Primary Care

Costs pose a barrier to early childhood immunization

A national priority for the year 2000 is full immunization of at least 90 percent of U.S. children by age 2. Yet the vaccination rate for children ages 19 to 35 months was only 78 percent in 1996. A recent study places part of the blame on economic barriers to timely immunization. It shows that children are vaccinated later in the practices of providers who do not receive free vaccine supplies, those that tend to refer uninsured children to a public vaccine clinic rather than do the vaccinations themselves, and providers who over-interpret contraindications to vaccination. These findings provide support for the 1994 Federal Vaccines for Children Program, which provides free vaccines to providers and public clinics that immunize disadvantaged children.

Clearly, furnishing free vaccines to health care providers who care for disadvantaged children can increase immunization rates, assert Richard K. Zimmerman, M.D., M.P.H., of the University of Pittsburgh, and his colleagues. With support from the Agency for Health Care Policy and Research (HS08068), they interviewed 29 primary care physicians at HealthEast multispecialty group practices in Minnesota about their likelihood of immunizing a child in a particular clinical situation. They then correlated physicians' stated practices with actual immunization practices.

Significantly more children seen by providers who received free vaccines were vaccinated on time compared with children seen by providers who did not receive free vaccines (measles-mumps-rubella, MMR#1, 77 percent versus 48 percent; diphtheria-tetanus-pertussis, DTP#3, 84 percent vs. 71 percent; and DTP#4, 82 percent vs. 66 percent). Children seen by providers who were knowledgeable about the proper contraindications to vaccination were more apt to be vaccinated on time. For example, children seeing providers who were unlikely to give an MMR vaccine to a child with mild diarrhea (which is not a contraindication to vaccination) had vaccination rates for MMR#1 of 62 percent vs. 76 percent for providers willing to vaccinate such children. Fewer children seen by providers likely to refer an uninsured child to a health department for vaccination received MMR#1 on time than children seen by providers who were more likely to immunize uninsured children themselves (69 percent vs. 81 percent).

See "Are vaccination rates higher if providers receive free vaccines and follow contraindication guidelines?" by Dr. Zimmerman, Tammy A. Mieczkowski, Ph.D., and Matthew Michel, in the May 1999 Family Medicine 31(5), pp. 317-323.

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