Costs to the State of Adding Vaccine Requirements: Testimony by Jerri Johnson Health and Human Services Policy Committee January 27, 2003

Costs to the State of Adding Vaccine Requirements

Immunization requirements are enforced by child care providers, state
licensers of child care providers, and the public schools. This
enforcement costs money for staff to do record-keeping and follow-up.
Much of this cost is borne by the state. A study in 1998 estimated
that enforcing the immunization requirements cost the state at that
time around $5 million per year.

Will adding new vaccines to the list increase costs to schools? It
will, because many more follow-up contacts will be needed for these
particular vaccines.

Currently, 35% of parents are not vaccinating their children for
chickenpox. Minneapolis Public Schools estimated that each parent
follow-up contact cost $18 in staff time.

Minneapolis Public Schools wrote to the Department of Health asking
that no immunization requirements be added until funding is in place
to enforce them.  In addition to the state costs of enforcing vaccine
requirements, these vaccines cost money in health care dollars.

I have included a handout in your package with medical cost analyses
of pneumococcal and chickenpox vaccines. Chickenpox and pneumococcal
vaccine programs actually cost more money than they save from
preventing disease. The pneumococcal vaccine, for example costs
around $60 per dose, or $240 per child for the four-dose series. The
chickenpox vaccine also does not recover costs when looking at the
cost of the vaccine compared to the cost of the disease. Only by
factoring in indirect costs, such as lost wages for a parent to
stay home with a child sick with chickenpox, is this vaccine deemed
to be cost-effective.

But these assessments of indirect costs did not include the cost of
caring for vaccine-injured children. Hospitalization and medical
costs for these children are extremely high. During school years, they
require special education services, costs borne by the state. These
children may later be cared for in group homes the rest of their
lives, incurring huge costs to the state. Twelve per cent of our
children now have chronic disease of some sort, and many medical
experts believe that the rapid increase in diseases such as autism,
ADD, juvenile diabetes, and asthma is partially attributable to the
increase in required vaccines.

A parent who stays home for 5 days when her child has chickenpox may
use vacation days or may lose some income. But parents of children
disabled by vaccines often must quit work permanently to stay home
with their child, losing years of income, and the vaccine-injured
child may never grow up to earn a productive income.

But ultimately, the question before us is not about dollars and
cents. When we are preventing communicable disease, and when we are
preventing vaccine injuries, the real issue is the value in human
life that can't be quantified. You can't put a price on the joy of
having a healthy baby, and you can't quantify the grief of a parent
who loses a baby, no matter what the cause.

And so the Minnesota Natural Health Coalition is calling for the
following:

1. Safer vaccines. Pharmaceutical companies need to be held
accountable to produce vaccines that have fewer serious side effects.

2. The State of Minnesota should not require new vaccines if we do
not know whether they are safe for our children. In the case of the
pneumococcal vaccine, during the pre-licensure study, where 17,000
healthy infants with no acute or underlying chronic disease were
given Prevnar, 162 infants required emergency room care and 24 were
hospitalized within 72 hours of receiving the vaccine, 8 infants who
had never had seizures before had seizures within 72 hours. 40
infants who had never had asthma before required doctor's care for
asthma, wheezing, shortness of breath or breath-holding within 72
hours of the vaccine. One previously healthy child developed
congestive heart failure within 72 hours of the vaccine. Three
children developed hypotonic/hyporesponsive episodes. Were these
serious situations caused by the vaccine? There is no way to
determine this without following the time-honored scientific process
of comparing the test group with a control group that did not receive
a vaccine. This was not done. One variable, the test vaccine, was
compared with another variable, another experimental vaccine.

Yet the physicians who conducted the study concluded at the end, this
test "did not reveal any severe adverse events related to vaccination
that resulted in hospitalization, emergency room visits, or clinic
visits." This is the Vaccine Information Sheet on Prevnar given to
parents at their clinics. It says, "So far, no serious reactions have
been associated with this vaccine." Given the structure of the
clinical study, it is not scientifically possible to say that these
reactions were caused by the vaccine, nor is it possible to say that
they were not.

3. If it is inherently impossible to produce a vaccine without a
significant risk of serious adverse effects or death, then we need to
be clear about that. If the pneumococcal vaccine effectively reduces
pneumococcal disease, but at the price of death or disability to a
few babies, we need to know those numbers. Our research needs to be
science-based, with control groups, and parents need to know the
risks so they can make an informed decision.

We are having a good debate in this country on the smallpox vaccine.
This could be a great model for our infant vaccination programs.
Public health officials are doing a good job of articulating the
risks of smallpox and the risks of the vaccine. 1 or 2 deaths
per million from the vaccine is being taken very seriously. Adults
are weighing the risks and benefits. 

We should afford the same courtesy to infants and their parents in
the routine vaccine program. 

4. Parents should be educated that if their child is ill, vaccination
should be postponed. They should be told that if their child suffered
a seizure or bad reaction to a previous vaccine, she is at risk for an
even greater reaction to the next one. .If parents have a family
history of a severe vaccine reaction, they should know that their
child may be at risk. The CDC already has guidelines on this, and
they are printed on the sheets given to parents when the child
receives a vaccine. If parents knew this before making their
appointments with the doctor, perhaps many vaccine injuries could be
avoided. Again, the smallpox discussion is a good model on this -
people are being informed that if you have eczema, you are at risk
from the vaccine. . If you are on corticosteroids, you are at risk.
Similarly, parents of infants could be advised on this at an early
date.

5. If new vaccines being produced can not be safer, then perhaps we
need to rethink the model which vaccinates the entire population for
a disease. This model was developed in response to overwhelming
epidemics like polio. However, in the case of invasive pneumococcal
disease, which affects only 0.2% of Minnesota children, this may not
be an appropriate model.

6. Finally, parents who believe that their child was harmed or killed
by a vaccine need to be heard and taken seriously. They should not be
brushed off by being told it was not related to the vaccine. Their
experience should be studied for clues to how we can have safer
vaccine programs.