Childhood Vaccinations Drop During COVID-19 Pandemic

IRA FLATOW: This is Science Friday. I’m Ira Flatow. There’s been an unintended consequence of families sheltering at home. Vaccination rates for kids have gone way down. In New York, for example, vaccine doses for kids older than two dropped by more than 90%. And that could mean we could see outbreaks of measles and whooping cough while we also struggle with COVID 19.

Joining me today to talk about decreasing vaccine rates are two pediatricians, Dr. James Campbell, professor of pediatrics at the University of Maryland School of Medicine in Baltimore. He’s also a member of the American Academy of Pediatrics Committee on Infectious Diseases. And Dr. Amanda Dempsey, professor of pediatrics at the University of Colorado in Denver. Welcome to Science Friday.

AMANDA DEMPSEY: Thank you, Ira.

JAMES CAMPBELL: Thanks for having us.

IRA FLATOW: You’re welcome. Let me ask both of you. Let me ask you, Dr. Dempsey, first. What are you seeing on the ground in terms of how much of an issue this is?

AMANDA DEMPSEY: Yeah, we’re definitely seeing an impact of vaccination rates from the COVID pandemic. We hear a lot of reports around my area of clinics being closed because they don’t have access to personal protective equipment or need to reorganize how they do their clinical workflows to make sure that their patients are as safe as possible.

And I think, as a result, there has been a marked decrease in the amount of well-child checkups, which is where we usually give vaccines.

IRA FLATOW: Yeah, and Dr. Campbell, seeing the same thing?

JAMES CAMPBELL: Same thing here in Maryland. Yeah, I mean, there’s been reported across the state a reduction of about 71% of measles containing vaccine in the month of April with the last month that we have full data. And it’s the same issue, I think, probably in every state.

IRA FLATOW: And what about vaccines of infants? Newborns and whatever. When they go in that schedule, are you seeing fewer of those?

JAMES CAMPBELL: I mean, the good news from the– some of the data is that the single dose that’s given at the time when babies are born, the hepatitis B vaccine, that– because those babies are still mostly being born in the hospital is still being given. But every age after that, the rates are down.

IRA FLATOW: So is the biggest fear then– we’re talking about whooping cough and measles and the triple shot?

AMANDA DEMPSEY: Yeah, I think there’s a lot of concerns, not just about those diseases, but really about all the vaccine preventable diseases. Like any vaccine preventable disease, there is a certain threshold above which there needs to be a population level of vaccination. And if you fall below that, you really run the risk of increasing the number of outbreaks that you see.

So things like measles, we’re kind of right on that threshold, which is why we see more and more outbreaks happening over time. But we’re certainly at risk for other diseases as well. If there is a huge drop in vaccination rates, I would say any of those vaccine preventable diseases have the possibility of coming back.

IRA FLATOW: So what do you say to parents who might be thinking, well, my kids can get their measles shot in a couple of months when things are a little more back to normal. Why is it so important to have kids vaccinated on schedule?

AMANDA DEMPSEY: Well, every day that a child could receive a vaccine but actually doesn’t for whatever reason is one more day when they are unnecessarily being put at risk for contracting a vaccine preventable disease. And even though people are staying indoors more than they have in the past, there’s still really no way to predict when you might come into contact with somebody who is infected.

People are still going out. Even if children themselves aren’t going out much. But if their adults in their family are go to work or going to the grocery store, or really anywhere, or if they’re going to the playground, you can– and even just sometimes, for example, in measles, which is highly infective, even just potentially passing people on the bike path can infect you.

So it’s really important to get your vaccines on the schedule as much as possible. Not only for the vaccine preventable disease prevention, but also because during those visits, pediatricians will do a lot of other things. Screening for developmental problems or growth problems or lots of other things that could be going on during childhood that can be really important to pick up early.

IRA FLATOW: Dr. Campbell, I have heard that some of these diseases, like whooping cough, have similar symptoms to COVID. Is that right?

JAMES CAMPBELL: Some would. I mean, whooping cough, which can be a very severe disease, especially in the youngest children, also can have respiratory related symptoms meaning, obviously, cough. And you can see cough and other respiratory symptoms with COVID 19. So there’s some overlap, not only with whooping cough, but with other respiratory diseases or other diseases that cause fever.

So yes, it is possible. And as we get further along here in this– through the summer is when influenza vaccine will become available. And among all of the respiratory diseases that we have vaccines for, influenza and COVID 19 have the closest relationship in terms of the symptoms. The constellation of symptoms that you would see.

