May 2004
Carol Ruppel (
cruppel@ecbt.org)
Congress is currently at an impasse in its
fiscal year 2005
budget negotiations (budget resolution). The
Senate is stalemated on the issue of whether to
require
offsets—lower spending in some areas and/or revenue increases--in order
to
accommodate any new tax cuts or spending increase.
The budget resolution sets spending limits
for the appropriations committees. Whether
or not Congress can reach agreement on a final
budget
resolution, appropriators may send spending bills to the floor
beginning on May
15.
We are finding that Members of Congress understand the
importance of immunization and the need to increase spending. Their ability to do so is severely challenged
this year, however. Readers must make
the case at every opportunity by citing the reduced illnesses and
deaths
achieved every day. Your state wishes to
immunize low-income adults against flu, pneumonia, tetanus and
hepatitis in
local health departments but cannot; pneumococcal conjugate vaccine is
very expensive
but also very effective. Finally,
efforts are underway to lift price caps on the relatively inexpensive
vaccines,
and soon even more vaccines will be recommended. These
arguments are all clear to us, and we
need to make them clear to legislators.
Senators Jeff Bingaman’s (D-NM) and Gordon
Smith’s (R-OR) Children’s Vaccine
Access Act
(S. 2272) has had a positive reception with Congressional staffers. The bill would allow state and local health
departments to administer vaccines allocated to the Vaccines for
Children (VFC)
program to privately-insured children who lack coverage for
immunization
services. VFC is an entitlement program,
and as such, is a guarantee to those who qualify. Currently
those “under-insured” children can
only receive vaccines through this program at federally-qualified and
rural
health centers, which can be inaccessible to many families. By expanding the sites where VFC vaccine is
offered, states would save on the vaccines they can purchase with 317
discretionary federal funding, which is limited. States
would be able to purchase vaccines for
other low-income populations with their federal (317) grant dollars. This bill is unlikely to move unless Members
of Congress hear from their constituents.
There is some discussion about recommending the use of
Hepatitis A vaccine to everyone. On
April 21, the Congressional Biomedical Research Caucus (a group of
Members of
Congress who share this interest) sponsored a briefing on Hepatitis A. Dr. David P. Greenberg, director of a vaccine
research center connected to the University of Pittsburgh School of
Medicine
and Children’s Hospital of Pittsburgh,
explained the disease and its impact. The
Hep A virus causes liver inflammation in about 100,000
per year in
the U.S. The vaccine is nearly 100 percent effective
with two doses. In states where the
disease burden is highest, Hep A immunization is required for school
entry. Greenberg recommends universal
coverage at age two. However, CDC and
other experts who make the decisions about vaccine recommendations
believe that
the population is adequately protected from Hep A based on current
recommendations.
Facilitating the use of electronic rather than paper medical
records has been high on the list of federal priorities in the last
month. As the Alliance for Health Reform,
the group
that is co-chaired by Senators Rockefeller (D-WV) and Frist (R-TN) to
inform
members of Congress on health care policy, reports “the health care
sector has
languished behind almost all other industries in adopting information
technology, which has the potential of vastly improving quality. For example, a variety of studies have found
that prescribing drugs through a system known as computer physician
order entry,
compared with a handwritten prescription, greatly reduces the incidence
of the
wrong medication being prescribed or the wrong dose dispensed.” At an Alliance
briefing on May 7, Dr. Thomas E. Sullivan, president of the
Massachusetts
Medical Society which publishes The New England Journal of Medicine,
suggested that Congress commit funding to support the effort.
President Bush mentioned the need to use electronic systems
for medical records in this year’s State of the Union address,
connecting their
use to reductions in medical errors and medical costs.
On April 27 the president announced his
intention of establishing a nationwide electronic medical records
system within
10 years. For that purpose he’s created
the Office of National Health
Information
Technology at the Department of Health and Human Services (HHS), and
appointed
David J. Brailer, MD, Ph.D director. Dr.
Brailer is a senior fellow at the Health
Technology Center
in San Francisco, has
designed and
advised electronic health information exchange projects.
