Recollected in tranquillity, his tenure as secretary of health, education and welfare seemed to Joe Califano to have been an almost unbroken chain of controversies. But it was not entirely so:
"For every dollar spent on polio vaccine, our society saves $90 in (health care and rehabilitation) costs, the highest cost-benefit ratio of any public health program. . . . There isn't much controversy about even the most aggressive attempts to immunize children against the childhood diseases."
Today, however, there is controversy about almost everything, even about what it is that people are disagreeing about. For example, at his press conference last week President Reagan showed unusual pique when complaining, with obvious sincerity, about accusations that his budget is unfair to the poor. He said:
" . . . (i)n an editorial in the paper this morning, that struck at us because they said that we were--had less money for vaccinations for children and therefore there was going to be more sickness and perhaps more child death. Well, what they didn't see was that we had--we actually have more money in for that program than we've had for others."
What the editorial (in The New York Times) said was:
"Washington pays to immunize children against dread diseases. In 1981, the total was 6.3 million children. The 1983 budget would vaccinate only 3.8 million."
If the president was asserting that his fiscal 1983 budget calls for more dollars for immunization than the fiscal 1982 budget, he was correct. But the Times was correct enough.
In fiscal 1981, spending for immunization was $30.9 million. That funded immunization of 6.3 million children, about 40 percent of all children immunized that year. In fiscal 1982, funding declined to $28.3 million. The fiscal 1983 budget stipulates $29 million. But at this level, the number of immunizations will be substantially reduced-- perhaps halved.
The cost of vaccines is soaring. Only about half the nation's children are immunized by private doctors. And the most expensive publicly funded vaccinations are disproportionately for poor children, who must be tracked down. Thus cutbacks in immunizations will have a regressive policy effect: there is apt to be more sickness, especially among poor children.
The seven infectious diseases include polio (which can result in paralysis), measles (one in 1,000 cases involves encephalitis, which can produce death or brain damage), rubella (German measles, which can produce birth defects when it strikes a pregnant woman), mumps, whooping cough, diphtheria and tetanus. Studies demonstrate an inversely proportional relationship between the amount of funding for control of diseases such as polio and measles and the incidence of these diseases.
In 1952, there were 21,000 cases of polio. Last year there were six. Before the development of the measles vaccine, almost every child had measles by age 15. Because of federally supported immunization there was a 90 percent decrease between 1966 and 1969. Then, because of decreased federal funding, there was a threefold increase by 1971. Today the disease is 99 percent conquered. New York City has more muggings per day than it has cases of measles per year. For less than the cost of one hour of Social Security ($17 million), measles could be eliminated in America by the end of this year. Instead, the disease may make a comeback.
By requiring immunizations before children enter school, all 50 states acquire a moral obligation to make vaccinations available to the poor. States should increase their spending to compensate for federal insufficiency. But many will not, and communicable diseases do not respect state lines.
Of course parents should not be complacent, or thrifty in ways that jeopardize their children's health. But federal policy should not jeopardize children who were careless when choosing parents.
Immunization is a government program that works, spectacularly well. It is a facet of government's greatest achievement of this century, the public health improvements that have bred complacency about numerous diseases that, until a few generations ago, killed millions and terrified everyone else.
As a result of the last rubella epidemic, there are 30,000 children who will require $2 billion in special care. Conservatives understand that there are occasions when governments must arm in order to disarm; they should understand that sometimes governments must spend in order to restrain future spending. A challenge for conservatives is to prove that government can be hardheaded without being hardhearted.
A niggling attitude about vaccinations does not help. Rather, it helps those who say conservatives think protectable human life begins at conception and ends at birth.