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The Academy request includes the following increases over the President's

recommendation: $5.8 million for HiB, $24 million for the second MMR, and $15 million for the first year of a three-five year phase in for Hepatitis B; $30 million additional for CDC infrastructure to support the outreach and demonstration needs; and, finally, $4 million for the vaccine stockpile. The Academy recommendation for the entire Childhood Immunization Program is $336.8 million.

National Vaccine Program Office

We still have goals we have not reached in the quest to wipe out vaccine-preventable diseases. The National Vaccine Program Office and other related programs are a part of our overall strategy to achieve these goals. The Academy recommends $15 million.

Infant Mortality Initiative

While the recent announcements regarding the decrease in the infant mortality rate are encouraging, it is still unacceptably high. The Academy commends the President and Secretary Sullivan for choosing to increase federal efforts to reduce infant mortality in this country. There are many areas, both urban and rural, where infant mortality is unacceptably high. The announced initiative is to examine social and other non-financial barriers preventing pregnant women from receiving prenatal care, to develop target treatment programs, and to link existing programs. Existing studies and reports could be utilized which would eliminate the cost of further examination of the barriers; some of these also outline successful treatment programs. We do agree that reinforcing the linkages among various federal programs (i.e., Medicaid and the Maternal and Child Health Block Grant) could be helpful. However, the proposed budget would fund this initiative through a combination of reprogramming monies from existing programs and new money. The Academy urges this subcommittee to not support the reprogramming concept -- taking money from the Maternal and Child Health Block Grant does not solve the infant mortality problem since much of what this program does is to ensure such needed services. Maternal and Child Health Block Grant

This program is designed to assure mothers, infants, children, and adolescents access to quality health care that reduces infant mortality and morbidity, helps children with special needs, ameliorates chronic illnesses, and encourages healthy lifestyles. Through cooperation with other federal programs limited resources can be used effectively to reduce duplication and fragmentation of services. The Academy recommends this program be funded at its full authorization level of $686 million.

The remainder of our testimony consists of a listing of all the programs of concern to the Academy with our recommendations. The Academy joins with its many friends in other organizations and coalitions in presenting these recommendations.

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Senator HARKIN. Thank you very much, Doctor. Let me get this straightened out here. The Childhood Immunization Program-the President's request is $257 million. You are requesting $336.8 million, 31 percent over. And you say that is necessary to respond to the increased outbreaks of measles, and what, rubella?

Dr. WALLACE. Mumps. And, of course, we have increased our needs for the second MMR. We also are increasing our needs for HIB vaccine. We had an unfortunate and fortunate example with young Caitland this morning, who is deaf from the haemophilus influenza B meningitis she suffered as an infant. If we had given her the vaccine, she almost assuredly would not have had that meningitis.

Senator HARKIN. How early can you give that vaccine?

Dr. WALLACE. We can now give it at 2 months. And part of the problem is that the old vaccine we have been using for the last 3 or 4 years, we could give only at 5 months of age. We have a new one that we can give at 2 months, 4 months, 6 months and 15 months, which immunizes the very susceptible first year of life, that is when most of the cases of meningitis occur. Obviously this is a four-shot series instead of a one-shot series. It costs a lot more. Senator HARKIN. What does that series cost? Do you know what that series costs?

Dr. WALLACE. For the State vaccine, I believe we are probably about $30. Now that is a rough estimate. In my office, is about $80. Obviously we are buying on the open market.

Senator HARKIN. Does every child need to have that series?
Dr. WALLACE. Yes, sir.

Senator HARKIN. In high-risk areas?

Dr. WALLACE. Every child needs to have it.

Senator HARKIN. Now, tell me about Iowa again. You said that there was an outbreak and what did you say, you need $8 million more?

Dr. WALLACE. Yes; I corresponded with the Iowa Department of Health, and they estimate if they gave every child in Iowa a second dose of MMR at State costs, obviously this is the worst case scenario, because some children are given the vaccine at the private cost, they would need $8 million to buy the vaccine at the Federal funding rate. And, of course, the bind that they will be in is that this vaccine will be mandated before school entry within the next few weeks.

Senator HARKIN. Well, this is one area that the subcommittee is most interested in. From a preventative health standpoint, it just makes imminently good sense to fund a child at immunization. I believe CDC put out a study not too long ago that showed that in immunization under the age of 2, we were one of the lowest in the Western Hemisphere.

Dr. WALLACE. That is correct.

Senator HARKIN. Ranked just above Haiti.

Dr. WALLACE. That is correct.

Senator HARKIN. Senator Specter.

Senator SPECTER. Thank you, very much, Mr. Chairman.

Have we acted sufficiently on the problem of liability to manufacturers of vaccines? Have we eliminated the problem that had existed where research was not being conducted because of the potential liability on damages which resulted from immunization?

Dr. WALLACE. The funding and work we have done to help the liability problem on behalf of the manufacturers, I think, has been accomplished. The problem of research was not the main problem that they protested, it was the liability for untoward effects.

In my personal opinion, and I do not speak for the academy, I feel that they have adequate protection against liability due to the foresight of Congress in the vaccine compensation legislation. However, I can candidly say I have seen no decline in the cost of the vaccines that were raised so tremendously because of the question of liability.

