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A vote for a Vaccine Czar.

No one who knows me well would ever describe me as a political animal. As a registered Independent, I switch allegiances based on my gut response to a candidate's stated position, his voting record ... and, of course, his or her hairstyle and sartorial choices. When forced to choose based solely on the issues, I tend to side with those who claim that less government is better.

However, from time to time, this attitude of "just leave us alone and we'll sort it out ourselves" just doesn't work. A frightening example in which market forces and communal altruism have failed us is the current shambles we have made of our national vaccine program.

I had already begun to write this letter when Dr. Michael Pichichero's I.D. Consult column appeared in the February issue of PEDIATRIC NEWS ("Feds Should Help Bring Vaccines to U.S. Market"). He knows far more than I do about the details of how the system works and fails. And, he offers some rational solutions to at least some of the problems. But I can't resist the temptation to add my less knowledgeable and more emotional 2 cents' worth to his observations.

First, let me restate his frustration and concern about the current state of our vaccine supplies. While I admit that when it comes to remembering PIN numbers and passwords, age has taken its toll on my memory, I think I still qualify for a "pretty sharp" rating in most categories. But I have thrown in the towel when it comes to keeping up to date with the latest recommended vaccine schedule and its many addenda.

I now rely totally on our nurses to compare the patient's immunization records with the newest guidelines and our fluctuating vaccine supply and then come up with the best fit. The process is so time consuming for our clinical staff that I routinely room more than 50% of my patients. The patients and their parents may at times be flattered when the doctor summons them from the waiting room himself. And it does add a bit more of a homey quality to our medical home. But clearly it is not the most efficient way of providing medical care.

Vaccine costs and the inscrutable, unscrupulous, and variable reimbursement practices of the third-party payers has left us gun-shy when it comes to adding .new vaccines to our offerings. We stay clear of the cutting edge of vaccine technology to avoid being shredded to ribbons and left holding a very expensive bag of immunizations. As someone who remembers when Haemophilus influenzae meningitis sat at the top of the rule-out diagnoses for a young child with fever, the Hib vaccine shortage makes me very nervous.

It is clear to even the less-government-is-better folks like myself that the federal government must step into the arena and ensure that vaccines are not only safe, but available. It must also create and maintain sufficient financial incentives to keep the private sector enthusiastic about vaccine research and development.

Regardless of whom we elect this November, the year 2009 should provide an excellent opportunity for change. Dr. Pichichero's recommendations take advantage of the current system, but I think we need to think bigger. Let's raise vaccine supply and safety issues to the cabinet level.

It's time for a Vaccine Czar, a Godfather (or Godmother) of Immunization. Someone who has the president's ear every day. Someone armed with a sharp knife that cuts red tape like warm butter. Someone who carries a big stick to whack the kneecaps of the insurance companies. And someone with an ample supply of carrots to keep the pharmaceutical companies drooling for the profits of newly developed vaccines.

I fell under the spell of Obama Charisma many months ago, but I think any of the top candidates can be convinced that vaccine supply is a critical issue. We just need to start yelling louder and they'll hear us.


DR. WILKOFF practices general pediatrics in a multispecialty group practice in Brunswick, Maine. Write to Dr. Wilkoff at our editorial offices (
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Title Annotation:Letters From Maine
Author:Wilkoff, William G.
Publication:Pediatric News
Date:Mar 1, 2008
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