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Clinton Eyes Plan To Purchase Vaccines To Insure All Children Are Immunized

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WASHINGTON--The Clinton Administration is considering a plan under which the federal government would purchase childhood vaccines from drug companies and distribute them free to private-practice doctors and public-health clinics, according to a White House spokeswoman.

Although different versions of the plan are still being circulated, the one most likely to win approval, observers say, is for the government to purchase enough vaccines each year to immunize all the nation's children against such diseases as polio, tetanus, and diphtheria.

Such an effort would cost between $300 million and $500 million a year, according to the federal Centers for Disease Control and Prevention.

Currently, fewer than 60 percent of preschool-age children receive all the recommended immunizations, and 50 percent of poor, inner-city children in that age group receive no immunizations at all, according to the Public Health Service.

The C.D.C. points to this disparity in coverage as the main cause of the 45,000 cases of measles in the past two years, the largest outbreak of the illness in more than two decades.

Officials of the Health and Human Services Department have been at work on a "blueprint'' for a new national vaccination program since before the November election. It is expected to be released sometime in the next few months.

According to the department, access to proper health care, the cost of vaccines, and logistical factors often prevent families from immunizing their children.

The costs for the simple procedures have risen dramatically in the past decade, and, as a result, children are not able to afford the fees private practitioners charge, public-health officials say.

Drug Company Doubts

The set of vaccines commonly recommended by physicians cost $23 per child in 1982; by 1992, the cost was $244, according to the C.D.C.

"We don't provide a means test for water, and there should be no means test for something as important as immunizations,'' said Kenneth J. Bart, the director of the national vaccine-program office at the H.H.S.

A new program to make immunizations universally available would likely include an advertising campaign and community outreach that would help dismantle cultural and language barriers that exist between the populations and the providers, Dr. Burt said.

Public-health officials point to the cost-effectiveness of vaccinations. For every dollar spent on vaccinations for measles, mumps, and rubella, $14 is saved in long-term medical costs, according to a C.D.C. report.

Currently, the public sector purchases 50 percent to 60 percent of all childhood vaccines each year, with private providers purchasing the rest.

Although they were reluctant to comment on the proposal itself, drug-company representatives last week said any purchasing system of the sort being discussed would be "tantamount to price controls.''

Revenues lost under such a system, they said, could stall the development of new vaccines.

But child-health advocates argue that universal access to vaccinations is crucial.

Marian Wright Edelman, the president of the Children's Defense Fund, said in a statement last week that "there is no excuse for the American failure to reach all children'' with vaccinations.

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