Routine childhood vaccinations in U.S. slipped during pandemic
Kindergartners in the United States fell behind on routine childhood vaccinations during the pandemic, the Centers for Disease Control and Prevention reported Thursday, a slide that experts attributed to skipped checkups and to a groundswell of resistance to COVID-19 shots spilling into unease about other vaccines.
During the 2020-21 school year, about 94% of kindergartners had the required vaccines, a drop of approximately 1 percentage point from the previous school year, the CDC said. That pulled coverage levels below the target of 95%, raising fears that life-threatening childhood illnesses such as measles could at some point become more prevalent.
“This means there are 35,000 more children in the United States during this time period without documentation of complete vaccination against common diseases,” Dr. Georgina Peacock, acting director of the CDC’S immunization services division, said Thursday. “This is further evidence of how pandemic-related disruptions to education and health care could have lingering consequences for children.”
Enrollment in kindergarten also had fallen by about 10%, Peacock said, meaning that 400,000 additional children who had been expected to start school but did not may also have fallen behind on routine vaccinations.
Some states showed dramatic declines in coverage, while others held steadier. Maryland, for instance, reported an approximately 10% drop in coverage with the measles, mumps and rubella vaccine from the 2019-20 school year to 2020-21 among kindergartners. Wisconsin, Georgia, Wyoming and Kentucky all reported declines of about 5%.
Idaho had among the lowest levels of coverage during the 2020-21 school year with the measles, mumps and rubella vaccine, at 86.5%.
The CDC said coverage had fallen in a majority of states. Virginia, Kansas and Alabama were among a small number of states reporting higher levels of measles, mumps and rubella vaccine coverage during the past school year.
CDC scientists emphasized that extra barriers to reporting vaccination data during the pandemic, including reduced staffing and difficulties collecting information from parents, also could have lowered recorded coverage levels artificially in some places.
Nationally, vaccination coverage fell slightly below 94% for the measles, mumps and rubella vaccine; the diphtheria, tetanus and acellular pertussis vaccine; and for the varicella vaccine, the CDC said. The United States had very nearly lost its status as a country that had eliminated measles in 2019. During that year, the country experienced an unusually high number of measles outbreaks in communities where vaccination levels had dropped.
CDC scientists ascribed the coverage declines in part to missed well-child checkups, which pediatricians said that some families were avoiding during the pandemic out of fear of coming into contact with children with COVID-19. The agency said disruptions to schooling, including eased immunization requirements for remote learners and heavy demands on school nurses, also could have contributed to reduced vaccinations.
Pediatricians said that those issues had also collided with growing levels of antivaccine misinformation aimed at the coronavirus shots, which they said had prompted more resistance to ordinary vaccines, too.
“There’s a greater proportion of parents who are questioning routine vaccines,” said Dr. Jason V. Terk, a pediatrician practicing in a suburb of Dallas who also is a spokesperson for the American Academy of Pediatrics.
“The experience of the pandemic, and the agenda-driven disinformation that has been pushed out relative to COVID vaccines,” he added, had “fed the fire of distrust and skepticism that is really sort of the new pandemic of hesitancy for routine vaccines.”
Public health experts also noted a movement by some state legislatures to create new restrictions around requiring vaccines, although they said that many bills were still pending.
The CDC study did not find evidence of a surge of families seeking exemptions during the pandemic: It said that the percentage of kindergartners with an exemption for one or more required vaccines was 2.2% in 2020-21, similar to the figure reported a year earlier.
The agency said that it estimated vaccination coverage based on counts provided by federally funded immunization programs that work with schools and local education departments to examine students’ vaccination and exemption status. It noted that the pandemic sometimes interfered with efforts to collect and report vaccination data and that national coverage estimates for 2020-21 included only 47 of 50 states and the District of Columbia.
Signs of declining childhood immunization rates had emerged earlier in the pandemic, including reduced vaccine orders from states as part of a federally funded program for uninsured patients.
Dr. Gary Kirkilas, a pediatrician in Phoenix who cares for patients whose families are often poor or homeless, said conversations about vaccines with the families of children entering kindergarten are often straightforward. After all, he said, the shots needed at that age are often effectively booster doses of vaccines that were administered at younger ages. But he said vaccinating children in families that were transient, unused to seeing doctors regularly or distrustful of the medical community required a special level of attention. Skipped well-child checkups during the pandemic exacerbated those problems, Kirkilas said.