While physician distrust and congressional criticism of the Clinton administration's Vaccines for Children program continue to dim prospects for a successful national immunization effort, providers are finding their own ways to protect the newest crop of toddlers.
Soaring costs and lack of education have contributed to low immunization rates-almost 50% of America's 8 million children under age 2 haven't been vaccinated. But community leaders are showing that strong partnerships and new strategies with healthcare providers can help raise inoculation rates.
Operation Immunization.One recent example, Operation Immunization, was launched in Los Angeles County by Burbank-based UniHealth America, which operates hospitals throughout the San Fernando Valley, and the Los Angeles Times.
While the county health department supplies the vaccines, more than 25 businesses and community organizations, along with hundreds of volunteers, support the program. It will give free immunizations for the next three years, at a cost of about $250,000 for the first year. UniHealth coordinates the program and supplies nurses to give the shots. So far more than 1,000 shots have been administered at an average of 3.4 shots per child. The program will expand free clinics into Orange County and other parts of the Los Angeles area.
"Since the first clinic, we've given shots to children who have never been immunized before," said Greg Waskul, the program's director. "That in itself is an accomplishment."
However, simply providing vaccines for children isn't enough, Mr. Waskul said. Though immunization rates remain lowest among the country's poor and uninsured, missing shots is a problem for all economic classes. "Two-thirds of parents don't understand they need to have their kids immunized before age 2, which is why educating the community is the biggest part of the program," he said.
As part of its ongoing educational campaign, UniHealth has organized presentations at hundreds of schools, businesses, churches and synagogues throughout the valley, distributing free literature in English, Spanish and other languages. Mr. Waskul added that parents can call a toll-free, 24-hour inoculation hot line for more information.
Though the primary focus is on children under 2, children of any age can participate in the program. Clinics are held at elementary schools, farmer's markets, McDonald's restaurants and other community centers, on weekends and weekdays, to maximize accessibility.
"We had to be choosy about how we selected the clinic sites," Mr. Waskul explained. "Lots of kids haven't been reached by normal methods, because their parents can't take them to the doctor's office or because they're illegal immigrants and won't go to a government clinic." Many of the clinics also provided premium items, such as ice cream cones and food coupons, to encourage families to attend.
Shots 4 Tots.Some states have taken similar approaches to providing free immunizations, though reaching families in Lucas County, Ohio, has been facilitated by the use of a mobile clinic. The Shots 4 Tots program, which began in 1993, provides clinics at schools and community centers. But it also maintains a renovated 40-foot American Red Cross first-aid van that travels to supermarkets, shopping malls, fairs and festivals to provide free immunizations.
Although a $145,000 grant from the Ohio Department of Health provided the initial funding for the program, Shots 4 Tots could not operate without the support of a coalition of nearly 40 community and healthcare organizations, including Toledo Hospital; St. Vincent Medical Center, Toledo; Mercy Hospital, Toledo; Flower Hospital, suburban Sylvania; St. Luke's Hospital, Maumee; and St. Charles Hospital, Oregon, Ohio. Though the grant has been renewed for the same amount this year, "the government money is only enough to pay for the core nursing staff," explained Julie Majo, director of clinical services for the Lucas County Health Department.
Gifts from the community included approximately $40,000 in cash and services from organizations such as the Rotary Club of Toledo, the Junior League of Toledo, and Kroger Co. "If the community hadn't been behind us, we would still be sitting here waiting for money to roll in," Ms. Majo said.
Like Operation Immunization, Shots 4 Tots implemented a 24-hour "shotline" so parents could obtain information, including clinic locations and dates.
The effort has paid off. Though the precise number of children serviced by Shots 4 Tots clinics was unavailable, since the program's launch in April 1993 vaccine doses administered in Lucas County Health Department clinics alone are projected to jump to 9,000 from 5,402, by the end of 1994, and the number of children immunized is projected to rise to 3,200 from 878.
Educating parents.In other states, resources for free immunizations simply are not available. In Houston and surrounding Harris County, for example, funding from the health department is channeled into emergency, not preventive, care. Providers have turned to aggressive advertising and education efforts to raise immunization rates.
At Texas Children's Hospital in Houston, physicians have organized an ad campaign to educate parents.
According to Celine Hanson, M.D., immunologist and project coordinator, 400,000 households in the Houston area received immunization reminder cards with their water bills. Other agencies and some private businesses plan to include the cards with bills and paychecks.
"Even parents who know the importance of immunization need to have their memories jogged," Dr. Hanson said.
Texas Children's has also used focus groups to educate parents. "Many parents don't realize that shot requirements have changed since they were children," Dr. Hanson said. "Why, some vaccines given now didn't even exist when I was a 2-year-old. These groups try to drive this point home."
An immunization hot line also has been put into operation in Harris County. Parents can punch their zip code on their touch-tone phones and choose from menus in English, Spanish and Vietnamese. The hot line provides them with the name of the nearest clinic, the specific bus or train needed to reach the site, whether an appointment is necessary, and cost. The hot line also directs homeless people to nearby shelters where they can have their children immunized.
Furthermore, Texas Children's uses an electronic tracking system for its ambulatory clinic department to access patient records. If a child comes to the clinic with a runny nose, a physician can find out if the child is up to date on his or her shots. "Whenever we can get our hands on a kid, we can get a shot into his arm," Dr. Hanson said.
Ideally, she said, a statewide system should be established so health departments, hospitals and physicians anywhere in the state can access on-line information to provide necessary care.
But regardless of the approach, future successes will require public and private sectors to work hand in hand. "This issue is too important for hospitals to remain independent of the public sector," UniHealth's Mr. Waskul said.
Dr. Hanson added that quality care can only be achieved through teamwork.
"Providers need to develop a sort of consortium where they can offer their expertise and counsel each other," she said. "We need to rid our system of elitism if we're going to get anything done. Immunization is a shared problem and unless we work together our children will remain at risk."