Patricia Stinchfield is the president of the National Foundation for Infectious Diseases
During the long months of COVID-19 restriction, work and school patterns were upended, routine healthcare visits were delayed and many children fell behind on recommended immunizations.
Those desperate early days of the pandemic have passed, but another threat is now emerging — too many children, especially those who are uninsured or underinsured, have not caught up on missed vaccinations and are falling further behind, giving preventable diseases the chance for a dangerous comeback.
In July, the New York State Department of Health reported the first case of polio in the United States in almost a decade. Weeks later, health officials found polio virus in wastewater samples, prompting a warning that hundreds of people may be infected.
Most of us have never seen a case of polio, thanks to the resounding success of vaccines. Beginning with Edward Jenner’s smallpox vaccine in the 1800s and leaping ahead in the mid-1950s with the Salk polio vaccine and many others since then, vaccines have indeed contributed to the elimination of once common diseases. But these successes have led many to let down their guard — and the detection of polio in the U.S. is a loud alarm. If we don’t place greater urgency on immunizing all children, we risk turning the clock back nearly a century.
According to the Centers for Disease Control and Prevention, immunization rates declined across the board beginning in March 2020, but the most significant drop was among children who receive vaccines through the Vaccines for Children program.
VFC is a federally-funded program that provides vaccines at no cost to children from birth through age 18 years who are Medicaid-eligible, uninsured or whose insurance does not cover some or all recommended vaccines, or American Indian/Alaska Native. Almost half the children in the US (49.7%) currently qualify to receive vaccines through the VFC program. The program is critical in removing cost barriers so that infants, children and teens who might otherwise not have been able to afford them can be vaccinated against measles, mumps, meningitis and 13 other preventable infectious diseases.
The CDC reports that by the age of 2 vaccine rates for children who are not covered by private insurance may be as much as 36.8% lower than rates for privately insured children. Uninsured children are more likely to be completely unvaccinated than children with private insurance.
As a pediatric nurse practitioner specializing in infectious diseases, I know what happens when children are not protected against vaccine-preventable diseases. I have personally cared for very sick children with influenza and measles and I have seen the devastation these diseases can cause. Make no mistake, these and other preventable diseases have not disappeared and may only be a plane ride away. And although other diseases like polio and diphtheria are no longer commonly seen in the US, a diphtheria case was just reported in an unvaccinated 2-year-old in Australia — the first case in a century.
We know that from the start of the pandemic in March 2020, enrollment of children in Medicaid jumped more than 12% (4.3 million children) by September 2021, meaning more children than ever rely on the VFC program. At the same time, disparities in healthcare access that existed before the emergence of COVID-19 were only exacerbated by the pandemic.
Clearly, many children are slipping through the cracks.
At the National Foundation for Infectious Diseases, we believe this is a public health crisis requiring an all-hands-on-deck solution. Advocates, public health leaders, policymakers and healthcare professionals at all levels need to address the dramatic decline in immunization rates among our most vulnerable children by examining barriers to immunization, new policies to incentivize vaccination and effective campaigns to make sure parents and healthcare professionals know about the VFC program. We not only need to improve vaccination rates, but we also need to bring the many children who may have missed vaccines up to date, to ensure they are protected.
We certainly cannot predict what the virus that causes COVID-19 will do next or what other health challenges may arise. But we do know how to prevent or mitigate diseases that once caused millions of childhood illnesses and deaths. And we need to use all available tools to ensure the health of our children.
A new school year is approaching. Now is the perfect time for parents to look at their children’s immunization history and talk to a healthcare professional about what vaccines their children may need. If we can bring immunization rates up, we will protect not only those children and teens who get vaccinated, but also the vulnerable older adults and immunocompromised family members around them. Together, we can help prevent future outbreaks of preventable diseases.
