Health Desk – 27 Mar, 2021: AS MANY PEOPLE ACROSS the U.S. focus on getting themselves or their loved ones vaccinated against COVID-19, health providers and federal officials are raising red flags about another urgent vaccination matter: an apparent decline in routine shots for children.
At a recent briefing, Dr. Rochelle Walensky, director of the Centers for Disease Control and Prevention, said CDC orders for childhood vaccines had dropped by about 11 million doses during the pandemic. CDC representatives later explained that data from late February shows total orders for childhood vaccines other than flu vaccines made through the CDC’s Vaccines for Children program were down by 11 million doses when comparing 2020-2021 with 2019-2020.
“When planning for your child’s safe return to childcare programs or their return to school, please check with your child’s doctor to make sure that they are up to date on their vaccinations,” Walensky urged parents, pointing out that the CDC has a catch-up schedule for children who have gotten off track with their vaccines. Her call to action came about a month after the CDC unveiled its first guidance under the Biden administration for safely reopening schools.
“As we work to get our children back to school, we certainly do not want to encounter other preventable infectious outbreaks such as measles and mumps,” Walensky said.
This isn’t the first time concerns have been raised about the pandemic’s disruption in care causing children to fall behind on standard vaccinations.
A federal report last May indicated that routine child vaccinations plummeted early in the pandemic. In September, the Centers for Medicare & Medicaid Services said preliminary data indicated that fewer children enrolled in Medicaid and the Children’s Health Insurance Program were receiving vaccinations and other medical services in the early months of the pandemic, although enrollment in the two programs had increased. Data from March through May 2020 showed a decrease of 1.7 million – or 22 % – in vaccinations for beneficiaries up to age 2 and a decrease of 3.2 million, or 44%, in child screening services compared with the same period in 2019.
According to the CDC, substantial declines in pediatric outpatient visits began around the start of the pandemic last year. Along with those came a decline in provider orders for childhood vaccines. Among the slate of childhood vaccines, the CDC is particularly concerned by a reduction in orders for measles-containing vaccines such as the measles, mumps and rubella vaccine. Orders for those shots through the Vaccines for Children program were down by 1.4 million doses, or 21.3%. Orders for HPV vaccines were down by 21%, and those for the tetanus, diphtheria and pertussis vaccine were down 21.1%.
Yet similar to enrollment increases in Medicaid and CHIP, CDC representatives say eligibility “undoubtedly” rose during the pandemic for the Vaccines for Children program, which provides free vaccines for children whose families might not otherwise be able to pay, perhaps because their parents are uninsured. According to estimates by The Commonwealth Fund, roughly 7 million people in the U.S. may have lost their employer-sponsored health insurance due to job losses early in the pandemic.
“Ensuring children are up-to-date on recommended vaccines will help keep them safe as we plan for in-person schooling,” a CDC spokesperson tells .
The American Academy of Pediatrics, which released 2021 schedules for vaccinations in February, says disruptions to any part of the routine vaccination schedule for children and adolescents is worrisome.
“The immunization schedule is very carefully and thoughtfully prepared and put out and reviewed by infectious disease experts at the CDC and at the AAP,” AAP President Dr. Lee Savio Beers says.
A pediatrician in Washington, D.C., Beers says she saw a decline in kids coming in for visits early on in the pandemic. Now, a year later, she says AAP members are reporting a slow return to routine care, but visits still aren’t back to regular levels.
Beers says it would be unfortunate to see an outbreak of a vaccine-preventable disease during the pandemic due to low immunization rates. In 2019, the U.S. saw close to 1,300 cases of measles, marking the country’s highest total since 1992. The majority of cases occurred among people who were unvaccinated, and the illness led to restrictions and canceled school activities in the hotbeds of Washington state and New York City.
Beers says the AAP has been focused on educating parents over the past year on the importance of getting their kids caught up on their vaccinations. In May, the academy launched a social media campaign encouraging pediatricians to share the hashtag #CallYourPediatrician along with educational materials on the importance of getting their kids vaccinated and visiting their pediatrician.
“I think a really important piece of our role is to help parents understand that their pediatricians’ offices are very safe places to be,” Beers says. “The institutions have really gone above and beyond to make sure that their offices are safe for families.”
Dr. Jesse Hackell, a pediatrician in Pomona, New York, with Boston Children’s Health Physicians, says safety is a No. 1 priority and a key to getting kids back into the office.
“Not only let (families) know offices are safe, but demonstrate,” he says. At Hackell’s facility, he says, they’ve been intentional about separating sick kids and healthy kids, who are each brought in via separate entrances. There’s also no waiting room.
“We just simply limit the contact. They sit in the car until we have a room ready for them,” Hackell says.
Hackell says his office saw a 75% decline in visits in the first few months of the pandemic. Since then, thanks to the AAP campaign and efforts by himself and his colleagues, he says regular visits are back to near-normal levels, though regular vaccinations are still down. In the beginning of the pandemic, doses of MMR and other vaccines given to infants fell significantly, but they’ve since creeped upward again, Hackell says. Vaccines for teens have been slower to recover, however, which Beers says has been an issue seen in general and aside from the pandemic.
For Hackell, who says he and his colleagues are fierce vaccine advocates, that means they’re pushing hard to bring kids up to speed.
“Every kid that comes in is getting caught up on their vaccines,” Hackell says. “We don’t miss an opportunity to immunize.” That includes vaccinating kids who come in for visits for other reasons. The office also has been calling to remind patients who are overdue for visits to come in.
Hackell says parents who are worried about paying for vaccines, especially if they’ve experienced a loss of insurance, can take advantage of the Vaccines for Children program and get the vaccines done at no cost.
“We’ve always made the point that we need to do what’s right for your children,” Hackell says. “We don’t want to let money stand in the way.”