AAP: The vaccine management crisis: a pediatrician’s bill of rights

October 14, 2008

In assessing the current state of vaccine management in the pediatrician’s office, Stuart Cohen, MD, did not mince words.

In assessing the current state of vaccine management in the pediatrician’s office, Stuart Cohen, MD, did not mince words.

“The system is broken,” he said. “The bottom line is that there are no quick and easy solutions.”

Cohen, from the University of California San Diego’s School of Medicine, highlighted current problems the system. He touched on vaccine pricing and purchasing; universal purchase programs, mandates, and related federal solutions; vaccine coding and payment; negotiating with managed care companies; and the dilemma of vaccine refusers.

Cohen said that there is a need for a billing infrastructure to bill private third-party health plans for allowables, as well as to institute appropriate firewalls and accounting for the Vaccines for Children (VFC) program versus the Section 317-funded vaccine program. In addition, there should be more robust 317 appropriations, or expansion of VFC to underinsurers, he said.

Given the crisis that pediatricians face in vaccine management, Cohen has devised a Pediatrician’s Bill of Rights that defends specific freedoms he feels are being trampled. These rights include:

• The right to refuse a vaccine refuser, under certain conditions
• The right not to split, delay, or miss shots, or deviate from standard community pediatric practice
• The right to ignore vaccine agendas and dictums that go against core pediatric scientific beliefs
• The right to practice the pediatric profession without interference from interest groups
• The right to promote the science of public health (including routine childhood immunization) without fear of retribution from anti-science groups
• The right to change policies and practices on childhood immunization based on newly validated research at any time
• The right to refrain from offering durable goods and vaccines to patients when acquisitions and overhead costs exceed contractually agreed-upon payments, and when good-faith negotiations fail to provide injunctive relief