Buy-in key to state’s strong vaccine rates

TOP RANKED: Dr. Elizabeth Lange, at Waterman Pediatrics in East Providence, administers a vaccine. Rhode Island ranked first in the U.S. for adolescent vaccination rates, according to the United Health Foundation.
TOP RANKED: Dr. Elizabeth Lange, at Waterman Pediatrics in East Providence, administers a vaccine. Rhode Island ranked first in the U.S. for adolescent vaccination rates, according to the United Health Foundation.

By ranking first in the nation for adolescent vaccination rates, Rhode Island bested other high-performing New England states – New Hampshire (second), Connecticut (third) and Massachusetts (fifth), according to the 2016 United Health Foundation’s America’s Health Rankings of Women and Children.

Overall, the United Health Foundation report, released in late September, ranked the state ninth-best in the nation for the health of women and children.

Dr. Ailis Clyne, R.I. Department of Health medical director, division of community health and equity, suggests several reasons for the state’s strong immunization rates: R.I.’s health department has direct and frequent contact with all medical providers; KIDSNET (a secure database of children’s medical information, including vaccines) is a resource for pediatricians and a universal vaccine-purchase program relieves providers of administrative burdens.

Under the program, pediatricians order vaccines online, the health department processes and sends these orders to the Centers for Disease Control and Prevention, which ships vaccines directly to pediatricians, said Tricia Washburn, DOH chief, office of immunization.

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A combination of assessments from fully-insured and self-insured insurance plans operating in Rhode Island, Medicaid and some CDC funds pay for the vaccine costs and the state’s administrative expenses of the program launched in the early 1990s in Rhode Island, she said.

By comparison, pediatricians elsewhere must negotiate with vaccine producers to buy vaccines and with insurance companies for reimbursement rates. Local pediatricians don’t have those burdens, said Dr. Elizabeth Lange, a pediatrician with Waterman Pediatrics in East Providence. “Our vaccine rates … are phenomenal and pediatricians are proud of [that]. Supply access is a big part of this.”

In Rhode Island, insurers are willing to pay upfront for vaccines, said Washburn, whose office works to provide low- or no-cost vaccines to the public and providers. That is an important element of health department Director Dr. Nicole Alexander-Scott’s vision of reducing health disparities for everyone, regardless of their zip code, said DOH spokesman Joseph Wendelken.

The health department’s Vaccinate Before You Graduate program collaborates with The Wellness Co. to hold school-based vaccination clinics to ensure all high school students receive their full array of recommended vaccines. Although it’s recommended children receive vaccinations and checkups from their pediatricians, occasionally school-based clinics are more convenient, said Washburn, who oversees 11 employees and coordinates the Rhode Island Vaccine Advisory Committee, which Lange chairs.

Those vaccines don’t come cheap; the DOH estimated that the cost for nearly all childhood and adolescent vaccines and program expenses for the fiscal year ending June 30, 2017, is nearly $18.6 million, covering nearly all of the approximately 211,000 Rhode Island residents who are 18 or younger.

But the National Conference of State Legislatures’ Immunizations Policy Issues Overview suggests the expense may be worth it: “According to the Association of State and Territorial Health Officials, every $1 spent on immunizations saves $16 in avoided costs.”

Lange called vaccines the “single most successful health-preserving medical development in the last century.” Almost two years ago, Waterman Pediatrics became a “vaccine-only practice,” committed to vaccinating all children, adhering to the CDC’s vaccine schedules.

Anecdotally, Washburn and Clyne could only recall a couple of outbreaks of vaccine-preventable illnesses in recent years: Meningitis at Providence College and chicken pox at the state’s Adult Correctional Institutions. In such cases, Clyne, Washburn and others often help with a vaccine clinic at the outbreak’s site. As is the case in most other states, vaccine exemptions exist: Parents may seek religious exemptions for specific vaccines or generally, requests that are far more common than medical exemptions that must be authorized for specific vaccines.

“Vaccines seem scarier than an illness” that we haven’t experienced, Lange said, but talk to your grandparents, who remember quarantines of kids with polio, or to someone with … cancer now. … With generations of good health, people may not realize vaccines’ benefits, yet complications from measles include ear infections, deafness, pneumonia and encephalitis, said Lange, a past president of the Rhode Island chapter of the American Academy of Pediatrics. •

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