Vaccine program on chopping block

January 10, 2009

John Stucke The Spokesman-Review

Darcy Pope, age 10 months, receives her vaccinations at Northwest Pediatrics this past Thursday. The state of Washington may pull back on its coverage of childhood vaccines, from mumps and rubella, to chickenpox and HPV. The worsening budget picture puts funding of these important immunizations an issue. Private insurers will likely be asked to shoulder more cost.
(Full-size photo)

HPV vaccine Introduced in 2007, the HPV vaccine, in conjunction with regular pap smears, is expected to dramatically cut the instances of cervical cancer, said Dr. Sharon Cathcart at North Spokane Women’s Clinic. But researchers are years from being able to compile concrete data showing the vaccine is working to reduce cervical cancer, she said. “It’s one of those things that doesn’t show an immediate payoff if you’re trying to balance money with proven programs,” she said. Each year about 11,000 American women are diagnosed with cervical cancer. About 3,800 die from the disease. HPV is the most common sexually transmitted disease, so the promise for the vaccine is great, Cathcart said. Gardasil is recommended for girls 11 and 12 years old. Between May 2007 and August 2008, there were 92,117 girls immunized against HPV in Washington. Numbers for Idaho vaccinations weren’t immediately available. There had been some controversy regarding the vaccine, with some parents likening it to a ticket for their daughters to be promiscuous. Cathcart dismisses the criticism. “About 80 percent of all married couples have evidence of having an HPV infection,” Cathcart said. “Like other vaccines, it can save lives. Why would you deny it to someone?” The average total cost of the three doses of Gardasil is between $300 and $400. There are now studies to see if Gardasil is effective in boys or men, who can contract penile or anal cancer from HPV. “We see it as an important public health issue,” Cathcart said.

Darcy never saw it coming.

The 11-month-old with wispy red hair cuddled in her mother’s arms and smiled at all the fuss and bustle of nurses preparing to stick needles into her thighs.

As the syringes emptied into her tiny legs, she whimpered and then cried. But don’t feel bad for Darcy Pope: She just received the modern miracle of vaccination courtesy of Washington taxpayers.

Every day the staff at Northwest Spokane Pediatrics immunizes Spokane children against diseases that had historically sickened, crippled and killed children in haunting numbers.

State health programs, buoyed by liberal social policies, flush with cash and aiming to reverse lagging vaccination rates, had turned Washington into a state where all children received free vaccines. Parents and insurers, including Medicaid, were still on the hook for the cost of administering the shots, but the state-paid vaccines put Washington among a group of six states that offered universal coverage.

That is about to change.

The economic downturn, along with years of increased state spending, has created a $6 billion budget hole that the Washington Legislature will reckon with beginning this month.

Providing free vaccines to every Washington child – regardless of family financial means – costs about $42 million every year. It was an obvious place to start finding budget savings, said state Secretary of Health Mary Selecky.

“We had to look at every place we spent money,” she said of her office’s efforts to help Gov. Chris Gregoire come up with a budget plan. “Our largest singular expenditure is vaccines.”

The cuts are likely to be adopted so that HIV/AIDS education, family planning and funding for local health districts can be spared.

The state’s money now supplements federal funds that are earmarked to ensure poor children have access to immunizations along with Native American and Alaska Native children. Without state money, private insurers will pick up the cost rather than their customers receiving the state-subsidized vaccinations.

Scott Forslund, a spokesman for Premera Blue Cross, said the health insurer is ready to pay for its customers receiving the vaccines if the Legislature approves the spending cuts.

Insurance executives, however, are concerned that the move is further aggravating the practice of “cost-shifting” – having private insurers and their customers pay more to compensate for inadequate government spending on health care. Forslund points to a study that shows private insurance is shouldering an extra $1.4 billion a year in payment shortfalls from Medicare and Medicaid.

“Yet we also understand that the state is in an unprecedented bind right now,” Forslund said.

The federal dollars, Selecky said, should be enough to cover the vaccines for children who qualify for Medicaid.

An unknown is who will pay for the vaccines of children who fall through the coverage cracks between Medicaid eligibility and affordable health insurance.

“Certainly there are things we don’t know yet,” said Tim Church, spokesman for the Washington Department of Health.

That’s why the cutbacks will unfold in two phases, he said.

Starting July 1 the state will no longer pay $7 million a year for the vaccine for Human Papillomavirus – or HPV – that pharmaceutical company Merck developed and began selling 18 months ago under the brand name Gardasil. The vaccine is recommended for girls and young women ages 9 to 26, and immunizes against 70 percent of the HPV strains that cause cervical cancers, along with many organisms that cause vulvar and vaginal cancer and 90 percent of cases of genital warts.

Then, beginning July 1, 2010, the state will stop paying for other vaccines, including those guarding against polio, diphtheria, tetanus, pertussis, Haemophilus influenzae B, mumps, measles, chickenpox and others.

Zadia Short, who took her baby Keira for immunizations last week, said she hopes that vaccines are readily available to her daughter as changes occur.

“They’re so important,” she said. “I hope nothing happens to make getting vaccines difficult.”

Selecky said the hope is that the state can use the year between the HPV and other vaccine spending cutbacks to identify coverage gaps so that every child in need of vaccines can get them without parents having to balance dollars and disease risk.

Washington and Idaho both rank in the bottom five nationally for vaccinating children ages 19 months to 35 months old, according to the Centers for Disease Control and Prevention.

About two-thirds of Idaho children have received the full regimen of six vaccines requiring multiple doses. The national average is 77.4 percent.

Washington fared just a bit better in the survey – 69.0 percent of toddlers had been vaccinated.

Selecky said part of the problem with vaccination rates is the reluctance of parents – often because of concern over the safety of immunizations.