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NATIONAL VACCINE PROGRAM OFFICE INCOMING DIRECTOR ROBBINS

Executive Summary

NATIONAL VACCINE PROGRAM OFFICE INCOMING DIRECTOR ROBBINS will coordinate the restructured office's efforts on behalf of President Clinton's comprehensive children's immunization initiative, HHS Deputy Assistant Secretary for Science D. A. Henderson, MD, told the National Vaccine Advisory Committee Sept. 9. Boston University professor of public health Anthony Robbins, MD, who joined HHS last spring as a consultant to Henderson, "is about to be appointed" as director of NVPO, the deputy assistant secretary reported. Robbins has served as state health commissioner for Vermont and Colorado and president of the American Public Health Association. As an aide to House Energy & Commerce Committee Chairman Dingell (D-Mich.), Robbins helped draft legislation establishing the National Vaccine Program in 1986. He will succeed Kenneth Bart, MD, who has moved to the Agency for International Health. Joining Robbins at NVPO will be attorney Peter Bouxsein, who served as counsel to Rep. Waxman's (D-Calif.) Energy & Commerce/Health Subcommittee for six years before leaving in 1990 to become deputy exec VP of the American College of Physicians. Bouxsein, who also worked for the Health Care Financing Administration, will be responsible for the children's vaccine initiative vaccine purchasing program. Others scheduled to join NVPO in the next few months include a point person for dealing with providers and professional groups and a person to oversee vaccine R&D and supply. At the end of September, the program office will be moved to HHS headquarters in downtown Washington, D.C., from its current location at the Public Health Service's Parklawn building in Maryland. Henderson explained to the committee that the need to restructure the National Vaccine Program is the result of the Clinton Administration's interest in immunization. "The legislation [establishing the NVPO] as previously written," he said, "was really an attempt to encourage the [Reagan] Administration to pay attention...But we just don't have that need anymore." What is needed is "a number of different people and a different structure for our National Vaccine Program," he explained. NVPO functions as a unit of the Office of the Assistant Secretary for Health, headed by Philip Lee, MD. Henderson joined OASH in April to spearhead implementation of the children's immunization initiative ("The Pink Sheet" April 26, p. 6). Under the final immunization initiative enacted Aug. 10 as part of the 1993 budget reconciliation bill, HHS will purchase vaccine for all Medicaid-eligible or uninsured children; as is current practice, underinsured children -- those with insurance that does not cover immunization -- will be able to be immunized at a public clinic ("The Pink Sheet" Aug. 9, p. 6). States may choose to purchase additional vaccine at the HHS price. The price the government will pay for existing vaccines will be limited to the Centers for Disease Control & Prevention discount price as of May 1993 plus the change in the CPI; new vaccines will be bought at a price negotiated by HHS. Senate rules precluded the inclusion in the final bill of provisions directed at expanding vaccine registries and outreach programs. Those provisions will be reattached to other legislation this fall, and "should be passed in the not too distant future," Robbins told the advisory committee. Robbins is working with various HMOs as one of his first activities directed toward achieving the 1996 goal of 90% immunization. He hopes to encourage HMOs to have all children immunized in the first year of the initiative. "There are no apparent obstacles for them," Robbins contended. The HMOs appear to see the challenge as an opportunity, Robbins suggested, "a way to show that they can do something better than others." He is also working with insurance companies to encourage first dollar coverage for immunization, and, with CDC and FDA, pursuing ways to simplify immunization schedules. Other important elements of the initiative will be improved surveillance, effective reminder systems and portable immunization records for parents.
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