Reducing the threat of vaccine-preventable diseases starts with kids

Americans have been warned — again — about lax attention to routine vaccinations. This time the warning comes from measles, an age-old, vaccine-preventable disease, with an outbreak in central Ohio among nearly 80 children and counting, almost all of them unvaccinated against measles.

Once well-controlled in the U.S., which has maintained “measles elimination status” for almost 20 years, this disease may no longer be a rarity as millions of children in the U.S. are missing or behind on routine vaccinations. Globally, there were about 9 million measles infections and 128,000 deaths in 2021, and a record high of nearly 40 million children missing a vaccine dose last year.

A dangerous combination of pandemic fatigue, waning health literacy, and the unmitigated spread of health misinformation and disinformation are to blame. The inability of the U.S. government and the country’s underfunded national health care infrastructure to effectively and equitably educate the public about the risks of disease and benefits of vaccination have created a perfect storm for the reemergence of measles in Ohio and polio in New York.

Things could get worse. When the public health emergency ends, which could come as early as Jan. 11, 2023, as many as 6.7 million children could lose their insurance coverage, which would disproportionally affect Black, Latino/a/x, Asian American/Pacific Islander, and Native American children. Gaps in insurance coverage have been linked to worse developmental, health, and academic outcomes for children.

The question is not if or when threats will arise from vaccination and insurance gaps — they will — but how federal and local governments and the health care infrastructure should respond to the predictable and impending threats of current and future outbreaks, including those from vaccine-preventable illnesses.

Whether judging by the uptake of Covid-19 vaccines, which continues to be alarmingly low among the nation’s pediatric populations, or by the worrisome declines in rates of routine immunizations over the past couple of years, American children are not being prepared for the preventable health threats that are likely to emerge during their childhoods or those that could develop later in life, like cancers related to infection with the human papillomavirus.

To make matters worse, more than one-third of U.S. adults are not sure (17%) or incorrect (19%) about the facts on childhood vaccination. According to the latest Kaiser Family Foundation data, nearly 30% of respondents said parents should not be required to vaccinate their children for school even if it puts other children at risk. This will make it hard for caregivers to know what tools they can use to safely protect their kids.

The government and the nation’s public health and health care infrastructure need to act equitably, swiftly, and decisively to protect the health and well-being of the nation’s children. We and our colleagues with the Children’s Health Equity Working Group see six top priorities for the government:

• The Biden administration must make childhood vaccines a greater priority, ensuring that all vaccines are fully covered by the Vaccines for Children program, and reestablish the National Vaccine Program Office, an office that was eliminated during the Trump administration.
• Congress must expand funding for the Centers for Disease Control and Prevention’s vaccine programs, school-based health clinics and community health centers, and the infrastructure necessary to interrupt and counter anti-vax disinformation.
• States must prepare to re-enroll children for health coverage when the public health emergency ends (whether that is Medicaid, the Children’s Health Insurance Program, or the Affordable Care Act), expand public health infrastructure and access to vaccines, and work to counter the anti-vax misinformation that threatens the health of children.
• Local community clinics, public health and community-based organizations, and trusted messengers like community health workers must be funded to continue enabling equitable access to information about vaccines and preventive health measures for children.
• A point person for childhood vaccination should be chosen to oversee a national communication effort and set ambitious goals, including getting all school-aged children up to date on their immunizations. There is currently no coordinated effort to make it easier and more compelling for vaccine-accepting parents — who represent the vast majority of parents — to get their kids vaccinated.
• Engage people at the community and health provider level wherever adults get vaccinated or boosted, from health centers to retail clinics to pharmacy chains, to ask about the vaccination status of children and encourage pediatric vaccinations, including offering incentives such as gift cards, badges, and other simple bonuses.

A crisis is brewing that will disproportionately harm America’s children and follow them into adulthood. They are neither immune to nor invincible from preventable infectious diseases, and it is a travesty that we would allow the health and safety of children to be threatened by harms that are easily preventable.

It’s time for a coordinated effort across government, public health, and health care organizations to do more to support childhood vaccination. Ensuring access to vaccination, health care, and health information must be immediate and top priorities.

Rhea Boyd is a pediatrician and child and community health advocate and scholar. Bruce Lesley is the president of First Focus on Children, a bipartisan advocacy organization focused on children and families. Alexandra Quinn is the chief executive officer of Health Leads, a national nonprofit organization focused on innovation and advocacy in racial health equity. The authors are writing on behalf of the Children’s Health Equity Working Group, a multi-sector group formed by the Vaccine Equity Cooperative that includes the American Academy of Pediatrics, foundations, community organizations, and others that has developed two sets of recommendations advocating for equitable access to vaccinations, health, and well-being for America’s children.

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