'Fixing The Crisis In Childhood Immunization' by Sean Palfrey, MD

Massachusetts may be a model for health care reform, but we’re losing our grip on one of the state’s most effective disease prevention programs: childhood immunization.

For years, Massachusetts has maintained some of the highest rates of childhood vaccination in the world. Now, our childhood immunization program is in crisis.

Vaccines are the most cost-effective public health interventions since clean water. According to the Centers for Disease Control, every dollar spent on immunization saves $18.40, producing aggregate savings from all vaccinations of $42 billion to US society. We’ve eliminated diseases like smallpox and polio and can prevent many others. We’ve been so effective that people don’t even remember how deadly these illnesses can be.

Effectiveness of a vaccination program is largely based on its ability to create “herd immunity.” Vaccinating a large proportion of children protects not only those immunized but non-immune individuals as well, both children and adults, because the illness cannot exist in such a highly protected population.

Recently, however, several factors have put Massachusetts' children and communities at risk from vaccine-preventable illnesses

:

• Some individuals have chosen not to vaccinate their children, so serious cases of HIB, measles and whooping cough have struck.
• New, highly refined and important, but expensive, vaccines have been developed.
• State budget cuts have eliminated more than $6 million this past year. Currently, there is no state funding for human papillomavirus (HPV) vaccine. This July, new cuts will eliminate state funding for the infant rotavirus vaccine.
• Funding for other adolescent and adult vaccines has also been reduced.
• Our Immunization Registry, critical to successful programs, has been shelved.

Given these barriers, primary care providers can no longer vaccinate all children with all recommended vaccines. More children are becoming incompletely immunized, placing us all at risk of serious illnesses that could be prevented.

For years, the CDC, through its Morbidity and Mortality Weekly Report, reported that Massachusetts' childhood immunization rates were tops in the country. By 2007, we had dropped to 20th. The next year, we rebounded to 11th. Better, but still not where we need to be.

Massachusetts' long history of “universal distribution” of all nationally recommended vaccines for all children has become impossible to sustain.

But there’s a fix for the problem.

The Massachusetts Chapter of the American Academy of Pediatrics (MCAAP), working with the Massachusetts Department of Public Health (MDPH), the Medical Legal Partnership at Boston Medical Center, and the law firm of Ropes and Gray, has proposed legislation offering a solution. The bill establishes a framework that would enable Massachusetts to guarantee that all children 0-18 years receive all recommended vaccines in perpetuity.

The legislation (highlights here) represents an innovative public-private partnership and will alleviate the current immunization crisis by addressing financing, reimbursement, and immunization tracking.

For financing, the legislation creates a Trust Fund into which money will flow from federal sources, state appropriations, and contributions from insurance companies. A state Advisory Council will be established, the Massachusetts Commissioner of Insurance will oversee the trust fund contributions by insurance plans, and the MDPH will once again purchase, administer and distribute all vaccines for all children in the state.

For reimbursement, the bill mandates that insurers pay for all recommended vaccines for their covered children and adolescents up to age 19 through the Trust Fund (at the 40 percent federal discount rate - millions below current commercial costs), and provide adequate reimbursement for all associated administrative costs to providers.

For tracking, the bill establishes the framework to revive and maintain the state’s Immunization Registry. Massachusetts is currently one of only a few states in the country not to have some form of registry. Our registry, developed through years of research, has been sitting in mothballs for more than a year. Registries are essential to the efficient coordination, management and oversight of vaccine distribution, help identify un- and under-immunized children and adults, and can save the state three to five times their annual cost.

Compelling reasons exist to support this cost-effective approach: the health of our children and the communities around them. How many more incentives do we need?

Sean Palfrey, M.D. is Chairman of the Immunization Initiative of the Massachusetts Chapter of the American Academy of Pediatrics and a past president of the chapter. He is a Professor of Pediatrics and Public Health at Boston University School of Medicine and an attending physician at Boston Medical Center.