April 27, 2020

More kids are going unvaccinated due to lockdowns. Here are the creative ways providers are tackling the problem.

Daily Briefing

    Vaccination rates in the United States are dropping rapidly as Americans avoid health care facilities out of fear of being exposed to the new coronavirus—an issue that providers are concerned could lead to outbreaks of vaccine-preventable diseases.

    What parents want from low-acuity pediatric care

    Data shows declining vaccination rates amid Covid-19 epidemic

    Data on vaccination rates across the country indicate a drop in immunizations that coincides with America's coronavirus epidemic, the New York Times reports.

    Pediatric EHR company PCC analyzed vaccine information from 1,000 U.S. pediatricians and found that the administration of vaccinations for measles, mumps, and rubella during the week of April 5 decreased by 50% when compared with the week of Feb. 16. The data also revealed that, over the same time frame, vaccinations for diphtheria and whooping cough decreased by 42% and human papillomavirus vaccinations decreased by 73%.

    Vaccine doses distributed to uninsured patients by Vaccines for Children also have decreased, the Times reports. For example, Massachusetts' Department of Public Health during the first two weeks of April saw a 68% drop in administered doses when compared with the same time last year. Minnesota has similarly reported that it saw a 71% decline in administered doses of the measles, mumps, and rubella vaccine as March came to an end.

    Providers say drop in vaccinations tied to canceled well visits

    Providers believe the declines in vaccination rates could be due to parents canceling well visits for their children. Some providers say parents have expressed feeling apprehensive about bringing their children to a doctor's office to receive immunizations during the new coronavirus epidemic because of the risk of potential exposure to the virus.

    Likewise, providers have been cautious about asking patients to come to their facilities to receive vaccinations, according to the Times. During the first few weeks of states implementing shelter-in-place orders, most providers delayed vaccination schedules for older children and instead focused on vaccinating infants under two years of age, the Times reports.

    Decline raises concerns of future outbreaks

    CDC, the American Academy of Pediatrics (AAP), and the American Academy of Family Physicians have encouraged providers to continue adhering to vaccination schedules for children, especially for babies and young children. According to the Times, experts are concerned that delaying immunizations for children could put millions at risk for deadly illnesses like whooping cough, measles, and tetanus—potentially leading to preventable disease outbreaks and creating another public health crisis.

    According Elizabeth Meade, a physician and president of AAP's Washington chapter, the drop in immunization rates due to the new coronavirus could be especially problematic in the United States given that childhood immunization rates have been steadily decreasing across the country.

    In fact, America almost lost its measles elimination status in 2019 amid an outbreak of the disease that lasted nearly a year. The measles outbreak was the worst the country had seen since 1992.

    Mease said, "[O]ur vaccine rates were already tenuous, so any additional hit to that is a great worry."

    "The last thing we want as the collateral damage of Covid-19 are outbreaks of vaccine-preventable diseases, which we will almost certainly see if there continues to be a drop in vaccine uptake," said Sean O'Leary, a member of AAP's committee on infectious diseases.

    How doctors are addressing the decline

    Providers are looking for new ways to ensure patients follow their immunization schedules amid the epidemic.

    Kristina Gracey, a family medicine physician at the Barre Family Health Clinic, and her colleagues have been administering vaccinations via home visits and a special vaccination tent they set up in a field. "[F]or a new mom who has concerns about the risks of coming into the office, it can feel comfortable to receive care within the home," Gracey said.

    Other providers across the country are also using creative measures to maintain vaccination rates. For instance, some practices are encouraging parents to wait in their cars until they have exam rooms ready for children to receive their vaccinations, which could help limit patients' potential exposure to the new coronavirus. Other practices are scheduling well child visits during morning hours and sick visits during afternoon hours, and taking extra precautions to decontaminate the facilities in the evenings.

    Jeanne Marconi, a physician from Connecticut, has adapted drive-thru flu clinics to administer vaccines to children in parking lots. Parents drive kids up to health care workers, the children extend their arms outside of the car, and a worker dressed in protective gear administers the immunization.

    "We're trying to alleviate all of the fears they have and keep up with the care," Marconi said.

    Eleanor Menzin, managing partner of Longwood Pediatrics, said that providers should be proactive in providing special accommodations to young patients and their families to help encourage vaccinations. "It no longer suffices for us to say, 'We're open if you want to come in,'" she said. Instead, providers should say, "'We want you to come in because this is important. What is keeping you from getting your child vaccinated and let's solve that together" (Hoffman, New York Times, 4/23; Klar, The Hill, 4/23).

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