IRA FLATOW: I suspect that, as a parent, I am a parent, and my kids went through the vaccination process. But I would suspect that parents today are thinking, it’s not safe for kids to come into the doctor’s office to get vaccinated, James. What kinds of precautions are going on there?

JAMES CAMPBELL: Yeah, I mean, it’s– I understand those parents concerns because we’ve all been concerned about where is it safe for us to go, and what things should we consider essential. But I think the best way for parents to think about it is that is where their medical home is. Pediatricians and other care providers for children and families, obviously, think about this quite a bit. And they’re not going to offer you to come in without having safety measures in place.

People will see when they’re calling their pediatrician that they’ll be asking screening questions. And they may have a way where only certain times for well children versus those who might be ill. And they have new cleaning policies. And what’s called personal protective equipment like gowns and gloves and masks and things. And some people are checking in outside rather than coming in the clinic first just to be sure, or in your car if it’s a drive– a clinic with a parking lot, and things like that.

So there are many things that pediatric practices have put into place to make it the safest place for you to go. So I think people should have– not to worry about their own particular practice. Call first, of course. But we all have thought this through quite a bit, and we have new policies that protect our families.

IRA FLATOW: And what about the fear that some parents may have, if I get the vaccine, my kid’s immune system is going to be down shifted. So there might be more susceptible to COVID 19. Bad worry?

JAMES CAMPBELL: Yeah, that is something that may be out in some social media circles. But it’s just not true. What happens when you get a vaccine is just the opposite. It pokes your immune system. It triggers your immune system to actually be activated specifically against whatever that vaccine is for. So it will not reduce your ability to fight off the thing you were vaccinated for, or any other disease at all.

And there have been excellent studies looking at that exact question of do you have reduced immune response or ability to fight off another infection or any disease. And it’s just not true.

IRA FLATOW: Let’s get into some of this disinformation that you mentioned. Amanda, there’s been a lot of this information out there about COVID 19. Are you concerned that by the time there’s a vaccine on the market for it that you’ll have to battle vaccine disinformation for that, too?

AMANDA DEMPSEY: Yeah, I think that’s definitely a concern that a lot of medical providers have. There’s a lot of vaccine misinformation out there right now along with a lot of COVID misinformation. And it could be really difficult for people who aren’t in the medical profession to be able to sort out what’s a reputable website and what’s a disreputable website.

So I definitely think it’s a concern. And I imagine that with the way that COVID vaccine is being fast-tracked through the regulatory process, there may be even more questions and information out there that’s surrounding the vaccine. Because it’ll definitely make a big media splash when and if it does come out.

So we’re going to have to be really, I think, proactive as a medical community and public health community to try to make sure that we have avenues where very clear and reputable messages are able to get out into the public.

IRA FLATOW: It’s interesting that you bring that up because perhaps you’re referring to a Associated Press survey this week that found that half of the people they surveyed said they were fearful of getting a COVID vaccine when it’s available because they feared that the vaccine was being rushed to market too soon.

AMANDA DEMPSEY: Yeah, that doesn’t surprise me. If you look at vaccine hesitancy among parents of young children, about half of parents are what we would define as vaccine hesitant already, which in that definition is people who have significant concerns or questions about vaccines even if they go ahead and get their children vaccinated.

So what you’re describing, that statistic, seems right in line with what we already knew, at least from the parent perspective.

JAMES CAMPBELL: One of the benefits, I think, and that may be a positive through all of this is that, most of the time, what’s going on with vaccine development, which is typically a long process, lots of people being tested before vaccines are licensed, goes on without a lot of press and media coverage. And without people really seeing what all goes into it.

So on the positive side even though there may be some people who would be hesitant and worried, is it’s out in the open and people are seeing. Every day they’re hearing about what’s going on with this vaccine or that vaccine with COVID. So seeing what the evidence is, it will be more available or in the open for people. And I think they will realize just how much work goes into looking at the safety and efficacy as we develop vaccines.

IRA FLATOW: For a parent who wants to take their child to get vaccinated, to the doctor’s office, are through barriers to finding doctors who will do that? I mean, are some of them closing up? Or what are the barriers that they might have to face?

AMANDA DEMPSEY: Yeah, I mean, there definitely are some unique barriers that have arisen during this pandemic time. As I mentioned earlier, some practices have closed their doors temporarily. And in a few cases, maybe even permanently as the financial toll of the pandemic has percolated through communities. It affects practicing providers as well as other types of businesses.

So we’ve heard reports of some practices, as much as 20% to 30%, that might not be able to reopen because of the financial impact. And so there’s definitely that is a barrier. And even among practices that are opening, a lot of times they have different hours or procedures that may make it harder for some families to be able to access their services.

