The drop in rates of childhood immunization since the start of the SARS-CoV2 pandemic is well documented [1-6]. It is perhaps unsurprising that during the early days of the pandemic, when all aspects of our lives were shutting down, that routine vaccination wasn’t a top priority. However routine childhood immunization rates have not yet rebounded to pre-pandemic levels [1].
This places vulnerable children – especially those under 5 for whom there is no currently-available COVID vaccine – at dual risk for both negative outcomes from COVID illness as well as the potential for outbreaks of other vaccine-preventable disease. In the context of a societal push to ignore the pandemic, and greatly reduced mitigation efforts, primary care clinicians must ensure patients are up to date on routine immunizations to avoid such outbreaks.
Further complicating the issue is pervasive vaccine misinformation which has exploded during the pandemic years, resulting in an erosion in trust regarding not just COVID-19 immunization but routine vaccines as well [7,8]. Anti-vaccine groups masquerading as neutral information resources during the pandemic have wasted no time capitalizing on the chaotic media landscape, and have made more money than ever before. By focusing on the confusion around COVID-19 and flooding the zone with constant attacks on immunizations and public health officials, deceptively-named organizations such as “Children’s Health Defense” and “Informed Consent Action Network” – both large purveyors of anti-vaccine misinformation and conspiracy theories – more than doubled their fundraising between 2019 and 2020. Their highest-profile spokespeople make well over $200,000 a year, (in addition to lucrative speaking fees) by demonizing vaccines, and casting doubt on public health measures [9,16].
The vaccine hesitancy of the early 2000s was the domain of educated white individuals with higher socioeconomic status [10,11]. This is in contrast to the vaccine hesitancy which has developed during the pandemic, which has preferentially affected minority ethnic groups and those with lower socioeconomic status. These demographics have also been the most adversely impacted by the pandemic, and are less likely to have access to a primary care provider [3,5,12]. Missing routine vaccination in this cohort will deepen health disparities over time, compounding the yet-uncertain long term post-COVID disability; given the increased burden of COVID-19 infections in minority populations, there is concern that chronic COVID symptoms will likely be more common in this population, which has been targeted by misinformation efforts [17,18].
So, as primary care clinicians, what can we do to help attenuate this problem?
- The good news is that primary care/personal healthcare providers have been consistently rated as a top source of reliable information about immunization [5,13]. When we discuss vaccines with our patients, it makes a difference! There has been so much emphasis on COVID-19 vaccination recently, that routine immunizations are often placed on the back burner. That’s why it’s important to discuss routine immunization at every visit as well.
- Due to the explosion of misinformation regarding vaccines, now is a good time to brush up on common anti-vaccine messages and how to discuss these topics. There are great resources here at NDs for Vaccines, as well as Children’s Hospital of Pennsylvania, Boost Oregon, and Vaxopedia, Immunize.org and Dr. Gretchen LaSalle’s excellent book “Let’s Talk Vaccines”.
- As more patients are returning from telemedicine to in-person care, keep in mind that during the height of the pandemic many – especially kids – likely missed some indicated immunizations. If you’re meeting patients for the first time, or after a long hiatus due to the pandemic, remember to check for immunizations that might have been missed.
- If a patient is more behind on their vaccines than can be addressed at one visit, make a plan using the CDC catch up schedules.
- Remember that delayed immunization is delayed protection. More than 15 million people, including 6.7 million kids, are likely to lose their Medicaid coverage when the Public Health Emergency status expires in the next few months [14,15]. Missed vaccinations now may leave them at increased risk of preventable illness, and with limited ability to seek care. This Medicaid enrollment purge could occur before a COVID vaccine for under 5 year olds has been authorized, at a time when funding for vaccination has run out.
During this relative lull in pandemic activity, prioritizing delayed wellness care and immunization is essential to protect our patients from vaccine-preventable illness.
References:
- https://www.scientificamerican.com/article/vaccinations-have-sharply-declined-nationwide-during-the-covid-19-pandemic/
- https://jamanetwork.com/journals/jamapediatrics/fullarticle/2784888
- https://bmcpublichealth.biomedcentral.com/articles/10.1186/s12889-021-11725-5
- https://www.cdc.gov/mmwr/volumes/70/wr/mm7023a2.htm
- https://www.aafp.org/dam/AAFP/documents/patient_care/immunizations/vaccine-survey-pandemic.pdf
- https://www.unicef.org/press-releases/covid-19-pandemic-leads-major-backsliding-childhood-vaccinations-new-who-unicef-data
- https://www.nature.com/articles/s41591-022-01728-z
- https://www.tandfonline.com/doi/full/10.1080/21645515.2020.1780846
- https://www.nbcnews.com/tech/internet/struggling-anti-vaccination-groups-enjoyed-pandemic-windfall-rcna14402
- https://pubmed.ncbi.nlm.nih.gov/21812176/
- https://pubmed.ncbi.nlm.nih.gov/15231927/
- https://www.kff.org/coronavirus-covid-19/poll-finding/kff-covid-19-vaccine-monitor-november-2021/
- https://www.kff.org/coronavirus-covid-19/report/kff-covid-19-vaccine-monitor-december-2020/
- https://ccf.georgetown.edu/2022/02/17/millions-of-children-may-lose-medicaid-what-can-be-done-to-help-prevent-them-from-becoming-uninsured/
- https://www.urban.org/sites/default/files/publication/104785/what-will-happen-to-unprecedented-high-medicaid-enrollment-after-the-public-health-emergency_0.pdf
- https://www.usnews.com/news/politics/articles/2021-12-15/how-a-kennedy-built-an-anti-vaccine-juggernaut-amid-covid-19
- https://www.statnews.com/2021/05/10/with-long-covid-history-may-be-repeating-itself-among-people-of-color/
- https://www.washingtonpost.com/business/2022/01/25/cdc-congress-long-covid/
Maxwell Cohen, ND
Max Cohen, ND is a naturopathic physician in Portland, Oregon. He currently works for a Federally Qualified Health Center (FQHC) providing primary care for a wide variety of patients. He is a member of the Board of Directors of the Naturopathic Academy of Primary Care Providers (NAPCP), as well as the Scientific Advisory Board for Boost Oregon.He completed his medical training and residency at the National University of Natural Medicine. Prior to medical school he worked as a microbiologist in a tuberculosis vaccine development lab. Twitter @MaxwellCohenND
