to 12.

Health officials are leaning on businesses and civic groups as well as health organizations for cooperation. The plan itself is the result of meetings last fall with more than 50 health, social, religious, civic and business groups.

Minority groups are a high priority. In one survey of randomly selected San Diego kindergartners, only 20% of blacks were immunized, 34.6% of Latinos and 37.4% of Asians. In comparison, 47.3% of Anglo children were immunized.

At present, the health department offers immunization information in English, Spanish and Vietnamese. But Lea Cassarino, the county’s supervising public health educator, and others would like to see more languages, as well as more culturally oriented materials--for instance, pamphlets geared to migrant workers.

Reaching parents who do not take these diseases seriously is also a large part of the problem.

Most parents “are young and have never seen any of these illnesses,” Ross said. “If you don’t see a risk, you don’t see a reason to put out the effort to prevent the disease. If you are a parent born in the ‘60s, you don’t see kids with wasted limbs, so you don’t worry about polio.”

County and federal health officials realize that financially strapped San Diego may not be able to implement everything in its pilot program. Nonetheless, the plan itself is significant, they say.

“If you don’t have a blueprint for your dream house, it remains in your mind,” said Dean Mason, chief of program operations with the CDC’s immunization division. “This allows a plan of action, a strategy.”