Don’t Let Kids Die to Save a Buck

Today, fully 45 years after U.S. virologist Jonas Salk developed the polio vaccine, leading to successor vaccines that nearly eradicated childhood diseases like rubella, mumps and whooping cough, the United States has fallen far behind other developed nations in the prevention of childhood disease. Only about 75% of U.S. children receive medically necessary vaccinations, as compared with more than 90% in Europe.

The problem is especially acute in California, where the rate of some vaccine-preventable diseases like hepatitis A is twice the national average. Last year 41 of the state’s 61 health departments reported cases of vaccine-preventable diseases, and since 1997 the number of reported cases of whooping cough has more than doubled.

The rise of preventable infectious disease is partly the result of an increasingly cosmopolitan population. But much of the problem is also due to perverse fiscal incentives in managed care. HMOs have reduced pediatrician payments to well below the national average, discouraging some doctors from being properly aggressive about administering vaccines. California pediatricians receive an average of only $24.24 per child per month from health plans, for example, even though the cost of providing adequate vaccines during the first year of life alone is $47 per month.

Next week, Assembly Speaker Bob Hertzberg (D-Sherman Oaks) can solve much of the problem by scheduling two worthy bills for a vote during the tight legislative session that ends Aug. 31.

* SB 168, by Sen. Jackie Speier (D-Daly City), would require health plans to reimburse physicians for federally recommended vaccines at not less than the actual acquisition cost of the vaccine.

* SB 1291, by Sen. Richard Polanco (D-Los Angeles), would enable California’s Healthy Families program to get the same volume discounts provided to the federal Vaccines for Children purchasing program, thus halving the California program’s $11-million annual vaccine costs.

The two bills are sensible and broadly supported in the Legislature. Whether they will be signed into law by Gov. Gray Davis, however, is uncertain.

In 1997, then-Gov. Pete Wilson vetoed a bill that would have required health plans to cover all pediatric vaccines deemed medically necessary. In his veto message, the governor said the bill was “really about how physicians are paid,” a matter that would be “best left to the contracting parties.”

Davis staffers have told Speier that they are having similar qualms, worrying that if the governor signs her bill he could be besieged by other specialist physicians requesting that he mandate certain treatments.

The flaw in that argument is that it fails to recognize the unique role vaccines play in medicine. They are key to the prevention of childhood disease, a standard by which social progress has long been measured. And they are essential to preventing diseases from spreading to people with compromised immune systems, like the frail elderly.

The administration of vaccines should be a public health priority, not a business decision. As Chris Calvin of the American Academy of Pediatrics puts it, “vaccines are not Viagra.”