For example, if they are– for example, we’ve heard of some practices where they’re only seeing well children at one of the clinics in town and sick children at the other clinic in town. And so if you happen to live far away from the clinic within a system that’s seeing the well children, that might be difficult for you to get transportation to that area. So there can be some barriers that way.

And then, I think we’ve also heard some concerns from parents about the finances of paying for vaccines. Although vaccines are generally a covered entity under the Affordable Care Act. And there are other government programs that can provide vaccines for free to children who don’t have enough insurance or are uninsured.

So the reality behind those finances is actually pretty favorable in that almost all children are able to get vaccines for free if they can’t pay for them within their families themselves. But I think there is still concern among parents that that might not be the case. And so that could also be a barrier.

IRA FLATOW: In case you’ve just joined us, I’m Ira Flatow. And this is Science Friday from WNYC studios. I’m curious– wondering how this issue is being treated outside of the United States, Dr. Campbell? Are other countries also worried similarly, or do they not face the same challenges?

JAMES CAMPBELL: Oh, they definitely face the same challenges. And in low and middle income countries, they’ve been hit very hard. And they are at even higher risk for some of these vaccine preventable diseases, some of which we have either very low or no cases in the United States.

In some of those places, they depend not only on the way we vaccinate, which is what you call routine vaccination services, where you have certain ages that children are expected to go to their doctor, have an exam, a developmental assessment, et cetera, and get vaccinated.

But they have what are called campaigns. So where they’ll say, all children under a certain age in a certain region are going to receive, for example, polio vaccine or measles vaccine. And those help quite a bit to reduce epidemics. There have been disrupted programs in dozens of countries that have had to suspend those campaigns.

And there is a– WHO estimates 80 million children missed getting vaccines due to COVID 19 over the last few months. So very high risk that some of these diseases that we were ahead of are going to come back.

IRA FLATOW: Wow, I didn’t realize it was that big a number. Yeah, and it’s hard to break through, right? It’s hard to break through the concern and the focus that’s on COVID 19 to talk about the other ones. So I guess that’s a real challenge.

JAMES CAMPBELL: It is, especially with limited resources. In many countries, there are a limited number of health care workers and providers that can offer these services. And so then, when there’s things like epidemics, they often are redirected in those services to help with the epidemic.

But it is the WHO and others, including UNICEF, have come out with statements very recently to try to reverse this, and to give countries and others tips and means to try to get back on track.

IRA FLATOW: So what should pediatricians– what’s the message that pediatricians should communicate to people that it’s safe to get your kids vaccinated?

JAMES CAMPBELL: Well, I think that message needs to come from multiple sources, including pediatricians, obviously, who are talking to their families. Some are doing it through their– they have web sites, or they’re doing reach out through their front office staff or the pediatricians themselves.

And then, I think we need to have that message also to be coming from, for example, our group in the American Academy of Pediatrics from the Centers for Disease Control from the authorities that make recommendations. One, to let people know, I think, everyone may have had the thought that there might be some reduction in pediatric vaccinations with COVID 19. But I think we didn’t expect just how bad it would be.

And then, second is just, as you said, for people to be reassured about the safety of coming to a pediatric provider in order to get one’s– child to get vaccinated.

IRA FLATOW: Dr. Dempsey?

AMANDA DEMPSEY: Yeah, I really encourage parents to call their pediatrician’s office and talk through what the safety measures that that practice has put into place are, because every practice has done so. And I think that that can really provide a lot of reassurance for parents once they know what to expect, and how much the risk has been mitigated through these procedures. It can go a long way in making people feel comfortable.

And just reminding parents that the same things that we’ve always focused on in pediatrics and in terms of well child care and screening and all that, none of that has changed. And those problems are still occurring at the same levels as they always have. So we still need to be diligent about making sure that we catch those early on and provide the necessary treatment, if needed, for those kinds of things.

So there’s a lot of reasons to be going to pediatricians besides vaccination, although that’s obviously a really important one. And there’s a lot of things that we have done to make sure that our families can remain safe.

IRA FLATOW: Well, we’ve run out of time. Very interesting. I’m glad that we could do something here to advance that conversation that we need to have about the kids. Dr. James Campbell, professor of pediatrics at the University of Maryland School of Medicine in Baltimore. Also a member of the American Academy of Pediatrics Committee on Infectious Diseases. Dr. Amanda Dempsey, professor of pediatrics University of Colorado in Denver. Thank you both for taking time to be with us today.

AMANDA DEMPSEY: Thank you so much.

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