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Officials Say States Misused Vaccination Aid

Childhood immunization rates reached a record high this year, but children in rural areas and inner cities are still dangerously under-immunized, federal officials and child-health advocates said last week.

Meanwhile, they said, some $300 million of the $459 million the federal government has poured into state and local health departments since 1992 to bolster their vaccination systems has gone unspent or been spent improperly.

Witnesses at a hearing of the Senate Appropriations Subcommittee on Labor, Health and Human Services, and Education, said that public health systems are so short of funds that some have been using money targeted for improving immunization services to pay for salaries or other ongoing initiatives.

Walter A. Orenstein, the director of the National Immunization Program at the federal Centers for Disease Control and Prevention, said state hiring freezes, contractual barriers, and grants that arrive too late in the fiscal year to plan new programs have contributed to the problem.

The fact that millions of dollars have been "unspent and clogged in bureaucratic pipelines," said Dr. Irwin Redlener, the president of the Children's Health Fund, "is unconscionable on every level and deeply troubling to me as a pediatrician."

Dr. Redlener said immunizations should be administered at the same place where all of a child's health care is delivered. He urged lawmakers to target funding to "immunization crisis zones"--areas where at least 70 percent of young children have not been vaccinated--to ensure that health-care providers can offer such comprehensive services for children.

The witnesses contended that the misuse of vaccination funds is a hint of what might happen if Republicans succeed in giving states control over more federal funds.

"Until we can address that breakdown," said Dr. Redlener, "I don't see how we can begin a discussion of block granting."

Sen. Dale Bumpers, D-Ark.--who chaired the hearing in the absence of Sen. Arlen Specter, R-Pa., the panel's chairman--agreed that widespread use of block grants would be "an unmitigated disaster."

Mr. Bumpers suggested that immunization services could be tied more closely to the Special Supplemental Feeding Program for Women, Infants and Children, or to school-based health clinics.

Welfare Debate

The Senate resumed floor debate on welfare reform last week, striking down the Democratic leadership's proposed substitute on a 54-45, party-line vote. The substitute called for replacing the main welfare entitlement program with a federal program that required most recipients to work and limited the time individuals could spend on the welfare rolls.

The Senate is expected to take up many proposed amendments to the massive welfare measure when debate continues this week.

Republican leaders plan to introduce a package of amendments to the Work Opportunity Act, S 1120, that would prohibit additional benefits for mothers who have more children while on welfare, pay for sexual-abstinence-education programs, and provide financial bonuses to states that reduced illegitimacy rates.

Senate leaders hope to bring the bill to a final vote this week.

Technical Assistance

A recent evaluation of the Department of Education's Indian-education technical-assistance centers found that most educators who received help were satisfied with the centers' accessibility and responsiveness, but said they focused too much on administrative issues such as how to fill out grant applications.

The department set up the six centers in 1980 to serve school districts, tribes, and community groups eligible for Indian-education grants. Like most centers that help schools with particular categorical programs, they will be phased out next spring and their duties consolidated in 15 regional "supercenters" to provide schools with one-stop shopping.

Contracts for the new centers may be awarded as soon as next month.

"The whole thrust is toward moving beyond just waiting for the phone to ring," said Susan V. Ross, a program analyst in the department's office of planning, evaluation, and services. "Sometimes people who need the help don't know how to ask for it."

Copies of the report, "Evaluation of the Indian Education Technical Assistance Centers," are free from the U.S. Education Department, Office of Planning and Evaluation Services, 600 Independence Ave., S.W., Room 4168, Washington, D.C. 20202; (202) 401-0590.

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