January 1, 1993, when a bill unrelated to the NVICP but containing language that would have extended the tax was vetoed by President Bush. The trust fund into which the excise taxes were paid had a balance of about $620 million at the beginning of 1993.

It is too early to assess the program's impact on future cases of liability against individual manufacturers, and it is not entirely clear that the compensation program is having the desired impact on the number of vaccine manufacturers in the business (see Appendix B). Despite the apparent drop in vaccine-related lawsuits and despite the increased activity in vaccine-related R&D (see Chapter 4), none of the companies that dropped out of vaccine manufacturing in the United States in the 1970s and 1980s have returned. However, as noted in Chapter 4, foreign companies, many of whom have traditionally shied away from the U.S. vaccine market, appear to be readying themselves to enter the U.S. market, either by applying for FDA licenses for their products or by entering into alliances with other companies and entities that currently hold U.S. product licenses.

American Academy of Pediatrics. 1993. Childhood Vaccine Act. January. Washington, D.C.

American Law Institute. 1992. Principles of Corporate Governance. March 31. Philadelphia.

Clinton WJ. 1993. Statement at the Fenwick Center Health Clinic, Arlington, Virginia. February 12.

DeBrock L. 1983. The Domestic Vaccine Industry: The Economic Framework. Paper presented at the Institute of Medicine Conference on Barriers to Vaccine Innovation, November 28–29. Washington, D.C.

Douglas GR. 1992. Testimony before the Senate Subcommittee on Appropriations. Childhood vaccine research and development issues. April 8. Washington, D.C.

Douglas GR. 1993. Testimony before the Senate Labor and Human Resources Committee and the House Subcommittee on Health and the Environment. April 21. Washington, D.C.

Freeman P, Robbins A. 1991. The elusive promise of vaccines. The American Prospect. Winter:80–90.

Institute of Medicine. 1985. Vaccine Supply and Innovation. Washington, D.C.: National Academy Press.

Institute of Medicine. 1986. Proceedings of a Workshop on Vaccine Supply and Innovation. Report for the Subcommittee on Oversight and Investigations of the Committee on Energy and Commerce. U.S. House. August. Washington, D.C.

Institute of Medicine. 1992. Proceedings of Working Groups on The Children's Vaccine Initiative: Planning Alternative Strategies Towards Full U.S. Participation. June. Washington, D.C.

Katz S. 1993a. Could the childhood vaccine act be bad? Letter to the Editor. Pediatrics 91:160.

Katz S. 1993b. Testimony before the Subcommittee on Access to Immunization Services, National Vaccine Advisory Committee. A Public Hearing on the Economic and Commercial Underpinning of Vaccine Supply, February 24, Bethesda, Maryland.

Koop CE. 1993. In the dark about shots. February 10. Washington Post, p. A21.