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Struggling to seal cracks in the immunization system

Vaccinations are considered to be one of the most cost-effective means of improving public health, but experts say financial gaps are straining the system.

By Victoria Stagg Elliott, amednews staff. July 23, 2001.

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Public health officials talk about the measles outbreak of 1989-1991 the way some people talk about the day Kennedy was shot or Pearl Harbor was bombed. They know where they were. They remember how they felt. It was a disease that had almost been eliminated through vaccination, and then it was back -- striking 43,000 and killing 100.

"I had a warehouse full of vaccine," said Edward Mihalek, a supervisory public health adviser with the Centers for Disease Control and Prevention's immunization program who works with the Chicago Dept. of Public Health. "But kids were still dying."

Measles is no longer endemic to the United States, according to the CDC.

But this experience with the illness is an important reminder of what can still happen. Public health officials say another outbreak of a vaccine-preventable disease may not be too far off unless the holes in the national immunization system -- gaps affecting both children and adults -- are filled.

"Cattle are better immunized than children," said David R. Smith, MD, chair of the Institute of Medicine's Committee on Immunization Finance. "And children are better immunized than adults."

What is needed, say experts, is more money to pay for vaccine supplies, strengthen delivery systems, fund immunization registries and educate physicians, parents and other adults about needed immunizations.

Vaccinations, particularly childhood ones, are considered among the most cost-effective preventive services, ranked alongside smoking cessation in terms of public health bang for the buck. But federal funds have been cut by more than 50% from a high point in the early 1990s, according to "Calling the Shots: Immunization Finance Policies and Practice," a report published by the Institute of Medicine last year. [...]