Feds weigh in on "vaccine wars"

As the measles outbreak moved around the country in February, a Senate committee hearing could hardly have been more bipartisan in supporting efforts to combat trends toward leaving children unvaccinated.

The new Republican chair of the Health, Education, Labor, and Pensions Committee, Sen Lamar Alexander (R, Tennessee), decried the fact that in some California elementary schools vaccination rates are as low as in Chad or in South Sudan, even as the nation moves into new frontiers including personalized medicine.

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Top committee Democrat Sen Patty Murray (D, Washington) said that in “any cases where take-up rates are low, we are providing information and spreading awareness so that more people can be protected. The [human papillomavirus] vaccine is a great example. It prevents life-threatening cancers, including cervical cancer, which impact thousands of lives in the [United States] each year. Despite that, [the Centers for Disease Control and Prevention (CDC)] reports that take-up rates for the vaccine are still unacceptably low.”

Failing vaccination rates a concern

Testifying at the hearing, Mark Sawyer, MD, professor of clinical pediatrics and pediatric infectious disease specialist at the University of California San Diego, told the committee: “Pediatricians are concerned that the emergence of disease is a signal that bigger outbreaks are yet to come.” He said that in his opinion, the best way to decrease the number of families refusing to vaccinate is to improve communication about vaccine effectiveness and safety; increase the science literacy of the population; limit the philosophical exemptions for school entry requirements for vaccination; and continue to monitor the safety of all vaccines in use.

Anne Schuchat, MD, top immunization official at the CDC’s National Center for Immunization and Respiratory Diseases, told the committee there are indications that some of the “micro-communities” where many parents don’t vaccinate may be getting larger.

In her written testimony, she pointed to recent research in the journal Pediatrics that found these micro-communities come about because people who seek personal belief exceptions tend to live near each other: “We think these micro-communities are making it difficult to control the spread of measles and are making us vulnerable to having the virus establish itself in our country again.”

What all this agreement on the problem will mean for federal policy is another question.

The president’s recently released proposed budget for the CDC immunization effort is $560.5 million, which is a cut of $50.3 million in the current levels. The agency’s budgetary justifications note “Health insurance expansion will further increase access to immunizations . . . .”

Sen Susan Collins (R, Maine) said it was puzzling the administration would cut the program in the midst of a measles outbreak.

The CDC’s Schuchat said the cuts “Will be accounted for through a reduction in vaccine purchase. The idea is that instead of paying for vaccines for insured people the health departments will be able to bill the insurers so they will pay their way. But, absolutely, protecting the public health infrastructure at that state and local level is critically important, as is the communication outreach and the provider work that we do.”

Addressing antibiotic resistance

On the same day across Washington, the National Vaccine Advisory Committee (NVAC) was discussing, among other things, how to make vaccines part of the new push to combat the threat of antibiotic resistance.

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After reports from the CDC that antibiotic resistance causes 2 million illnesses and 23,000 deaths each year in the United States, President Obama has made it a national security priority. In his proposed budget, he calls for doubling funding to $1.2 billion for research, antibiotic stewardship, outbreak surveillance, antibiotic use and resistance monitoring, and other efforts.

At the advisory committee meeting, Larry Kerr of the National Security Council pointed out, for example, “The introduction of conjugate vaccines for [Streptococcus pneumoniae] led to decreases in drug-resistance infections as well as a marked decline in overall cases.”

Timothy Cooke, co-chair of the Vaccines Policy Advisory Committee for the Biotechnology Industry Organization, told the NVAC that the industry is pursuing vaccines as part of the solution to antibiotic resistance. However, he said, “Vaccine companies assess [antimicrobial resistance]-related targets based on the same criteria used for all vaccines and pharmaceuticals: scientific feasibility, cost/time to develop, medical need, treatment availability, market size, revenue, fit with existing portfolio/platform.”

A new report on moving forward with antibiotic-resistance efforts was expected soon from the administration. 

Ms Foxhall is a freelance writer in the Washington, DC, area. She has nothing to disclose in regard to affiliations with or financial interests in any organizations that might have an interest in any part of this article.