He was CEO of a health care management
company that provides on-line services. An
advisory committee to the President is dedicated to
information
technology, and one of its subcommittees deals with health care.
HHS Secretary Thompson held a summit earlier this month with
health care industry and technology company leaders, physicians and
others to
discuss medical information technology. The
National Health Information Technology office is to
coordinate and
evaluate current and future HHS Department information technology
efforts and
establish technical standards to allow physicians and hospitals to
share
electronic records. For those familiar
with immunization registries, please note that HL 7 standards will be
used in
the expanded set of standards. (The
Health Level 7 is a voluntary international health standards setting
organization that has been adopted by many immunization registries.)
ECBT
Attends 2004 National Influenza Vaccine Summit
Jennifer Zavolinsky (
jennifer@ecbt.org)
The 4th Annual National Influenza Vaccine
Summit was hosted
by the Centers for Disease Control and Prevention (CDC) and the
American
Medical Association (AMA) in mid-April. ECBT participated in the
conference
along with approximately
130 stakeholders involved in the research, production, distribution,
administration, and
advocacy of the influenza (flu) vaccine. The
purpose of each Summit is to discuss important issues related to the
influenza
vaccine and to work together to achieve the Healthy People 2010 goals
for
influenza vaccination. At the meeting,
participants discussed: the importance of all stakeholders working
together to create
and deliver consistent messages on the benefits of influenza
vaccination; development
of tools and strategies to facilitate the provision of vaccine; and
methods to address
barriers that may reduce influenza vaccinations, such as reimbursement
issues
and possible shortages.
An example of a change made by the Advisory
Committee on
Immunization Practices (ACIP) resulting from the 2003 Summit
was the decision for the CDC and other agencies to wait until the
beginning of each
flu season to determine if there is a sufficient amount of vaccine
available for
everyone to begin receiving it in September and October.
In the event of a limited supply, a
two-tiered system, recommending that high-risk people be given the
opportunity
to receive the vaccine first, is put into effect.
ECBT was invited to participate in this year’s invitation-only Summit
because of the
ACIP’s new pediatric
recommendation to routinely vaccinate all healthy children 6-23 months
of age with
the flu vaccine. The decision to
implement this recommendation was made because studies have shown that
infants
and children younger than two years old are at increased risk for
influenza-related
complications, including hospitalizations. Hospitalization rates are
highest
among children aged 0-1 years and are comparable to rates reported
among people
65 years of age and older.
In addition to children less than two years
of age, the ACIP
recommendations also advise that close contacts of children aged 0–23
months
receive an influenza vaccination. For children younger than 9 years who
were
not previously vaccinated, two doses of inactivated influenza
vaccine
(flu shot) should be administered more than 1 month apart, and if
possible, the
second dose should be administered before December. If a child under
age 9 who
is receiving vaccine for the first time does not receive a second dose
of
vaccine within the same season, only 1 dose of vaccine should be
administered
the following season. Two doses are not required at that time.
Inactivated influenza vaccine for children
6-23 months of
age is currently available both with thimerosal as a preservative and
preservative-free.
For the 2004-05 flu season, it is predicted that 6-8 million doses of
inactivated flu vaccine without thimerosal will be available. However,
it is
important to note that the ACIP does not specifically recommend
that
children receive thimerosal-free flu vaccine. In addition, this
population can
not receive the live attenuated influenza vaccine (i.e., FluMist)
because it is
currently only indicted for healthy people 5-49 years of age. To view
the full
ACIP recommendations on the Prevention and Control of Influenza, please
visit http://www.cdc.gov/mmwr/preview/mmwrhtml/rr53e430a1.htm
Flu vaccine has been covered by the Vaccines
for Children
(VFC) program since March 1,
2003.
The following groups of VFC-eligible children can now receive influenza
vaccine
through the VFC program -- all infants and children ages 6-23 months
and
children and adolescents 2-18 years of age who have risk factors or are
household contacts of people with risk factors.
During the 2004 Summit,
the participants discussed numerous issues related to the new
recommendation
for children. One issue of particular interest to ECBT was the
possibility of giving
the first dose of flu (the priming dose) to children AFTER the flu
season is
over using any leftover flu vaccine, but BEFORE the vaccine expires.
