There is a knock at the front door. Peeking through the window, a mother sees a man and a woman, both in uniform. They are agents of health-care reform.
“And your four-year-old still needs the chicken-pox vaccine,” says the woman.
“He will not be allowed to start kindergarten unless he gets that shot, you know,” says the man—smiling from ear to ear.
“So, can we please come in?” asks the woman. “We have the vaccines right here,” she says, lifting up a black medical bag. “We can give your kids the shots right now.”
“We are from the government,” says the man, “and we’re here to help.”
Is this a scene from the over-heated imagination of an addlepated conspiracy theorist? Or is it something akin to what is actually envisioned by the health-care reform bill approved this week by the Senate Health, Education, Labor and Pension Committee.
The committee’s official summary of the bill says: “Authorizes a demonstration program to improve immunization coverage. Under this program, CDC will provide grants to states to improve immunization coverage of children, adolescents, and adults through the use of evidence-based interventions. States may use funds to implement interventions that are recommended by the Community Preventive Services Task Force, such as reminders or recalls for patients or providers, or home visits.”
Home visits? What exactly is the state going to do when it sends people to “implement interventions” in private homes designed “to improve immunization coverage of children”?
The draft of the bill posted on the committee Web site provides more details.
Title III of the bill is entitled, “Improving the Health of the American People.” It includes four subtitles. They are: “Subtitle A: Modernizing Disease Prevention of Public Health Systems,” “Subtitle B: Increasing Access to Clinical Preventive Services,” “Subtitle C: Creating Healthier Communities,” and “Subtitle D: Support for Prevention and Public Health Information.”
The program authorizing home “interventions” to promote immunizations falls under “Subtitle C: Creating Healthier Communities.” This subtitle directs the secretary of health and human services to “establish a demonstration program to award grants to states to improve the provision of recommended immunizations for children, adolescents, and adults through the use of evidence-based, population-based interventions for high-risk populations.”
The bill lists eight specific ways that states may use federal grant money to carry out immunization-promoting “interventions.” Method “E” calls for “home visits” which can include “provision of immunizations.”
Says the draft bill: “Funds received under a grant under this subsection shall be used to implement interventions that are recommended by the Task Force on Community Preventive Services (as established by the secretary, acting through the Director of the Centers for Disease Control and Prevention) or other evidence-based interventions, including—“(A) providing immunization reminders or recalls for target populations of clients, patients, and consumers; (B) educating targeted populations and health care providers concerning immunizations in combination with one or more other interventions; (C) reducing out-of-pocket costs for families for vaccines and their administration; (D) carrying out immunization-promoting strategies for participants or clients of public programs, including assessments of immunization status, referrals to health care providers, education, provision of on-site immunizations, or incentives for immunization;(E) providing for home visits that promote immunization through education, assessments of need, referrals, provision of immunizations, or other services; (F) providing reminders or recalls for immunization providers;(G) conducting assessments of, and providing feedback to, immunization providers; or (H) any combination of one or more interventions described in this paragraph.”
Many vaccines routinely administered to children in the United States are utterly uncontroversial. But in recent years there have been controversies about the chicken pox vaccine and the vaccine for HPV, which causes genital warts, which can cause cervical cancer.
On March 15, 2007, Bloomberg news summarized a study published in the New England Journal of Medicine, which discovered that the chicken pox vaccine does not provide permanent protection against chicken pox, leaving children who have been immunized vulnerable to getting ill with the virus later in life when it can cause a more serious bout of the disease.
“Merck & Co.'s chickenpox vaccine weakens as children age, possibly leaving them vulnerable to a more serious infection as adults, a U.S.-sponsored study in California found,” reported Bloomberg. “The power of the vaccine, Varivax, the only one available in the United States against chickenpox, starts to fade after five years, according to the study in today's New England Journal of Medicine. The results suggest that children should get a second dose, which advisers to the Centers for Disease Control and Prevention recommended in June.”
Bloomberg quoted the study as saying, "Waning immunity is of particular public health interest because it may result in increased susceptibility later in life, when the risk of severe complications may be greater than that in childhood.”
In March of this year, the Washington Post reported about the controversy sparked when the Merck pharmaceutical company campaigned to have states mandate that school girls receive Gardasil, its vaccine against HPV.
“Merck also began an ambitious marketing campaign and lobbying push to persuade states to add the vaccine to the list of those required for children to attend school,” reported the Post. “But the company eventually abandoned the strategy in the face of an intense backlash from critics who argued that the decision should be left to parents. Although many states considered such mandates, so far only Virginia and the District have imposed one, and [a Merck official] said the company has no plans to pursue that strategy again."
The Post's report noted that at least some experts questioned the wisdom of promoting use of the vaccine when its long term impact is still unknown.
“Federal health officials, Merck and others say they are confident that the vaccine is safe," reported the Post. "But some experts said they are concerned that there is insufficient evidence about how long Gardasil's protection will last, whether serious side effects will emerge and whether the relatively modest benefits for boys are worth even the small risks associated with any vaccine."