Although the COVID-19 pandemic brought the importance of vaccination to the forefront of health policy discussions, childhood immunization rates decreased markedly during this period both in the United States and worldwide.1 In keeping with National Infant Immunization Week, we spoke with pediatric immunization nursing experts to discuss strategies to improve immunization uptake and encourage catch-up vaccines.
In May 2020, the Centers for Disease Control and Prevention (CDC) reported a sharp decline in the numbers of noninfluenza and measles-containing vaccine doses ordered the week after the national emergency was declared on March 13, 2020 (Figure).1 Researchers have warned of a potential resurgence in vaccine-preventable diseases, particularly measles, as a result of barriers to pediatric vaccine uptake during the pandemic.
“COVID-19 has made previously routine vaccination a daunting challenge,” said UNICEF Executive Director Henrietta Fore.2 “We must prevent a further deterioration in vaccine coverage and urgently resume vaccination programs before children’s lives are threatened by other diseases. We cannot trade one health crisis for another.”
Debbie Scott, DNP, MPH/MS, FNP-BC, also expressed concerns about a resurgence risk stating “we have led physically distant lives over the past year, but when we resume ‘normal’ life, such as in-person schools and camps, the risk will very likely increase. Not only can this be a local public health problem but a global health problem as well. As we know, global health IS local health.” Dr. Scott has researched strategies to increase vaccination rates in adolescents in her role as director of Health Services at Pratt Institute in Brooklyn, NY. She is also a founding member of the Greater NYC Black Nurses Association Chapter.
Immunization Rates Were Low Before the COVID-19 Pandemic
Progress on immunization coverage was stalling worldwide before the pandemic hit. In 2018, more than 25% of infants aged 19 to 35 months in the US had not completed the 7-vaccine series (ie, diphtheria, pertussis, tetanus, poliovirus, measles, mumps, rubella, hepatitis B, Haemophilus influenza type B, chickenpox, and pneumococcal infections), according to data from the CDC.3 This rate is short of the 90% target in Healthy People 2020 initiative.
“Our study also showed that African American infants were less likely to receive the 7-vaccine series,” noted study author Ansh A. Kulkarni and colleagues. The odds ratio for completion of the vaccination series among non-Hispanic Black children was 0.92 compared with White children. “Such disparities [in this age group], especially in protecting infants from potentially preventable diseases, are unacceptable.”
“We have not completely eradicated some of these vaccine-preventable illnesses. We thought we were close to eradicating measles and then we had outbreaks over the past few years,” said American Association of Nurse Practitioners President Sophia L. Thomas DNP, APRN, FNP-BC, PPCNP-BC, FNAP, FAANP. “We could see a resurgence of these illnesses as a response of not keeping up with well-visit appointments during the COVID-19 pandemic.”
Parents are typically good at bringing newborns and infants in for regular checkups and vaccines, Dr. Thomas said. However, between the ages of 1.5 and 3.5 years is when the gaps in well-child visits typically occur in her practice at DePaul Community Health Center, a federally qualified health center in New Orleans, Louisiana. When children start to get ready for preschool or elementary school, parents bring children in again to catch up on required vaccines for school entry.