Pharmaceutical companies applauded President Clinton's intentto increase access to childhood vaccinations, but sought toinfluence the process after the president promised Friday tooutline a $300 million vaccination program when he unveils hiseconomic plan to a joint session of Congress on Wednesday.

"Like fluoridated water, fire protection and rodent control,vaccine should be recognized as a service we pay for as anation in advance, then deliver to ourselves for our ownprotection," said Marian Wright Edelman, president of theChildren's Defense Fund. Her agency announced in Decemberthat universal immunization of children is among its toppriorities. Edelman urged Clinton to spend $300 million to helpstates and the 30 largest cities expand their immunizationstaffs, and an additional $600 million for a universal vaccinepurchase and distribution system. Hillary Rodham Clinton is aformer board chairman of the child advocacy group.

President Clinton announced Friday that the $300 millionwould buy more vaccines and improve community service andoutreach efforts.

Tony Fiskett, executive director of public affairs for Merck &Co., told BioWorld that he met earlier last week with DonnaShalala, secretary of Health and Human Services. "Supply hasnever been a problem," he said, calling for clinics to be open"when and where parents need them."

The Centers for Disease Control and Prevention (CDC) had amajor initiative in the 1970s, "Immunization Action Month," hesaid, resulting in increased immunization rates and decreasedoutbreaks of disease.

"In the 1980s," Fiskett said, "I think some of the funding driedup. People got complacent and they took their eye off the ball."

Lederle-Praxis Biologicals, manufacturer of childhooddiphtheria, tetanus and pertussis vaccine, agreed through itsspokesman, Craig Engesser, that improved education anddistribution will improve vaccination rates.

Children in all 50 states are required to receive their shotsbefore they can attend school. However, the CDC said that inmany areas, especially urban centers, fewer than half ofchildren between the ages of 2 months and 2 years areappropriately vaccinated. Measles swept the U.S. from 1989 to1991, infecting 55,000 people and causing 150 deaths.

Immunization costs have risen from $7 per person in 1980 to$90 in 1992 because more vaccinations -- including two newtypes -- are administered and a federal excise tax wasinstituted in 1986 so companies such as Lederle-Praxis couldself-insure after a surge of product liability actions led to lossof coverage.

"The only profiteers in vaccine pricing have been the lawyerswho have launched hundreds of product liability lawsuits," saidDavid Williams, president of Connaught Laboratories Ltd.,"which is what has driven up the prices of vaccines over thepast decade. Our corporate profit in 1991 was 4.8 percent ofsales -- significantly less than that of the Fortune 500companies that President Clinton cited in his speech."

Ron Saldarini, president of Lederle-Praxis Biologicals, asubsidiary of Lederle Laboratories, added that about half theU.S. vaccine needs are met through federal contracts in whichmanufacturers sell vaccines at substantially lower prices. Thevaccines are distributed free to patients at public health clinicsand other locations.

He said 11 states have historically purchased all their vaccinesfrom the federal contract for free distribution to everyone, butimmunization rates there are not significantly different despitethis cost savings to patients.

Connaught's Williams suggested that health insurers berequired to reimburse well-baby care, including immunizations-- already a requirement in Pennsylvania. Other optionsinclude contracting with managed care or health maintenanceorganizations to provide these services, or supplying Medicaid-priced vaccine for needy patients to private physicians.

Distributing vaccine free to everyone would drive up costs tothe federal government, Williams said. "It doesn't make anysense to increase spending on buying a product that is inabundant supply when that money could be better used ineliminating barriers that obstruct access."

Former Surgeon General C. Everett Koop, a pediatrician andproponent of broadening immunization, also stresses increasedaccess, saying, "The Clinton administration's proposal that thefederal government purchase vaccines for all children is a littlelike a doctor treating the symptoms without trying to cure thedisease. ... The real problem is inadequate public education andaccess to, not availability of, vaccines."

Representatives from Merck, Lederle, Connaught andSmithKline Beecham will meet with White House officials thisweek to discuss the initiative. Clinton said he would directShalala to negotiate with these childhood vaccinemanufacturers to assure an affordable supply to all states.

-- Nancy Garcia Associate Editor

(c) 1997 American Health Consultants. All rights reserved.