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Many Barriers to Vaccines Preventable, N.A.S. Says

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Preventable obstacles ranging from health-care policies to family attitudes are keeping nearly one-third of 2-year-olds from receiving proper immunizations, a new report by the National Academy of Sciences concludes.

"We know that under-immunized children are experiencing illnesses that could be avoided, and that some may be suffering severe consequences, even death,'' said Lorraine V. Klerman, the chairwoman of the Institute of Medicine committee that prepared the report.

While most children receive the necessary vaccines by the time they reach school, child-health advocates have long argued that too many are at risk for serious illness when they are younger.

Statistics released last month by the U.S. Centers for Disease Control and Prevention show, for example, that, despite increased attention to immunization needs, measles-vaccination levels decreased slightly among 2-year-olds between 1991 and 1993.

Although coverage for other vaccines saw some increases, it is still at a "suboptimal'' level, the C.D.C. researchers said.

President Clinton has called for providing crucial immunizations for at least 90 percent of 2-year-olds by 1996. So far, however, his Administration has focused largely on the financial blocks to immunization, rather than the other barriers cited by the N.A.S. report.

"Removing the financial barriers will not, by itself, achieve full immunization of preschool children,'' the report argues. The document cites the organization and delivery of health care, the practices of individual health-care providers, and the knowledge, attitudes, and behavior of children's families as additional barriers to the success of immunization programs.

Improved Records Urged

To address such barriers to children's health, the report calls on health-care providers to insure that they have up-to-date vaccination guidelines, to improve their records systems to monitor each child's immunization levels, and, when possible, to give all appropriate vaccines in one visit.

The report also suggests that states develop "immunization action plans'' outlining requirements and resources.

Lucy Hackney, the acting director of the health division of the Children's Defense Fund, also cited the lack of after-work and weekend hours at clinics as a major block to getting children immunized.

"I sometimes think that the only people who realize that there are families with two working parents are grocery stores that stay open 24 hours,'' she said.

In addition to federal initiatives, Ms. Hackney said, local changes such as encouraging doctors to perform immunizations in their offices are key to insuring that every child is immunized.

Copies of "Overcoming Barriers to Immunization'' are available from the Division of Health Promotion and Disease Prevention, Institute of Medicine, 2101 Constitution Ave., N.W., Washington, D.C. 20418.

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