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G.A.O. Report Raises New Questions About Immunization Plans

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A Congressional watchdog agency has questioned whether a new vaccine program for infants and toddlers will inoculate more youngsters than the current program, as the Clinton Administration promised it would.

The General Accounting Office also cast doubt on whether the Vaccines for Children Program will be fully operational on Oct. 1, as scheduled.

The program, part of a larger childhood-immunization initiative, aims to reduce the cost of vaccines and to insure that 90 percent of the nation's young children are immunized.

The G.A.O. findings, which were released last month in a report, prompted concern from some lawmakers.

"I fear disaster will be on our hands'' if the program begins this October, Sen. Dale Bumpers, D-Ark., told his colleagues on the Senate Appropriations Committee during recent spending deliberations.

The Senate, in approving a social-services spending bill last week endorsed an amendment by Mr. Bumpers that would require the Health and Human Services Department to receive certification from Congress before implementing the program. The House version of the appropriations bill does not contain a similar provision.

Administration officials defended the vaccination program and said it will be launched on schedule.

"Our work is not done, but I am confident ... our new system will be up and running on Oct. 1,'' Secretary of Health and Human Services Donna E. Shalala said in a statement. "We will meet, and we will master, the challenges cited in [the G.A.O.] report.''

Stumbling Blocks

According to the Administration's plan, private doctors will receive vaccines after placing orders with state agencies. Those agencies will approve the orders and forward them to the Centers for Disease Control and Prevention, which will oversee distribution through vaccine manufacturers and a federal warehouse run by the General Services Administration.

The Administration has said that the program will lower the cost of vaccines by enabling the government to buy in bulk, allowing more children to receive shots. But the G.A.O. suggested that poor children already have access to vaccinations and that the new system may do nothing to increase the number of needy youngsters who receive them.

"Most recent studies, including those of four inner-city areas where the undervaccinated tend to be concentrated, indicate that vaccine cost is not an important barrier,'' the report says.

The report also questions the ability of the Centers for Disease Control and the General Services Administration to adequately administer the program, which it says is dependent upon an Oct. 1 start date.

The potential problems cited by the report include:

  • Contract negotiations. Only four of 15 necessary contracts with vaccine manufacturers had been secured as of early last month.
  • Doctor participation. The G.A.O. could not determine the number of physicians enrolled in the program.
  • Payment of doctors. Although the program makes vaccines available at no cost, it allows doctors to charge fees for administering them. These charges could exceed those for similar procedures paid for under Medicaid, the G.A.O. found.
  • Failure to devise a plan for evaluating the program and comparing it with the current system.

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