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


A new study from the US Centers for Disease Control and Prevention shows low vaccination rates for measles, polio, diphtheria and other diseases among US children.

The rate of required vaccinations among kindergarten students decreased from 95% to approximately 94% during the 2020-21 school year. And it fell further – to 93% – in the 2021-22 school year.

That’s still a big number, so why does this drop in fortification matter? What explains the decline? What could be the consequences if these numbers fall further? If parents are not sure about vaccinating their children, what should they do? What can be done at the policy level to increase immunization numbers?

To help us answer these questions, I spoke with CNN medical analyst Dr. Leana Wen, an emergency physician, public health expert, and professor of health policy and management at George Washington University’s Milken Institute of Public Health. She is also the author of Life Lines: A Doctor’s Journey in the Fight for Public Health.

CNN: Why is the problem with low child immunization rates?

Dr. Lina Wen: Reducing 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. In the previous four years, there were more than 16,000 cases of paralytic polio and nearly 2,000 deaths from polio each year across the United States. Widespread use of the polio vaccine eliminated polio from the country by 1979, according to the Centers for Disease Control and Prevention, sparing thousands of deaths and lifelong disabilities among children each year.

The measles vaccine was licensed in the United States in 1963. In the four years prior to that, there had been an average of over 500,000 cases and more than 430 measles-related deaths each year. By 1998, only 89 cases had been recorded – and there were no measles-related deaths.

These vaccines are very safe and very effective. The polio vaccine, for example, is more than 99% effective in preventing paralyzing polio. The measles vaccine is 97% effective in preventing infection.

We can do the same analysis for other diseases for which there is a routine immunization of children.

It is deeply troubling that immunization rates are declining for vaccines that have long been used to prevent disease and reduce deaths. This means that more children are at risk of serious disease – disease that could be avoided if they were vaccinated. Moreover, if the proportion of unvaccinated individuals in a community increases, this also puts others at risk. This includes children too young to be vaccinated or people who are not protected by vaccines as well – for example, patients undergoing chemotherapy for cancer.

CNN: What explains the drop in vaccination numbers?

Wen: There may be many factors. First, there has been significant disruption to the health care system in the United States during the COVID-19 pandemic. Many children missed routine pediatrician visits during which they would have had their vaccinations due to the pandemic restrictions. In addition, some of the community health services provided were disrupted as local health departments focused on Covid-19 services.

Second, disruption to education also played a role. Vaccination requirements are often checked before the start of the school year. When schools stopped in-person instruction, it left some families behind fortifications.

Third, misinformation and disinformation about Covid-19 vaccines may have sowed doubt about other vaccines. Vaccine hesitancy and misinformation were already major public health concerns before the coronavirus emerged, but the pandemic has exacerbated the problems.

According to a December Kaiser Family Foundation survey, more than one in three American parents said vaccinating children against measles, mumps, and rubella should not be a condition for them to attend public schools, even if doing so could result in health risks for the children. others. This was a significant increase from 2019, when a similar survey from the Pew Research Center found that only 23% of parents oppose school-based vaccine requirements.

CNN: What are some of the consequences if immunization rates fall further?

Wen: If immunization rates fall further, we could see widespread disease outbreaks. Diseases that were virtually eradicated in the United States could re-emerge, and more people could become severely ill and suffer lasting consequences or even die.

We’re already starting to see some results: Last summer, there was a confirmed case of polio in an unvaccinated adult in New York. It is devastating that a disease like polio is being recognized again in the United States, where we have a highly effective vaccine to prevent it.

There is an active measles outbreak in Ohio. As of January 17, 85 cases have been reported. Most of the cases involved children who were not vaccinated, and at least 34 have been hospitalized.

CNN: If parents are unsure about vaccinating their children, what should they do?

Wen: As parents, we generally trust pediatricians with our children’s health. We consult pediatricians if our children are diagnosed with asthma and diabetes, or if they develop new, worrisome symptoms of another disease. We should also consult our pediatricians about children’s vaccinations; Parents and caregivers who have specific questions or concerns should address them.

The National Association of Pediatricians, American Academy of Pediatrics, “strongly recommends routine, timed immunization for all children and adolescents in accordance with the recommended immunization schedules for children and adolescents.”

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

Wen: There should be a coordinated education campaign to address why it is important to be vaccinated against measles, mumps, rubella, chickenpox, polio, etc. One reason for vaccination reluctance, in my experience, is that these diseases have been rarely seen in recent years. Many parents now didn’t face the devastation of these illnesses growing up, so they may not realize how terrifying their return is.

Specific interventions should be targeted at the community level. In some places, low immunization levels may be due to access. Vaccination campaigns in schools, parks, malls and other places where families gather can help increase their numbers. Elsewhere, low turnout may be due to vaccine hesitation and misinformation. Different strategies will need to be implemented in this case.

Overall, increasing immunization rates against vaccine-preventable childhood diseases should be a national imperative. I cannot stress how tragic it is for children to suffer from the harms of diseases that are entirely preventable through safe, effective, readily available vaccines that have been given routinely for decades.

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