Thirty years ago today, President Clinton signed the Omnibus Budget Reconciliation Act of 1993, and the Vaccines for Children (VFC) program became law. VFC was a direct response to a concerning resurgence of measles—a threat thought to be nearly conquered by the late 1980s. Between 1989 and 1991, however, the United States saw an estimated 55,000 measles cases, mainly concentrated among low-income children in urban areas. Many of these children had seen a health care provider, but a pervasive barrier stood in the way of their access to protection—money.
To this day, VFC is a bulwark against contagious and potentially fatal diseases for the most vulnerable. The program provides vaccines at no cost for Medicaid-eligible children, uninsured and underinsured children, and American Indian or Alaskan Native children. VFC covers childhood vaccines recommended by the Advisory Committee in Immunization Practices (ACIP). The key, says Sara Rosenbaum, VFC’s original visionary and a former ACIP member, “is that the entire vaccination system for low-income children was put under a well-designed system for actually putting free vaccines where the children and providers were, so there would be no missed opportunities.”
Our story unfolds with a dazzling cast of characters. We interviewed Amy Pisani, CEO of Vaccinate Your Family, to gain a firsthand account of the work done by her forebears, late Arkansas Governor and U.S. Senator Dale Bumpers, Arkansas First Lady Betty Bumpers, President Jimmy Carter, and First Lady Rosalynn Carter.
We also interviewed the primary architects of VFC: Sara Rosenbaum, Emerita Professor of Health Law and Policy at The George Washington University, Timothy Westmoreland, Professor Emeritus at Georgetown Law, and Ruth Katz, vice president of the Aspen Institute, executive director of its Health, Medicine & Society Program, and director of Aspen Ideas: Health. Finally, we spoke with former HHS Secretary Donna Shalala. Their combined stories paint a picture of efforts that preceded VFC and the policymaking that led to its creation. They also testify to the program’s extraordinary societal value and the determination of the individuals who brought it from idealistic vision to reality.