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Maxwell Finland Award 1 995 Recipients MaxwellFinland Award Recipients 1995 -l or 25 yearsthe husband and wife vaccinationwent up, measlescases went team of Dale and BettyBumpers down.When funding fell, the cases went have worked together to build up." FormerCDCofficial Dr. BillWatson protection against infectious notesthat "you could track immuniza- childhooddiseases. tion levels in the country by what was "ft was in 1971 when my husband happeningto the federalfunds.,, wasgovernor of Arkansasthat I reallygot Mrs.Bumpers pursued her cause with interestedin children'simmunization,,, other stategovernor's wives. One was Mrs. Bumpersrecalls. The Centersfor RosalynnCarter whose husband was the DiseaseControl and Prevention(CDC) governorof Georgia.So, in 1977, when just had askedall stategovernor,s wives the Carterscame to Washingtonas presi- to participatein childhoodimmuniza- dentand first lady, Mrs. Bumpers moved tion effortsfor the childhoodvaccines quicklyto takeadvantage of this. that were becoming available.Cam- paignsfor immunizationagainst polio- myelitishad been developed in the i 960s whenmeasles vaccine was also licensed. '/AIm ost singl ehandedIy, A few yearslater came protection against mumpsand rubella. Betty Bumpers was As the state'sfirst lady and a board memberof the Arkansasvisiting nurse responsiblefor the association,Betty Bumpers set up a model remarkable improvement systemto immunizechildren. ,,1 made it my caLlse,"she says. As she pursued this in immunization levels vigorously,the immunizationrates in Arkansaschildren rose. against childhood diseases Shelearned how to work with public in the United States.,, healthofficials, and discovered that get- ting politicalcircles interested was the keyto galvanizingprograms. Theseles- Shewent to Mrs.Carter and, accord- sonsstood her in good steadwhen she ingto Dr.Alan R. Hinman, former direc- cameto Washingtonin 1975 asthe wife torof theimmunization division at CDC, of thenewly elected senatorfrom Arkan- shesaid to thefirst lady:',you know it,s sas. a cryingshame that the childrenin this It ishard today to appreciatewhat the countryare not well-immunized.r,Mrs. attitudetowards preventable childhood Carteragreed and mentionedit to her diseaseswas 20 years ago."ln fiscalyear husband.He in turncalled it to the atten- 1976,the budget for immunizationwas tion of hissecretary of health,education reducedto $4.96million from 96.2 mil- andwelfare, Joseph A. Califano,suggest- lion," recallsDr. WalterA. Orenstein, ing the secretarymight do something nowdirector of CDC's National lmmuni- aboutit. zationProgram. "We were in the midst Mr. Califanois not a man to ignorea of a majormeasles epidemicwith over goodidea, especially when it com-esfrom 57,000cases." his president.The resultwas the Child- lmmunization ofchildren had notbeen hood fmmunization lnitiative of 1977. organized, and i nterest wasconcentrated Theprogram had nruo targets : the firstwas on eachnew vaccine as it appeared.Dr. to raiseto 90 percentthe immunization Orensteinrecalls: "We had datawhich levelsin schoolchildren, and the second showedthat as federal funds for measles was to put in place a mechanismto maintainthose levels. The Carter admin- levels.Mr. Califanolikes to tell how his istrationincreased federal funds to about daughterwas once sent home from school $13 million."To us it seemedan incred- beciuse she did not have an adequate ibleamountof money," says Dr. Hinman. recordof immunizations. Almostsi nglehanded ly, continues.Dr' Buttheseregu lations were not enough. Hinman,Befty Bumpers was responslDle Therewas no mechanismto assurethat for the remarkableimprovement in im- childrenunder the ageof five were also munizationlevels against childhood dis- protected.In 1989 measlesstarted in- easesin the United States. creasingagain. By 1990there was a full- blown epidemic. Caseshad risen from 1,500 in 1983 to almost28,000.By.l 991 , over55,000 cases, including 160 deaths, "When Dale BumPers were reportedto the CDC' Nearlyhalf of came to Washington in thesecases occurred arnong pre-school childrenwho had not beenimmunized. 