This issue
will need to be discussed further with the Summit
participants before it can be promoted to vaccine providers.
At the meeting, ECBT also shared their
concern that
providers or parents may hold back on vaccinating children under 1
years of age
due to the fact that parents may not have introduced eggs (yolks and
whites) into
the child’s diet yet, and the ACIP recommendations state that persons
who have
a hypersensitivity to eggs should avoid flu vaccination. ECBT suggested
that
the leading medical societies take this issue into consideration when
promoting
the new pediatric recommendation to their members and offer guidelines
to avoid
any confusion when it comes to vaccinating young children with the flu
vaccine.
Subsequent to the meeting,
Summit
participants were asked to endorse NFID’s new initiative “Kids need flu
vaccine
too!”
In addition, NFID recently created
an online CME program titled, “Increasing Pediatric Influenza
Immunization in
Infants and Children,” to highlight the ACIP and the American Academy
of
Pediatrics (AAP) pediatric influenza recommendations and to examine
best
practice models pediatricians can use to design influenza vaccination
programs.
For more information on this CME program, please visit
http://www.pedflumodels.com/
ECBT will keep you updated on the latest information
related
to flu vaccination for children and you can also visit the CDC/NIP Flu
webpage
for updates related to the flu recommendations and related materials at
http://www.cdc.gov/flu/
Institute of Medicine Releases
Definitive Final Report Rejecting Relationship Between Vaccines and
Autism
Amy Pisani (
amyp@ecbt.org)
The Institute
of Medicine’s
(IOM) Immunization Safety Review (ISR) Committee released its final
report
examining the hypothesis that vaccines, specifically the
Measles-mumps-rubella
(MMR) vaccine and thimerosal-containing vaccines, are causally
associated with
autism. The committee concluded that
“the body of epidemiological evidence favors a rejection of a causal
relationship between the MMR vaccine and autism…and that the body of
epidemiological evidence favors a rejection of a causal relationship
between
thimerosal-containing vaccines and autism.”
The ISR was formed in early 2001 to provide independent,
non-biased advice
to vaccine policymakers, practitioners and the public. The committee is
chaired
by Marie McCormick, M.D., Sc.D. of the Harvard School of Public Health
and is
comprised of experts from a range of relevant disciplines. This report
titled Immunization Safety Review: Vaccines and
Autism is a follow up to the following seven reports:
- Measles-Mumps-Rubella
Vaccine and Autism, April 2001
- Thimerosal-Containing
Vaccines and Neurodevelopmental Disorders, October 2001
- Multiple
Immunization and Immune Dysfunction, February 2002
- Hepatitis B Vaccine
and Demyelinating Neurological Disorders, May 2002
- SV40 Contamination
of Polio Vaccine and Cancer, October 2002
- Vaccines and Sudden
Unexpected Death in Infancy, March 2003
- Influenza Vaccine
and Neurological Complications, October 2003
Dr. McCormick responded to a host of questions from the media
during an IOM
hosted teleconference and appeared on several national news interviews
including NBC Nightly News with Tom Brokaw where she encouraged parents
to
receive timely vaccines. During the
interview
Dr. McCormick, who is the aunt of two autistic children, stated that
she would
not hesitate to vaccinate her children with life-saving immunizations.
In
this final report, the committee does not recommend a policy review of
the
current schedule and recommendations for the administration of either
MMR
vaccine or thimerosal-containing vaccines. The
committee also recommends that funding for autism
research be
directed towards efforts that will result in promising outcomes. The full report can be found on the IOM
website at http://www.iom.edu/report.asp?id=20155
This
report spurred much news coverage. Following
are a few examples:
"Vaccine, Preservative Do Not Cause Autism - Report"
Reuters News (May 18, 2004)-- "Neither the measles, mumps and
rubella vaccine nor a mercury-based preservative used in many childhood
shots
cause autism, a U.S. health panel said on Tuesday in the most
definitive report
yet on the purported link."
