Falling childhood immunization rates are a major concern. Our medical analyst explains why

CNN
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Vaccination rate for measles, polio, diphtheria and other illnesses are falling among American children, according to a new study from the United States Centers for Disease Control and Prevention.

The immunization rate for required vaccines among kindergarten students has increased from 95% to approximately 94% in the 2020-21 school year. It has fallen further – to 93% – in the 2021-22 school year.

This is still a high number, so why is this drop in vaccination important? What explains the decline? What could be the consequences if these numbers drop further? If parents are unsure about having their children immunized, what should they do? And what can be done at the political level to increase the number of vaccines?

To help us answer these questions, I spoke to Dr. Leana Wen, CNN medical analyst, emergency physician, public health expert, and professor of health policy and management at George Washington University Milken Institute School of Public Health. She is also the author of “Lifelines: One Physician’s Journey in the Fight for Public Health.”

CNN: Why is it a problem that childhood vaccination rates are declining?

Dr AS Leana Wen: The reduction of vaccine-preventable diseases is one of the greatest public health success stories of the past 100 years.

The polio vaccine was introduced in the United States in 1955, for example. Over the previous four years, there were on average more than 16,000 cases of paralytic poliomyelitis and nearly 2,000 polio deaths each year in the United States. Widespread use of the polio vaccine had led to the eradication of polio in the country by 1979, according to the CDC, sparing thousands of deaths and lifelong disabilities among children each year.

The measles vaccine was licensed in the United States in 1963. In the previous four years, there were on average more than 500,000 cases and more than 430 measles-related deaths each year. In 1998, there were only 89 recorded cases – and no deaths associated with measles.

These vaccines are very safe and extremely effective. The poliomyelitis vaccine, for example, is more than 99% effective to prevent paralytic poliomyelitis. The measles vaccine is 97% effective to prevent infection.

We can do this same analysis for other diseases for which there are routine childhood vaccinations.

Worryingly, immunization rates are falling for vaccines that have long been used to prevent disease and reduce death. This means that more children are at risk of contracting a serious disease, a disease which could be prevented if they were vaccinated. Moreover, if the proportion of unvaccinated individuals increases in a community, it also puts the others at risk. This includes babies too young to be vaccinated or people for whom vaccines don’t protect as well – for example, patients undergoing chemotherapy for cancer.

CNN: What explains the drop in the number of vaccines?

Magnifying glass: There are probably many factors. First, there was substantial disruption to the US healthcare system during the Covid-19 pandemic. Many children have missed routine pediatrician visits where they would have received vaccines due to pandemic restrictions. In addition, some community health services also offered became disturbed as local health departments focused on Covid-19 services.

Second, the disruption of schooling also played a role. Vaccination requirements are often checked before the start of the school year. When schools stopped in-person instruction, it led to some families falling behind on their vaccinations.

Third, disinformation and misinformation around Covid-19 vaccines may have cast doubt on other vaccines. Vaccine hesitancy and misinformation were already major public health concerns before the outbreak of the coronavirus, but the pandemic has exacerbated the problems.

According to a December survey published by the Kaiser Family Foundation, more than one in three American parents said that vaccinating children against measles, mumps and rubella should not be a requirement for them to attend public schools, even though it may create health risks for children. others. This is a substantial increase from 2019, when a similar poll from the Pew Research Center found that only 23% of parents oppose vaccination requirements at school.

CNN: What are the consequences if vaccination rates drop further?

Magnifying glass: If vaccination rates fall further, we could see more widespread epidemics. Diseases that have been virtually eliminated in the United States could reappear and more people may become seriously ill with lasting consequences or even die.

We can already see the consequences: last summer, there was a confirmed case of paralytic poliomyelitis in an unvaccinated adult in New York. It is devastating that a disease like poliomyelitis has been identified again in the United States, since we have an extremely effective vaccine to prevent it.

There’s an active measles outbreak in Ohio. Since January 17, 85 cases have been reported. Most of the cases were in unvaccinated children and at least 34 were hospitalized.

CNN: If parents aren’t sure about getting their kids vaccinated, what should they do?

Magnifying glass: As parents, we generally trust pediatricians with the health of our children. We consult paediatricians if our children are diagnosed with asthma and diabetes, or if they have new and disturbing symptoms of another disease. We should also consult our pediatricians about childhood vaccinations; parents and caregivers with specific questions or concerns should respond.

The National Association of Pediatricians American Academy of Pediatrics“Strongly recommends timely routine immunization of all children and adolescents according to Recommended immunization schedules for children and adolescents.”

CNN: What can be done to increase the number of vaccines?

Magnifying glass: It takes consultation educational campaign explain why vaccination against measles, mumps, rubella, chickenpox, poliomyelitis, etc. is so crucial. In my experience, one of the reasons for vaccine hesitancy is that these diseases have been seen rarely in recent years. Many people who are now parents did not experience the devastation of these diseases growing up, and may not realize how terrible it would be for them to return.

Specific interventions should be targeted at the community level. In some places, low levels of vaccination may be due to access. Vaccination campaigns in schools, parks, malls and other places where families gather can help increase numbers. In other places, low uptake may be due to vaccine hesitancy and misinformation. Different strategies will need to be implemented in this situation.

Overall, increasing immunization rates against childhood vaccine-preventable diseases must be a national imperative. I cannot stress how tragic it would be for children to suffer the harms of diseases that could be entirely prevented with safe, effective and readily available vaccines that have been given regularly for decades.