Senator SPECTER. Well, the liability had been imposed in litigation on a theory that negligence, preventable consequences, was something that had not been taken into account. You are suggesting that was beyond the issue of research?

Dr. WALLACE. I think they always intended to continue the research, and we are not threatened by that. It was actually the side effects of the vaccine itself.

Senator SPECTER. Well, I had asked about that in terms of research on the proposition that had they done sufficient research, they would have accounted for the side effects, or perhaps there is just no way you can do that.

Dr. WALLACE. Given the extremely low incidence of the side ef fects, I doubt whether research would have disclosed it.

Senator SPECTER. Low incidence, but still sufficient to cause a real liability problem.

Dr. WALLACE. That is correct.

Senator SPECTER. But even after the Congress has moved ahead with the Vaccine Injury Compensation Act to try to deal with the problem of tremendous cost, the costs have not come down.

Dr. WALLACE. Correct.

Senator SPECTER. What do we do next? Cut out the compensation. legislation, audit the books, raise hell, all of the above?

Dr. WALLACE. No. 3 is my favorite, Senator.

Senator SPECTER. Why did you make me say it? All those bad words on the record.

Dr. WALLACE. I think all we can hope is that with the mechanism of the compensation legislation, continued funding, continued improvements in processing claims, that the manufacturers will indeed see that their liability is decreasing, that other manufacturers who have dropped out of production will come back in, thus increasing competition and drive the prices down. That is our hope. Senator SPECTER. Mr. Chairman, I regret that I cannot stay at this hearing. I would like to note for the record the presence of a number of Pennsylvania witnesses who I know will have very important testimony to offer. Ms. Geraldine Fox was here earlier today on the issue of of deafness and Ms. and Ms. Lynn Lynn Cooper Breckenmaker, the vice president of the Family Health Council of Central Pennsylvania from Hershey, has testimony on behalf of the National Family Planning and Reproductive Health Association; and Ms. Marie Whitehead from the coronary unit of the Medical College of Pennsylvania and president of the Pennsylvania Nurses Association, has important testimony to offer on nurse education programs; and Ms. Theresa Scheetz, board member of Planned Parenthood of Western Pennsylvania will testify on behalf of her group.

I think everybody understands that on a given morning, we have conflicting hearings with the the Defense Appropriations Subcommittee, the Foreign Operations Subcommittee, and the Agriculture Subcommittee, conducting hearings this morning. So I thank you, Mr. Chairman.

Senator HARKIN. Thank you very much, Senator Specter.


Senator HARKIN. Next is Dr. Alfred Healy, testifying on behalf of the American Association of University Affiliated Programs for Persons With Developmental Disabilities. Dr. Healy, of course, is from the University of Iowa.

It is good to see you again, Dr. Healy. Your statement will be made a part of the record in its entirety.

Dr. HEALY. Thank you, Mr. Chairman. I am here today representing the 54 university affiliated programs across the United States, sponsored under the Developmental Disabilities Assistance and Bill of Rights Act.

As you know, the university affiliated programs, or better known as the UAP's, have four central missions to accomplish. They provide direct services to persons with disabilities. They provide the training of the therapists and physicians and dentists and social workers and educators who provide care to those with disabilities. They also provide technical assistance to the communities and agencies who are required to put together the programs to serve such people. And they also disseminate the information necessary for those programs to work.

You had a vision 4 years ago, Mr. Chairman, that that network of services needed to be expanded. During the past 4 years, nine new university affiliated programs became available to provide such services. However, I need to very quickly point out to you that there are seven States and one territory who still do not enjoy the services and the abilities of university affiliated programs to serve their citizens with disabilities. I specifically refer to the State of Alaska, Delaware, Maine, Nevada, Oklahoma, Rhode Island, Wyoming, and the territory of Puerto Rico.

Our goal, and that which we are recommending to you and your committee, that a university affiliated program be founded in every State and in every population center across this country.

A year ago, Senator, in the reauthorization hearings, I brought with me a young woman from Bulga, IA, Kim Hurley, who communicated to you and your colleagues via an augmentative communication device, and interacted in an extremely appropriate way, even though she experiences dysarthria because of her cerebral palsy, and was unable to communicate with you verbally. She is a student at the University of Northern Iowa, and continues her studies in an exemplary fashion.

I just point out that Kim is a person that has utilized those four services of the Iowa University affiliated program. Since she was 3 years of age, she received medical services. And her therapy-the therapists and psychologists and administrators and others who were responsible for her education and therapy. We also provided the technical assistance so that she could utilize the augmentative communication device.

Kim is one of the 5,000 Iowans served by the UAP and one of the millions of U.S. citizens who have received other services through the auspices of these programs. You will recall, Senator, that there was a movie about 4 years ago that is still popular, an award winning movie, "Field of Dreams" that was filmed very close to your hometown. "Field of Dreams" brought together the possibility of what could be in the reality of an actual playing field for Shoeless Joe and his teammates from the Black Socks of 1919.

You have created a field of dreams, you and your colleagues have created a field of dreams by entitlements, by the Americans for Disabilities Act, and by a variety of other mechanisms. What is needed is that which is left, to bring the reality of that playing field together with the dreams of these Americans with disabilities who still need persons who are trained to assist them, dentists, social workers, speech and language pathologists, occupational therapists, physical therapists, administrators, advocates, all of those who can make that field of dreams for them become a very living reality.

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