More >> http://www.reuters.com/newsArticle.jhtml?type=healthNews&storyID=5183214
"Autism Link With Vaccine Is Disputed" Associated
Press
(May 18, 2004)-- "There is no evidence that a controversial
mercury-based vaccine preservative causes autism, concludes an eagerly
anticipated scientific review that says it's time to lay vaccine
suspicions to
rest and find the real culprit. Tuesday's conclusion by the prestigious
Institute of Medicine
pointed to five large
studies, here and abroad, that tracked thousands of children since 2001
and
found no association between autism and vaccines containing the
preservative
thimerosal."
More >> http://www.grandforks.com/mld/grandforks/news/nation/8695154.htm
The following Web sites ran the articles above:
- Grand Forks
(ND)
- USA
TODAY
- CNN
- Centre Daily Times (PA)
- Charlotte News Observer
- Palm Beach
Post
- Washington
Post
- MSNBC
- Biloxi
Sun Herald
- Kansas.com
- Atlanta
Journal Constitution
- Canada.com
- Mlive.com (MI)
- Montgomery
County Record
(PA)
- New York
Newsday
- Times Picayune (LA)
- WTOP (DC)
- Times Daily (AL)
- Tuscaloosa
(AL)
"Government
Says There is No Autism-Vaccine
Link" KOLD-TV (CBS Affiliate in Tucson)
(May 18, 2004)--
"The Institute of Medicine concludes that autism is not linked to the
vaccines. The IOM reviewed five recent large studies, here and abroad,
that
tracked thousands of children since 2001. The IOM says the
"overwhelming
evidence" indicates that neither the mercury-based vaccine preservative
thimerosal, nor the measles-mumps-rubella, or MMR vaccine, are
associated with
autism."
More
>> http://www.kold.com/Global/story.asp?S=1878156
"Experts
Reject Vaccine-Autism Link National
Vaccine Reform Group Questions Experts' Motives" WebMD Medical News (May 18, 2004)--" An expert panel
says conclusively that the mercury-containing vaccine preservative
thimerosal
does not cause autism in children. But a national, parent-led vaccine
reform
group says the panel is practicing politics, not medicine"
http://my.webmd.com/content/article/87/99457.htm?z=1728_00000_1000_1n_01
"CORRECTIONS"
Washington Post (May 20,
2004) "A May 19
article about an Institute of Medicine report on vaccines
and autism incorrectly characterized Rep. David Joseph Weldon (R-Fla.)
as a
'vaccine skeptic.' Weldon, who is a physician, supports childhood
vaccinations
and believes their benefits outweigh the risks. But he believes that
the
federal government has not done enough to study adverse reactions to
vaccines,
and specifically the hypothesis that the measles-mumps-rubella (MMR)
vaccine,
or vaccines containing the preservative thimerosal, cause autism. "
http://www.washingtonpost.com/wp-dyn/articles/A41364-2004May19.html
"U.S.
Panel
Aims to Quash Vaccine-Autism
Link" Forbes (Health Day News) (May 20, 2004) "In a large-scale
report aimed at snuffing out any embers of doubt, a U.S. government
panel has
concluded decisively that childhood vaccinations do not cause autism."
http://www.forbes.com/health/feeds/hscout/2004/05/20/hscout519065.html
"Research,
not arguments, is the answer" Andalusia
Star-News (AL)
(May 20, 2004)
"The
phone rang as the news report started. I raced to pick up the receiver,
trying
to hear the reporter as I answered the phone. "Hey," said Tim, my
youngest son. "Hi," I answered, straining to hear the
television."There is a report on the news about autism," my son said.
"It's on right now." "Yeah, I'm watching it," I said.
"Thanks for calling."
http://www.andalusiastarnews.com/articles/2004/05/19/opinion/opin05202.txt
"Report
rejects childhood vaccines as a cause
of autism" News-Medical in Child Health News (May 19, 2004)
"A pivotal
report
issued today by the Institute of Medicine (IOM) rejects childhood
vaccines as a
cause of autism. The findings, based on reviews of current scientific
evidence,
are a significant affirmation of vaccine safety, according to the
American
Academy of Pediatrics (AAP). 'For most parents, today's report should
assure
them of the safety of vaccines,' said AAP President Carden Johnston,
MD.
