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FEDERAL VACCINE PURCHASE WILL COVER 3 MIL. MORE CHILDREN under the age of six in addition to the 6.5 mil. currently on Medicaid, Sen. Riegle (D-Mich.) told a Dec. 6 meeting of Immunization Partnership, a joint project of the American Nurses Association and Every Child By Two. The expansion of coverage to those children without insurance and those whose insurance does not cover vaccines, as well as the Medicaid population, represents "a vital breakthrough," Riegle said, and the first step toward ensuring that "all preschoolers are properly immunized at the appropriate time." Furthermore, Riegle maintained that, by offering states the option to use their own funds to purchase additional quantities of vaccine at federal discount prices, the federal purchasing program will "enable limited state funds to reach more children at risk." The Vaccines for Children Program, which was passed by Congress in August and signed into law as part of the 1993 budget act, directs the federal government to purchase vaccines from manufacturers at a negotiated consolidated purchase price and provide them, through states, to all public and private health care providers for administration to Medicaid-eligible children, Native Americans, and children who do not have health insurance ("The Pink Sheet" Aug. 9, p. 6). In addition, insured children without immunization benefits may receive free vaccines at certain federal health clinics. The federal purchasing program is targeted in large part at children in low-income families, who have significantly lower immunization rates. However, National Vaccine Program Office Director Walter Orenstein, MD, noted, "the bulk of the immunization problem is still in the majority community," among families that are at or above the poverty level and among white children. Orenstein provided 1991 statistics on the breakdown of immunization rates both by income and race. Children in families at or above the poverty level had an 87% immunization rate for measles, Orenstein said, 76% for three doses of DTP, and 49% for three doses of polio. This compares to rates of 73%, 53% and 39%, respectively, for children below poverty. White children had rates of 83% for measles, 73% for DTP and 57% for polio. The rates for African American children were 77%, 51% and 36%, while the rates for children falling in the "other" category were 84%, 58% and 50%. Nevertheless, Orenstein pointed out, white children represent 67% of those who have received fewer than three doses of DTP, 63% of those with fewer than three doses of oral polio vaccine, and 75% of children who have never received a measles shot. Children in families at or above the poverty line make up 67% of those in need of DTP vaccine, 72% needing polio and 67% needing measles. Underimmunized children are also distributed fairly evenly among urban, rural and suburban areas, Orenstein said. The companion provisions to the Vaccines for Children Program that provide for outreach, tracking and the creation of immunization registries were placed in separate legislation that cleared the Senate Nov. 4 ("The Pink Sheet" Nov. 8, In Brief). Riegle declared that "we must now commit ourselves to aggressively work with the members of the House to achieve final enactment of this critical legislation next year." In anticipation of the start of the program, the Public Health Service reports that "arrangements for distribution are presently being developed, in consultation with states and manufacturers." The purchasing program is scheduled to begin Oct. 1, 1994, at a net cost to the federal government, including savings from eliminating Medicaid purchases, of $585 mil. from FY 1995 to 1998. Total federal vaccine purchases over those four years are estimated at $1.39 bil. Initial discussions between HHS and the vaccine manufacturers have brought to light a potential problem in implementing the legislative instructions with regard to vaccine delivery. The bill states that the prices negotiated by HHS will include delivery costs, and stipulates that if a state program does not provide direct delivery of pediatric vaccines to health care providers, "the vaccine manufacturer involved provide for the delivery of the vaccines on behalf of the state in accordance with such program and will not impose any charges for the costs of such delivery (except to the extent such costs are provided for in the price established: through HHS negotiations. For vaccines that are already on the Centers for Disease Control & Prevention's discount list, however, the negotiated price cannot exceed the price as of May 1993, updated by the Consumer Price Index. The contracts that vaccine manufacturers have with governments now include the price of the vaccine as well as the cost of distribution to a centralized point, or, if the contract involves distribution to individual providers, an additional delivery and shipping charge on each vaccine.

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