Mr. Chairman, Senator Gregg, members of the Committee, first let me thank you for the opportunity to testify on behalf of Every Child By Two, an organization Rosalynn Carter and I founded 10 years ago.  Our purpose was and is very simple:  to make certain all children are immunized against vaccine-preventable diseases.

The country has made tremendous progress in achieving this goal, but it is an increasingly daunting task.  Today the number of shots a child should receive by age 18 months is at least 20, and it is estimated that the number will triple in the next ten years.   When I became involved in childhood immunizations 30 years ago, there were only five recommended shots.  I have attached a copy of the current immunization schedule recommended by both the Advisory Committee on Immunization Practices and the CDC, to give you an idea of what we're facing.  The good news is that even with the increase in required shots, our immunization rates have risen to the point that today over 77 percent of the children in the country are fully immunized by age two and 95 percent by school age.

I was asked to give both the history of our role and our views on the effectiveness of the National Immunization Program.  I'll begin with our role.  I've told the story hundreds of times before and here it is again.  When Dale became governor of Arkansas in 1971, while pondering how I could use my position to do something meaningful for the State, I discovered that Arkansas' immunization rates were well below 50 percent.  At about that time, CDC approached all the first ladies about helping out.  So I answered the call and began marshalling the efforts of every organization in Arkansas that had any contact with the public, even the National Guard and the Agriculture Extension Service.  We immunized 310,000 children on one Saturday.  Soon Arkansas' children had a 90 percent immunization rate.  The program was so successful, CDC asked me to take it on the road and enlist other first ladies to do the same in their states.  Luckily, Rosalynn Carter, then First Lady of Georgia, was very interested, and as they say, "the rest is history."

Later, according to Rosalynn, I was the first person to come knocking on the door of the White House in 1977 after President Carter was elected.  The next thing I knew, Joe Califano, Secretary of HEW, called to tell me the President had told him not to make a move on creating an immunization program until he talked to me.  Mine and Rosalynn's first initiative was an effort to get the 11 states that required immunization prior to school entry to enforce the requirement, and to get the other 39 to pass such laws.  We succeeded, though it took several years.

A few years later, the U.S. suffered a terrible measles outbreak.  Measles cases rose from 1,500 in 1983 to 27,786 in 1989.  The epidemic rocked the nation, claiming the lives of 150 and hospitalizing thousands.  We suddenly realized that the school laws may have created a mindset among parents that they could wait until their child reached the age five to be immunized, when in fact we knew they should be fully immunized by age two.  So, we founded Every Child By Two (ECBT), with two goals:  to raise awareness levels and to establish a method that would result in all children being immunized on time.  We have visited almost every state, many of them more than once, and continue to use the model I used in Arkansas of encouraging grassroots coalitions to advocate for full immunizations.

Over the past 30 years Rosalynn and I have witnessed the cyclical way in which the public and Congress focus their attention on public health.  When immunization rates are low, attention and money are directed to the National Immunization Program.  This then results in increased immunization rates and lower disease incidence.  Organizations like ours go on high alert because we have learned that once the crisis is over and rates are brought to an acceptable level, people lose interest.  Eventually funding levels go down and immunization levels soon decline.  It is a never-ending struggle, but none of us can quit.  So we continue to work with state coalitions, legislators, governors, and Congress to leverage support for vaccine laws, regulations, and funding.

To reach our goal of establishing a method by which all children are automatically immunized, so we CAN quit, our continuing top priority at EVERY CHILD is helping states develop their computerized immunization registries.  Registries take care of so many infrastructure functions.  They produce vaccine inventories, children's shot records, reminders to providers that patients' shots are due, reminders to parents to take their kids in for shots; and they track of adverse reactions-many of the functions required of federally funded immunization programs.

Registries can serve another important purpose that we believe may have been overlooked.  While we are elated that in response to bioterrorist attacks, Congress will provide funds to support the nation's public health communications infrastructure, we are discouraged that the registries, which already perform many of the functions of these newly proposed systems, are not being considered for integration.  More than $240 million has already been spent to develop the immunization registries, and they can and should be indispensable in responding to bioterrorist attacks.

Continuing on the subject of systematizing vaccine delivery, last year EVERY CHILD was instrumental in working with the White House on its executive memorandum, now a WIC policy memorandum, that gives WIC, one of our favorite federal programs, the support and capacity to screen children for their immunization status and to refer them to their health care provider when they are not up to date.  It is a staggering figure, but true that WIC serves 45 percent of the children born each year in the U.S.  EVERY CHILD considers WIC an important partner.  We have been working closely with the National Immunization Program (NIP) and the Department of Agriculture to create an action plan that will accomplish the goals of the memorandum.  And, we will follow through on our promise to the President to stay with the WIC/Immunization Working Group until our task is complete.

Our experience in traveling the country for EVERY CHILD tells us that public health departments do a yeoman's job of administering immunization programs.  But if I have one message to bring to you in this new era, it's the same message I've always delivered.  We cannot afford to under-fund the National Immunization Program.  There's not a state or local health department that isn't cutting corners right now.  We all know that states are suffering big budget shortfalls, and since Medicaid is by far the largest drain on state budgets, especially health budgets, there are simply no more corners to cut.  The public is looking to federal agencies to ensure our health, and we must equip them for this task.

In our travels, we speak to public health nurses, state immunization program managers, immunization registry managers, state health officers and elected officials, and we often ask them what messages they want us to convey to the Congress and the National Immunization Program.  You ask, "Is the National Immunization Program working?"  We believe the program has a lot of very dedicated people for whom we have the utmost respect, and they work under strained budgets.  But what I sense is a lack of accountability tied to the 317 state grant funding.  I believe the NIP should have the power to require evidence of progress on each of the required functions of the grant before it allots the next year's funds.  The oversight mechanisms are set out in the NIP's annual site visits to state immunization programs, and also in the reports the states send back to NIP on how they used the 317 funds.  I believe that NIP knows how to get the job done, and has the research to prove it.

We have two final requests of this committee.  First, that it promote passage of S.1297, Senators Durbin and Reed's Comprehensive Coverage of Childhood Immunizations bill that would require all health plans, both ERISA and non-ERISA, to fully cover all immunizations recommended by the Advisory Committee on Immunization Practices.  Plans lacking such coverage leave minimum, or low-wage earners no choice but to bring their children to public health clinics where they can get federally funded immunizations.  [EVERY CHILD has unsuccessfully attempted to convince what is reportedly the largest employer outside the federal government to include immunizations and well child visits in their health plan package.]  Passage of Senator Durbin and Reed's bill would reduce the amount of funding required under section 317 for vaccine purchase by placing the responsibility for many immunizations back onto the private sector.

Our second request is that the committee promote passage of Senator Feinstein's bill, S.573, which would allow all State Children's Health Insurance Programs-not only those that expanded Medicaid-to be eligible to dispense vaccines purchased by the Vaccines For Children entitlement program.   Currently states that chose to create stand-alone programs are penalized by having to draw on their State Children's Health Insurance Program budgets to purchase vaccines for children at the expense of other services.

In closing, Rosalynn and I would like to thank this committee for allowing us to come and testify, and to thank Senators Reed and Durbin for their tireless efforts in supporting the National Immunization Program.

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