GEORGIA: Welfare Denial Threat Raises Immunization Rate

      A Georgia policy that threatened to withhold welfare payments from low-income families unless their children received regular vaccinations significantly increased the state's immunization rate during the 1990s, according to a study in today's Journal of the American Medical Association. After the federal government encouraged states to test innovative welfare and public health programs in the 1990s, several states implemented programs linking childhood vaccinations to welfare receipt, the AP/Baltimore Sun reports. So far, only Georgia and Maryland have completed evaluations of the impact of those programs, and researchers discerned no corresponding increase in immunization rates in Maryland. The Cambridge, Mass.-based research firm of Abt Associates Inc. evaluated Georgia's program from 1993 through 1996 -- when the program was restructured as part of nationwide welfare reform -- examining vaccinations for DPT (diphtheria, tetanus and pertussis); poliovirus; MMR (measles, mumps and rubella); Hib (Haemophilus influenzae type b) and hepatitis B. The threat of welfare withdrawal, coupled with frequent reminders from caseworkers and public service announcements, helped make the program a success, and few Georgia families lost welfare benefits, study co-author David Connell said. "Families weren't unduly burdened by this requirement," Connell said. But many others, including Dr. Matthew Davis, a University of Michigan pediatrician, and Dr. John Lantos, a University of Chicago ethicist, who penned an accompanying editorial in today's JAMA, have contested the policy as unfair or unethical, . "The ethical stumbling block [for this program] ... rests in the fact that financial penalties for delayed immunization were threatened only to individuals already at high risk for economic deprivation," Lantos and Davis write. But because children from low-income families are at a greater risk of vaccine-preventable diseases, the study authors contend, "It is both a public health obligation to encourage low-income parents to have their children immunized for these diseases and a benefit to these families and to the public as a whole" (7/5).