'There's no doubt we must find the causes of autism, but we need to
target
other more promising research areas.' "
http://www.news-medical.net/view_article.asp?id=1660
"IOM
finds
no link between thimerosal and
autism" CIDRAP ( Center for Infectious Disease Research and Policy )
(May
19, 2004)"The
Institute of Medicine (IOM) says it can find no evidence that
thimerosal-containing vaccines or the measles-mumps-rubella (MMR)
vaccine
causes autism and recommended that the search for the cause of the
disorder
focus on other possibilities. "
http://www.cidrap.umn.edu/cidrap/content/other/flu/news/may1904thimerosal.html
"Vaccine,
Autism Link Dismissed" Ivanhoe
Newswire (May 20, 2004) "Speculation that vaccines trigger autism
is
being dismissed by the American Academy of Pediatrics as they continue
to
encourage parents to vaccinate their children. The AAP assures the
safety and
importance of receiving vaccinations to protect healthy children from
12
diseases that are preventable by vaccination."
http://www.ivanhoe.com/channels/p_channelstory.cfm?storyid=8689
California's
Health Plans And Coalitions Spearhead Activities During Immunization
Week
Amy Pisani (
amyp@ecbt.org)
ECBT traveled to California
for several days in April to help immunization advocates promote
immunization registries and celebrate National Infant Immunization Week
(NIIW). The trip commenced in Berkeley, CA
where ECBT
Cofounder Betty Bumpers, Jennifer Zavolinsky, Senior Manager,
Immunization
Outreach Initiatives, and Angela Salazar from the Registry Support
Branch of
the CDC/NIP attended the California Statewide Immunization Information
System
(SIIS) meeting. SIIS is working to develop an integrated, statewide
computerized registry to network each child's full immunization
history. This
annual meeting consisted of representatives from local health
departments, the
California Department of Health Services Immunization Branch, and a
spectrum of
key stakeholders across the state. Mrs. Bumpers provided the keynote
address at
the meeting informing attendees of national immunization efforts and
ECBT’s recent
activities related to immunization registries.
The next two stops on the California
trip were Modesto and Stockton,
CA. While
there, Betty, Jennifer and Angela spoke at three
meetings hosted
by Blue Cross of California for the health plan’s participating office
managers, nurses and physicians. The goal of the meetings was to
increase
private provider participation in the RIDE registry program, which is
run by San Joaquin and Stanislaus counties in California.
At the meetings, ECBT spoke about
national efforts to increase private provider and health plan
participation in registries and highlighted the benefits that providers
can gain by
participating in their local registry. ECBT’s
CD-ROM, Health Care Providers Speak Out on Immunization
Registries was shown to the attendees followed by a demonstration
of the RIDE program by Justin Labadie. Participants were strongly
encouraged to enroll in the registry and ECBT received a great deal of
positive feedback at all three meetings. We currently await results
from registry staff to determine the effectiveness of this provider
outreach program.
The trip
culminated with a press conference held at the
Mission Neighborhood Health Clinic of San Francisco hosted by the
California
Coalition for Childhood Immunization (C3I). During
the media event, speakers, including Betty Bumpers, Edgardo Alfonso of
the San Francisco Giants, and Steve Barrow of C3I, touted the
importance of childhood immunization and the utilization of the
immunization registry as a primary method to improve immunization
delivery. Senator Speier’s registry bill (SB 1764), which includes
provisions to fully fund the California Statewide Immunization System
(SIIS), was highlighted during this event.
Please contact
Jennifer Zavolinsky at Jennifer@ecbt.org
or 202-783-7034, for a
copy of the CD-ROM or if you are interested in having ECBT participate
in a meeting
to increase health plan and/or private participation in your registry.
Photo
of kids singing at the press conference:
http://www.ecbt.org/images/kidssingingatpressconference.JPG
Photo
of all of the speakers at the press conference:
http://www.ecbt.org/images/Allthespeakersatpressconference.jpg
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