The global effort to find a coronavirus vaccine races forward at a feverish pace. Once again, we await biomedical science to come to the rescue.
Over the course of history, biomedical scientists have developed vaccines to reduce the spread of numerous diseases associated with viruses and bacteria. Today, starting at an early age, young children receive vaccinations to address acellular pertussis (whooping cough), chickenpox, diphtheria, hepatitis A, hepatitis B, influenza, measles, mumps, and rubella. These vaccinations staggered across the first two years of life protect children from infection and the broader society from outbreaks.
With the pandemic tracking across the United States and states seeking to protect its residents from the effects of COVID-19, what effect have safety measures had on childhood vaccinations?
After the United States declared a national emergency on March 13 due to the COVID-19 pandemic, federal and state jurisdictions implemented social-distancing strategies and quarantine policies to alleviate it. In a recent report, the Centers for Disease Control and Prevention (CDC) evaluated the impact of the pandemic on child vaccination coverage using data from the Michigan Care Improvement Registry. More specifically, the evaluation examined children at milestone ages of 1, 3, 5, 7, 16, 19, and 24 months. The report compared non-influenza vaccine rates for children less than 18 years old and children less than 24 months old during the period of January 2020 to April 2020 to the same time period and months in 2016 to 2019.
The CDC study demonstrated that vaccination coverage rates decreased in the state of Michigan within the milestone age groups of 1, 3, 5, 7, 16, 19, and 24 months with the lone exception of birth-dose hepatitis B, which is often given to children when they are born in hospitals.
For 5-month-old children, up-to-date status for recommended vaccines in May 2020 was 49.7 percent, while from 2016 to 2019, the rate ranged from 66.6 percent to 67.9 percent. For 16-month-olds, vaccination coverage for measles declined from 76.1 percent in May 2019 to 70.9 percent in May 2020. Non-influenza vaccine coverage rates decreased by 21.5 percent for those 18 years and younger, while for children 24 months and younger, coverage has decreased by 15.5 percent from January 2020 to April 2020 alone.
Furthermore, children of the milestone age groups enrolled in Medicaid have less vaccination coverage than those not enrolled. For example, for children at 7 months, 34.6 percent of those enrolled in Medicaid were covered, in contrast to 55 percent of those not enrolled.
This study of Michigan informs our local region as we consider the impact of COVID-19 on non-pandemic-related health services. During the period of stay-at-home orders, many health care providers shifted to telemedicine practices. However, services such as vaccinations and immunizations require face-to-face interactions. Therefore, access strategies to make this process as safe as possible warrant consideration.
The CDC calls for immunization services to include dedicated clinics, rooms or buildings for sick patients, and distinct access strategies for those seeking immunization and other non-COVID-19 related health care services. In addition, the CDC recommends reducing the number of patients in facilities; shutting down waiting rooms and registration areas; allowing patients to check in by phone; and securing vaccinations in automobiles in on-site parking lots.
Other recommendations include using patients’ electronic health records to inform family outreach; to identify children missing recommended vaccinations; and to communicate infection control measures employed to keep children and families safe and informed.
As these practices roll out over the days and months ahead, it is important that families secure vaccinations. Our fight to limit the spread of one virus should not ignite an outbreak of another disease.
The Michigan study suggests observed declines in vaccine coverage might place youth and communities at higher risk of vaccine-preventable diseases such as measles. Herd immunity requires vaccine coverage of 90%-95%. Without herd immunity, measles outbreaks represent a real possibility. Imagine battling vaccine-preventable diseases, while fighting to contain the impact of COVID-19 on communities and health services.
Locally, we need to remember the vaccination victories afforded children. And together we must work to regain any lost progress related to young persons’ vaccinations. We must fight on two fronts.
William F. Tate IV is the dean and vice provost for graduate education; Edward Mallinckrodt Distinguished Professor in Arts & Sciences; and faculty scholar, Institute for Public Health, Washington University in St. Louis. On July 1, he will begin his tenure at the University of South Carolina as USC Educational Foundation Distinguished Professor in the Departments of Sociology and Family & Preventive Medicine. In addition, he will serve as the executive vice president for academic affairs and provost. Find him on Twitter @WFTate4.
Kally Xu is a John B. Ervin Scholar and Gephardt Institute Civic Scholar at Washington University in St. Louis, where she is a candidate in the 3-2 Masters of Public Health in the George Warren Brown School of Social Work and the A.B. program in International and Area Studies and Asian American Studies.
