Missing the point 

Ask county health board president Dr. John Burrington about swine flu, and he sounds slightly irritated as he refers to "irrational" fears and "hysteria." Yes, a vaccine for the virus is still being developed, he explains, but the simple fact is that swine flu hasn't yet proven as deadly as the seasonal flu virus that pops up each fall.

Compare that to an illness like measles. Burrington, a retired pediatric surgeon, remembers treating children with brain swelling and other serious complications during outbreaks in the late 1960s.

"Measles is quite a deadly disease," he says dryly.

And while few Americans now worry about measles, Burrington is concerned that the immunization program that has proven effective at controlling it and other fearful diseases is fraying at the edges.

In simple terms, doctors often lose money administering vaccines. So locally, Burrington says, doctors are sending more patients to the worn backstop provided by the El Paso County Department of Health and Environment.

The health department delivered nearly 11,000 doses of different types of vaccines in 2007, the last full year for which data is available. Burrington worries that increasing demand for vaccinations at the health department could push that number much higher, creating a vaccination bottleneck as children return to school in August.

That could be dangerous, he says, if vaccination rates start falling. To block the spread of diseases like measles, Burrington explains, we need "herd immunity," or immunity in about 80 percent of the population.

Since vaccines don't give immunity every time they are administered, vaccination rates don't have to drop far before outbreaks are possible.

"It's a statistical craps game," Burrington says.

Money loser

Dr. Bruce MacHaffie, a pediatrician who chairs the El Paso County Medical Society's school health advisory committee, sees administering vaccines as less a gamble than a guaranteed money loser.

Start with the vaccines' hidden costs, which insurance companies don't cover: syringes, a commercial refrigerator, insurance to cover losses if and when the refrigerator breaks. Add in regular price jumps in vaccine costs, and a three- to six-month lag before insurance companies catch up.

"They never retroactively increase their price," MacHaffie says. "Therefore, we [as private physicians] have to give these vaccines at a loss."

The story gets worse when you start talking about specific types of insurance. MacHaffie has some patients covered by the military's TRICARE insurance plan, which pays a fixed rate for vaccines. While he can make the numbers work to protect against most diseases, he loses $10 to $15 every time he gives a shot for chickenpox or the MMR (measles, mumps and rubella) vaccine. So it just makes business sense for him to recommend that families with TRICARE, often from Fort Carson, receive these immunizations from a clinic on post.

Then there are patients from families with high-deductible insurance plans that don't cover immunizations. MacHaffie estimates he and the two pediatricians he works with might see a dozen such patients each month.

These are the people he suggests visit the health department. Its vaccination clinic is intended for families without a doctor and who are either uninsured or underinsured. It costs about $280,000 to administer this vaccination program; while the federal Vaccines for Children program picks up the costs of the vaccines themselves, the county does have to supply some money for those hidden costs mentioned above — recently about $42,000. The $14 administration fee it charges patients helps cover other costs associated with things like paperwork and supplies.

"The way these insurances are going," MacHaffie predicts, "we may be seeing more of these."

No tracking data

Dr. Bernadette Albanese, the health department's medical director, says she has no "hard data" showing whether the department is immunizing an increasing number of patients who, like those MacHaffie has seen, have insurance and a doctor.

"That may be something we decide to look into and track," Albanese says.

Statewide, about 80 percent of kids starting kindergarten each year are up to date with vaccinations for everything from two forms of hepatitis to polio to measles. With parents just now beginning to bring in their immunization records to register their children for a new year, it's too early to say what the numbers will look like this year.

This week, the El Paso County health department's immunization clinic was fairly busy, with the next available appointment about a week out.



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