1977, he made childhood The lessonwas clear.lf vaccineprevent- reduced,a pro- one of his able diseaseswere to be immunization grannhad to be setup to immunizethese priorities. He convinced youngsters. his congressional colleagues that vaccines "No two peoPlehave were cost'effective." influenced the effort to immunizechildren more Meanwhilethe senatorwas also play- than the senatorand BettY ine a vital role. When Dale BumPers Bumpers,whether it's cir" to Washingtonin 1977,he made childhoodimmunization one of his pri- through political orities.He convincedhis congressional colleagues that vacci nes were cost-effec- leadership,interesting the tive, alcording to one of his formerstaff right groupsor in getting assistants,Melissa Skolfield. For every dollarspent there was $10 or $15 saved peopleto work together prevent- on the medicalcosts of treating goal." able illnesses.Senator Bumpers got fed- towardsa common eral grantsfor stateoutreach progra.ms, whic-hwere funds to enablestates to hire of clinic nursesand to help buy vaccines. InJanuary 1991, the then-chairman While the senatorpushed funding in the NationalVaccine Advisory Commit- to the Congress,Betty Bumpers, alongwith Mrs. tee,Dr. VincentA. Fulginiti,went with a report Cart6rand the governor'swives network, assistantsecretary for health preschool wasworking to getall 50 statesto require that spelledout the barriersto per- that childrenbe vaccinatedby the time immunizationsuch as insufficient too few thev enteredschool. This mechanism is sonnel,limited clinic hoursand gS pointedout still in placetoday, and becauseof it clinic locations.The report perceniof our childrenare immunized that 80 percentof measlescases among to five years bv the ase of five and vaccine prevent- childrenaged 16 months had able dis6aseshave sunk to recordlow could have been preventedif they beenimmunized in a timely manner.So, ryay.of increases,"his wife comments, that same year, public health officials "but he neverletthe levelof fundsdrop.i, mounteda majorcampaign to deal with "No two people have influencedthe missedopportunities for protectingchil- effort to immunize children more than dren, creatinga demand for preschoot the senator and Betty Bumpers,,,Dr. immunization. Orenste.insums up, "whetherii,s through . Betty Bumpersand RosalynnCarter, political leadership,interesting the rig-ht who were also aware of the situation, groupsor in geftingpeople to work to- mounteda parallelcampaign entitled gethertowards a common goal.,, EveryChild by Two. Thisdrew attention to the need;enlisted the help of national t'Here's and..local organizations;encouraged a US senator who healthcare providers; and promotedia- tionaland localprograms to institution- hasso many things for alizethe immunizationof everychild by which he is responsible, the age of two. "What's going to save us are local and yet he hasmade healthworkers, both public and private, who areout in the field and doingtheir himself into a technical jobsas besttheycan," says Dr. Orenstein. expert on immunization. "When Mrs. Bumpersvisits them and tells them that what they are doing is He really understands the important,it stimulatestheir interest ind immunization theyfeel their efforts are being rewarded. program Shehas been invaluable." andissues....lt,s Dale Bumpers'grasp of the subject ,,Here,s impressesDr. Orenstein. a US invaluable having senatorwho hasso many things forwhich someone he is responsible,and yet he hasmade that himselfinto a technicalexpert on immu- knowledgeable in nization.He reallyunderstands the im- munizationprogram and issues.I can the Senate.rl talk to him as if he were a professional colleague.lt's invaluablehaving some- one that knowledgeablein the Sinate. By keepinghimself informed, Senator Bumpershas made . "You have to respectwhat he says it easierfor public about immunization.lt is alwayswell healthofficials to discussissues with him. thoughtthrough. He doesn,tshoot from It has also paid off with his political the hip and he's innovative."For ex- colleagues.What SenatorBumpers says ample,the senatordeveloped a program on immunizationcontinues to be lis- whereinstates are awarded money blsed tenedto with respectby both sidesof the on how well they immunizetheir chil- aisle. dren.The bettertheydo, the more money - Accordingto BettyBumpers, being a thev earn. tormergovernor's wife and a senatorial fhere wasless enthusiasm for funding spouse"gives you credibility.This helps immunizationwhen RonaldReagan and a greatdeal. Most first ladiescatch on CeorgeBush were in the White House. veryquickly and thoroughly enjoy spon- ButSenator Bumpers neverstopped work- soring a good program that especiaily ingfor chi ldhood immu n ization.,,tn those benefitschildren-and there are no nega- yearshe maynot havegotten much in the tivesto that in the Senrate," A.
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