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Critical audit imperils free vaccine program

Republican members of Congress say they intend to dismantle a federal program that distributes free vaccine to millions of children after a new report from congressional auditors found that the program was misconceived and mismanaged.

Even congressional Democrats say the program known as Vaccines for Children _ which had its share of skeptics when it was unveiled in 1993 _ must be radically changed or it will not survive.

President Clinton and his wife, Hillary Rodham Clinton, have cited the program as a prime example of what the government should be doing to promote public health.

After reading the report from the GAO, Sen. Dale Bumpers, D-Ark., said in an interview: "I would be perfectly willing to abolish the Vaccines for Children program and start all over again. It's been an unmitigated disaster from its inception. It proceeded on an absolutely false assumption, that cost was the big barrier to immunizations. We have study after study that shows cost is not a barrier."

The audit by the GAO, the investigative arm of Congress, was requested by Bumpers and by Reps. Scott L. Klug, R-Wis., and Ron Wyden, D-Ore.

Klug said: "Immunizing children is an important national priority, but I don't think you need a government vaccine-purchasing program to do it. This is the most bizarrely managed, poorly conceived government entitlement program there has ever been."

Clinton persuaded Congress to establish the program in 1993 by arguing that vaccine manufacturers were pursuing "profits at the expense of our children."

The program provides free vaccine against such diseases as measles, mumps, polio and whooping cough to children 18 and younger who are eligible for Medicaid, have no health insurance or have private insurance that does not cover vaccine. The government expects to spend $457-million on the program this year.

The program replaced an assortment of federal and state initiatives that provided vaccines under Medicaid, the Public Health Service Act and various state laws.

Drug companies and other critics said that it was based on faulty assumptions and that the government was ill-prepared to run such a huge enterprise.

After a yearlong study, the GAO said it "did not find sufficient evidence to conclude that the cost of vaccine for parents has been a major barrier to children's timely immunization." It also said:

The government's record-keeping systems are so poor that "it cannot distinguish between the number of children immunized and the number of doses of vaccine distributed."

The government cannot detect fraud, waste or diversion of vaccine.

The government "has no way to insure that Vaccines for Children is reaching the target population."

Dr. David Satcher, director of the federal Centers for Disease Control and Prevention, said, "We are not in agreement with most of the criticisms in the GAO report." He said the program had problems, but said, "We are well on our way to surmounting every hurdle."

The Children's Defense Fund, the American Academy of Pediatrics and some state officials are fighting to preserve the program.