CHILDHOOD IMMUNIZATION JOINT SENATE/HOUSE HEARING APRIL 21

CHILDHOOD IMMUNIZATION JOINT SENATE/HOUSE HEARING APRIL 21 will be convened by the Senate Labor & Human Resources Committee and the House Energy & Commerce/Health Subcommittee to review the Clinton Administration's immunization initiative and recently introduced related legislation. The initiative includes Health Subcommittee Chairman Waxman's (D-Calif.) HR 1640, Labor Committee Chairman Kennedy's (D-Mass.) S 732 and Senate Finance/Health For Families Subcommittee Chairman Riegle's (D-Mich.) 733, all introduced April 1 ("The Pink Sheet" April 5, p. 14). HHS Secretary Shalala is slated to testify. Also scheduled as witnesses are Connaught President David Williams, MD, Merck Vaccine Division President Gordon Douglas, MD, and Lederle-Praxis Biologicals President Ronald Saldarini, PhD. The American Academy of Pediatrics will be represented by Edgar Marcuse, MD, a member of AAP's Committee on Infectious Diseases and a former member of the HHS National Vaccine Advisory Committee. The convening of a joint hearing is an effort by congressional Democrats to expedite the immunization proposal. The legislative authority for the most debated portion of the proposal -- a universal vaccine purchase plan to be conducted by HHS -- is divided between S 732 and S 733. The latter bill, which has Riegle as the lead sponsor and has been referred to the Finance Committee, contains the authority for HHS to purchase the vaccines and negotiate prices. Authority to distribute the vaccines is contained in Kennedy's S 732, which has been referred to the Labor Committee. Waxman's HR 1640 would authorize both aspects of the vaccine program. The bill has been referred to both the Commerce Committee and House Ways & Means Committee. The House and Senate measures would direct HHS to issue, by "no later than" Oct. 1, 1994, regulations listing vaccines that "are recommended for universal use in children" and recommendations on appropriate dosage and ages for administration. Decisions on the vaccines to be purchased would be made by HHS in consultation with other federal agencies, a consultation that "may be effected through the establishment of a Vaccines Requirements Panel, composed entirely of representatives of the relevant agencies," both S 733 and HR 1640 direct. Purchases would be calculated to be sufficient to meet "anticipated needs for the routine and catch-up" vaccinations of children; address "foreseeable outbreak control activities"; and maintain a six-month reserve supply. The vaccines will be distributed without charge to health providers who are "members of a uniformed service or are officers" of the U.S.; public health centers; Indian Health Centers; or are located in states that have met requirements to receive a federal grant to set up and operate a national vaccine tracking registry. Providers may charge an administration fee but cannot withhold a child's immunization on the basis of the parent's inability to pay. The state registries are to track immunizations administered after Sept. 30, 1996. The bill authorizes appropriations of "such sums as necessary" for the vaccine purchases; HHS has estimated costs at about $1 bil. annually. For other activities outlined in the three pieces of legislation, the House and Senate proposals would authorize $152 mil. in FY 1995, $125 mil. in FY 1996 and $35 mil. in each of the three subsequent fiscal years. Secretary Shalala authored an editorial in the April 14 edition of the Journal of the American Medical Association on immunizations and will keep the issue in the limelight with a April 19 appearance in New York City to help launch the Health Insurance Plan of Greater New York's "Operation Immunization," which will provide free immunizations to pre-schoolers.