 Immunizations,
the AAP and Pediatricians
Dave Tayloe, Jr., MD, FAAP
District IV Chairperson
One of the most pressing
issues for pediatricians today is childhood immunization. We primary care
physicians are at the mercy of an immunization system that squeezes us from
three areas: business, medico-legal, and ethical. Immunizations are the
lifeblood of our practices; if we cannot give state-mandated childhood
vaccines, how can we convince families to keep appointments for the health
supervision visits recommended by the American Academy of Pediatrics (AAP)?
What is the AAP doing to help us to continue our participation in the
immunization system?
The Committee on Infectious Diseases (COID) of the AAP works with the
Advisory Committee on Immunization Practice (ACIP) of the Centers for
Disease Control (CDC) to make immunization recommendations for the US. The
Food and Drug Administration (FDA) must approve any new vaccine before there
can be a formal recommendation from the ACIP and AAP that children in the US
should receive the new vaccine. By the time these national entities
publicize the fact that that there is substantial scientific evidence that
certain children should receive a new vaccine, we pediatricians are up to
our ears in confusion and frustration: Why is there not enough of the new
vaccine to satisfy the demand of the families in our communities? Why don’t
the insurance companies, Medicaid, and SCHIP (State Child Health Insurance
Plan) pay us enough to cover our business expenses to implement the new
vaccine recommendation? Why doesn’t the state have the infrastructure and
funding in place to assure that indigent children have access to the new
vaccine? Who decided that federal/state government agencies and private
sector third party payers should spend millions of dollars on this new
vaccine instead of trying to fund the myriad of other child health services
that are unavailable to a large segment of the population we serve? How
cost-effective is the new vaccine? Why should we implement the new vaccine
recommendation when we are liable for problems caused by the new vaccine
since it is not yet included in the list of vaccines that are covered by the
vaccine-related injury compensation program of the federal government
(National Vaccine Program)?
Within the last
five years, the AAP has begun to do more and more to focus upon the critical
immunization issues outlined above. The current Immunization Action Team at
the Academy will soon be converted to a Task Force on Immunizations and
ultimately to a Subcommittee of the COID, in an attempt to carefully keep
all the players in the immunization system on the same page. There are
already AAP leaders involved as members of the ACIP, so we hope to avoid any
duplication of effort at the Academy on issues that are addressed by the
ACIP. The Academy will try its best to focus upon the real life problems
that practicing pediatricians are having because of the complexities of the
immunization system.
As a member of the Board of Directors of the AAP, I will focus on a short,
but complex list of prominent immunization issues:
Why can’t the ACIP,
when it recommends that children receive a new vaccine, carefully state,
within the recommendation, that the recommendation is a first step toward
assuring that all eligible children receive the new vaccine, but that it
will take time for primary care physicians to implement the new
recommendation because the vaccine manufacturer(s) cannot immediately make
enough vaccine, federal and state government leaders (legislative and
administrative) have not identified funding streams to assure implementation
of the recommendation, private sector insurance companies have not built the
new vaccine into their business plans, and medical liability concerns
involving the new vaccine have not yet been defined or addressed. The
Academy does have people in the right places to improve the ACIP process and
make their recommendations more comprehensive and physician-friendly.
Why can’t the AAP
become seriously involved in assuring that any new vaccine be proven to be
cost-effective prior to any final ACIP recommendation that all children
receive the new vaccine? We are all affected when a child in our practice
dies of a potentially preventable disease, and we wish we could prevent the
tragedy. But, should we spend precious health care dollars to provide a
vaccine that is not proven to be cost-effective, to all children so that we
prevent rare bad outcomes, while we are failing to provide much more
cost-effective health services to millions of children? We live in an era
of huge federal budget deficits and health services are funded along with
all other line items in federal and state budgets. The AAP must prioritize
the government programs on its child health “wish list,” while continuing to
lobby government leaders to convince them that preventive child health
programs should be at the top of everyone’s human service agenda.
The Private
Sector Advocacy Advisory Committee (PSAAC) of the AAP is working, with input
from the Section on Administration and Practice Management (SOAPM), to make
sure that private insurance companies pay physicians adequately for
administering vaccines to all eligible children. The Academy needs to
continue to invest significant resources in assisting practicing
pediatricians in getting paid fairly for providing the health services
recommended by the AAP.
I
welcome your input on the immunization system, or any other area of child
health that you think the AAP needs to address with some urgency. Hope to
see you at the upcoming National Conference and Exhibition (NCE) of the AAP,
when we will celebrate 75 years of advocacy for children, families, and
pediatricians.
September 2005
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