are able. Your task is to provide the funds to allow vital Federal programs to continue. We ask that you recognize the correlation among preventive and chronic health services, research and the training of new health professionals, and not increase one program at the expense of another. As pediatricians in practice, we see the integral tie between basic research and the care we provide in our practices, and see the impact of poverty and the environment on the health of our children in adolescence. And we know that the future of our work force depends upon the decisions we make today. The testimony of the academy offers several recommendations and has been submitted to you, Mr. Chairman, but I want to stress, in my last minute, immunizations. In my State of Iowa, which boasts a 97-percent fully immunized rate at kindergarten, we have only 54 percent of our 2-year-olds adequately immunized. As I speak, we have an outbreak of measles in Waterloo, and we have had cases of all the diseases that we could immunize against in this last year. To give every child in Iowa a second dose of the measles mumps-rubella, which will be shortly mandated by the Iowa Department of Public Health, prior to kindergarten, we need $4 million more. PREPARED STATEMENT The request that we have made from the academy for increased funding for this vaccine alone is only $24 million for the whole Country. So I think you can appreciate the dire straits we face. Mr Chairman, we pediatricians feel the subcommittee must know that we feel no better money can be spent than that used for insuring the health of our children. Thank you. The statement follows:] STATEMENT OF DR. PETER D. WALLACE Mr. Chairman, I am Dr. Peter Wallace, a practicing pediatrician from Iowa. I am pleased to be here today to speak on behalf of the infants, children, adolescents, and young adults in this country as a representative of the 41,000 pediatricians of the American Academy of Pediatrics. This statement is also supported by the 1300 members of the Ambulatory Pediatric Association and the 1100 members of the Society for Adolescent Medicine. I am especially pleased to be here on the first day of the hearings this subcommittee will hold pertaining to funding the many health, social, and education programs affecting America's youth. You will hear many organizations and individuals discussing the merits and needs of all those programs. As the time for decisions nears, the Academy urges you to remember one key fact -- ensuring the health of our children means providing for today's needs plus planning for tomorrow's. Our testimony, as well as those who will come before you through the next few days, will give this subcommittee the information regarding present and future needs. First, I would like to state that the Academy was pleased to see that the President's budget for fiscal year 1992 placed a priority on children's programs, especially the preventive health programs. The budget acknowledges that in recent years federal spending on most of these programs have not kept pace with increases in other areas. The Academy hopes this subcommittee will use its limited resources this year to reverse the trend. Fortunately, most infants are born healthy and continue to grow and develop if they have access to and receive basic health care services. Unfortunately, there are still far too many that suffer needlessly from disease, injury, abuse, or a host of societal problems. Our task as pediatricians is to treat them all, to provide such services as we are able. Your task is to provide the funds to allow vital federal programs to continue. We ask that you recognize the correlation among preventive and chronic health services, research, and the training of new health professionals and not increase one program at the expense of another. As pediatricians we see the integral tie between basic research and the care we provide; we see the impact of poverty and the environment on the health of our children and adolescents; and we know that the future of our workforce depends on the decisions we make today. The testimony of the Academy will offer recommendations for many programs, but I will focus primarily on only a few. Childhood Immunization Program This subcommittee is well aware of this preeminent preventive health program for infants and children. Yet, armed with this knowledge and the means to prevent a growing number of serious childhood illnesses, preventable diseases are on the rise in virtually every state in this country. We are experiencing outbreaks of measles, mumps, and whooping cough, and we anticipate the incidences of rubella to increase. Unless we declare an all out effort to conquer these diseases now many of our children will needlessly suffer or die. The President's budget includes a $40 million increase, targeted mainly at fortifying the infrastructure of our immunization program and stimulating innovative outreach programs, which we strongly support. However, it falls short of the necessary dollars it will take to immunize the increasing numbers of children who depend on the public clinic for their immunizations and to provide for these children the newly recommended second dose of MMR and the newly approved conjugate HiB vaccines for the prevention of meningitis. There is also a strong possibility that the varicella (chicken pox) vaccine will be licensed for routine use this year. If that occurs, additional monies would be needed in a supplemental next spring. De Academ request includes the following increases over the President's ommendation $$ milion for HB, $24 million for the second MMR, and $15 million de de frevene dé a three-sue vear phase in for Hepatitis B; $30 million additional for Cinessracture 12 support de outreach and demonstration needs; and, finally, $4 millor or the scene goctale. The Academy recommendation for the entire Childhood Immunoana ogun s $336.8 milion. Nato vite Program Office lever gat we have not reached in the quest to wipe out vaccine-preventable Boone Program Office and other related programs are a part of von! onego Pachieve these goals. The Academy recommends $15 million. 1.3.2 A REM ZAouncements regarding the decrease in the infant mortality rate are sxvisage de l å seil anoceptably high. The Academy commends the President and Costa Nonat & choosing to increase federal efforts to reduce infant mortality in this Thee në mum kods, both urban and rural, where infant mortality is yenounced initiative is to examine social and other non-financial qe kenal kegy women from receiving prenatal care, to develop target k existing programs. Existing studies and reports could be ....、、s but move comminate the cost of further examination of the barriers; some of A sh' vưa wisi treatment programs. We do agree that reinforcing the kata by bbcal programs (i.e., Medicaid and the Maternal and Child too. 2. Roxa všade vių be helpful. However, the proposed budget would fund this dive deegð í æðiation of reprogramming monies from existing programs and new kes this subcommittee to not support the reprogramming concept as a mock toda de Maternal and Child Health Block Grant does not solve the infant ja contar vàge much of what this program does is to ensure such needed services. ja veab hai phủ Mealth Block Grant vog na avtagered to assure mothers, infants, children, and adolescents access to keda reduces infant mortality and morbidity, helps children with special Gryphon va yuyung illnesses, and encourages healthy lifestyles. Through cow a jeden rederal programs limited resources can be used effectively to k, doa soa kad Bagmentation of services. The Academy recommends this program sa kur authorisation level of $686 million. 4. og var geyinmony consists of a listing of all the programs of concern to the we recommendations. The Academy joins with its many friends in other povat arvaseliiqux in presenting these recommendations. 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. Deviously we are buying on the open market. Senator HARKIN. Does every child need to have that series? 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 Fanding 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 eve CDC put out a study not too long ago that showed that in munization 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 exsted where research was not being conducted because of the potenalbability on damages which resulted from immunization? D WALLACE. The funding and work we have done to help the bability 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. my personal opinion, and I do not speak for the academy, I that they have adequate protection against liability due to the resight of Congress in the vaccine compensation legislation. However I can candidly say I have seen no decline in the cost of the cenes that were raised so tremendously because of the question of hability Senator SPECTER. Well, the liability had been imposed in litigaion on a theory that negligence, preventable consequences, was something that had not been taken into account. You are suggestthat was beyond the issue of research? D WALLACE. I think they always intended to continue the research, and we are not threatened by that. It was actually the side Senator SPECTER. Well, I had asked about that in terms of research on the proposition that had they done sufficient research, would have accounted for the side effects, or perhaps there is no way you can do that. |