Latino kids focus of hepatitis debate

By Aurelio Rojas -- Bee Staff Writer
Published 2:15 a.m. PDT Sunday, July 14, 2002

Rebuffed twice in its effort to make the hepatitis A vaccine mandatory for children entering California schools, drug giant GlaxoSmithKline has inched closer this year by focusing its efforts on Latino children and legislators.

The strategy has included funding a $50,000 study by the UCLA Center for the Study of Latino Health and Culture, which found epidemic rates of the disease among Latino children in Southern California. The virus is usually mild in children but can seriously affect adults.

Now a measure is moving through the Legislature that would require children in seven Southern California counties with large Latino populations to receive the vaccination before being admitted to kindergarten. Never before has the Legislature made a vaccine mandatory for schoolchildren in one geographic area of the state.

The UCLA findings are cited by supporters of the mandatory vaccination but are disputed by the state's latest statistics, which show historically low rates of hepatitis A throughout California.

GlaxoSmithKline has been a generous campaign contributor in the Capitol, giving at least $234,550 to members of both parties in the past two years alone.

Latino members of the Legislature have introduced a mandatory hepatitis A vaccine bill in each of the past three years. And Latino legislators have received a significant share of the money from GlaxoSmithKline.

As its focus on Latinos has intensified, the leading manufacturer of the vaccine used in public health also has contributed money to new candidates with ties to the 22-member Latino Caucus and a Latino political action committee.

The company did not sponsor the current measure -- Assembly Bill 915 -- as it did similar bills in the past. Instead, the latest bill is sponsored by the Latino Issues Forum, a San Francisco-based advocacy group that received $20,000 from GlaxoSmithKline to hold a community health care forum this year.

Efforts to make the vaccine mandatory statewide were scaled back amid opposition in the Senate Health Committee, which killed a similar bill last year. AB 915 faces its next hurdle Aug. 5 in the Senate Appropriations Committee.

Assemblyman Dario Frommer, D-Glendale, said he introduced the bill after consulting with health and community officials and reviewing the UCLA study.

Frommer said he was unaware the study was funded by GlaxoSmithKline. But he said he still believes the vaccine should be mandatory because Latinos have less access to health care than other ethnic groups.

"What persuaded me was the Latino Issues Forum's health forum, where we heard about the high rates of infection among Latino children," Frommer said. "It was not that someone from GlaxoSmithKline came to me and said, 'We're going to help you, and you help us.' "

Ramona DuBose, a spokeswoman for GlaxoSmithKline, said the UCLA study shows rates of "hepatitis A in epidemic proportions in California."

"Our only interest is in providing medicines that will help people," she said. "And in this particular case, we're looking at a serious illness that can devastate whole families."

Medical and public health officials, however, are divided about whether the vaccine should be mandatory. The California Medical Association, which represents about 34,000 physicians in the state, supports the measure.

The California Conference of Local Health Officers, which represents physicians who run the local communicable disease departments, opposes it. The rate of the disease has been declining since the vaccine was introduced on a voluntary basis in 1995, the organization says.

The complexity of the issue has raised concerns among health officials about whether the Legislature -- where money often drives agenda -- is the best forum in which to make science-based decisions.

Spurred by advances in biotechnology, California has mandated three other vaccines since 1994. Most experts agree vaccines are safe. But a growing number of parents and activists believe there is a correlation between increased rates of asthma, diabetes, allergies and autism in children and the increasing number of vaccines.

Critics argue the state is requiring too many vaccines too fast without weighing the accumulated risks.

Supporters of the hepatitis A vaccine maintain it would stem the spread of one the most common viral infections in the world. While most children who contract the virus do not feel any symptoms, they can pass it on to adults who can suffer permanent liver damage. The virus is spread by human feces or contaminated water or food.

Raquel Donoso, health policy director for the Latino Issues Forum, dismisses anti-vaccine sentiment as an "upper-middle-class movement."

"It's not an issue for working-class Latinos," she said. "We want our people to be vaccinated, and we want access to health care."

The state Department of Health Services has not taken a position on the legislation. But officials say the UCLA study masks the facts that the rate of disease has dropped dramatically and that the incidence among Latino children is approaching the level of non-Latinos.

"We could be at the bottom of a seven- to 10-year cycle, or we could be on our way to eliminating hepatitis A in California," said Celia Woodfill, acting chief of the department's Surveillance, Investigations, Research and Evaluation Section.

State officials say the reasons for the drop are a mystery and may be due, in part, to the voluntary use of the vaccine.

The bill would make the vaccine mandatory in Los Angeles, Orange, Riverside, San Bernardino and San Diego counties. Ventura and Imperial counties, which were not part of the UCLA study, have recently been added to the measure. State law exempts parents from requirements to vaccinate their children if they file an affidavit stating that immunization is contrary to their beliefs.

Dr. David Hayes-Bautista, director of the UCLA Center for the Study of Latino Health and Culture, acknowledges that hepatitis A rates are dropping. But he denies the center's study is misleading.

Hayes-Bautista said the study averaged rates in the five-county area between 1996 and 2000 because the method provided a more accurate picture of the cyclical nature of the "volatile" disease. The study found infection rates of 36 per 100,000 Latino children 14 years and younger.

The federal Centers for Disease Control and Prevention recommends routine vaccination of children against hepatitis A in states with an infection rate of 20 per 100,000.

But according to state statistics, the infection rate in the five counties measured in the UCLA study was nine per 100,000 Latino children in 2001 -- a level below the overall national rate.

Hayes-Bautista said 2001 rates were not available when the center conducted its study. Southern California counties, he said, still have a very high rate of the disease if the new numbers are factored in over a six-year period.

"It's a difference of interpretation," Hayes-Bautista said. "Do you want to use a one-year study or a six-year study?"

He said the center chose the long-range methodology, employing a formula the CDC uses to measure communicable diseases. He denied the findings were influenced by the contribution the center received from GlaxoSmithKline.

"When we were approached by GlaxoSmithKline, we didn't know what the trend was going to be, and we told them we would publish what we found," he said. The center, he noted, followed research protocol by publicly disclosing that the company funded the study.

Hayes-Bautista acknowledges that making the vaccine mandatory is a "judgment call." But he said he supports the bill, which health officials estimate would require an estimated $2.7 million from the general fund in the coming year.

Deborah Ortiz, chair of the Senate Health Committee, said the state's $24 billion budget shortfall may doom the measure this year.

Ortiz, D-Sacramento, said she voted for the bill despite misgivings "because you cannot ignore the high rates of hepatitis A in Latino children."

But she has concerns about whether the legislative process is the proper forum to shape the state's immunization program.

"I think we need the state Department of Health Services to tell us what vaccinations we should require," Ortiz said.

Department spokesman Ken August said the department offers legislators "technical assistance." But he said it does not recommend how legislators should vote because bills are subject to many amendments.

Dawn Winkler, head of California Vaccine Awareness, an anti-vaccine group, said the Legislature is the wrong place to decide such issues.

Winkler said vaccines are a "warm and fuzzy issue" that tug at legislators' hearts as pharmaceutical companies are filling their coffers.

"Here we are trying to mandate this medical procedure, and you have this political influence and money being passed around," she said.