Routine vaccination charges for kindergarten kids ticked down throughout the COVID-19 pandemic and have but to rebound whereas exemptions from faculty vaccination necessities have elevated, seemingly contributing to a latest surge in measles instances. On the identical time, vaccine hesitancy, fueled partially by vaccine misinformation, elevated throughout the pandemic, and public opinion on vaccine necessities has turn out to be more and more partisan. Vaccine insurance policies have emerged as an election concern, with each former President Trump and Unbiased candidate Robert F. Kennedy (RFK) Jr. embracing anti-vaccination attitudes and contributing to vaccine misinformation. That is in sharp distinction to present President Biden who has supported vaccine mandates and brought motion to broaden entry to vaccines for each kids and adults. This concern temporary additional explores this altering panorama by analyzing the newest developments in kids’s routine vaccination charges, the elements contributing to latest vaccination developments, and coverage approaches to growing vaccination charges as kids head into a brand new faculty yr. Key takeaways embrace:
The share of kindergarten kids updated on their state-required vaccinations has not rebounded to pre-pandemic ranges, and almost three-quarters of states had measles, mumps, rubella (MMR) vaccination charges beneath the Wholesome Folks 2030 “goal” charge (95%) for the 2022-2023 faculty yr. Additional, 12 states and D.C. reported charges beneath 90% in contrast with solely three states within the 2019-2020 faculty yr.
On the identical time, the share of kindergarten kids with a vaccine exemption has elevated nationally and for many (36) states because the pandemic started. For the 2022-2023 faculty yr, 10 states had exemption charges over 5%, that means it was not potential for these states to succeed in protection charges at or above 95%. Increased exemption charges are related to decrease vaccination protection charges, that means states with extra kids claiming exemptions report decrease vaccination protection charges.
Whereas each the influenza (flu) and COVID-19 vaccines are really helpful for kids, flu vaccination charges had been over thrice larger than COVID-19 vaccination charges for kids. Much like state-required vaccination charges, kids’s flu vaccination charges declined throughout the pandemic and has but to rebound again to pre-pandemic ranges.
There are a selection of things contributing to latest vaccination developments, together with shifts in public opinion and rising vaccine hesitancy because the pandemic started, seemingly fueled by vaccine misinformation. There are a selection of coverage choices and methods that can be utilized to extend vaccination charges, together with leveraging Medicaid to facilitate entry to vaccines for low-income kids.
What are latest developments in kids’s routine vaccination charges?
The share of kindergarten kids updated on their vaccinations ticked down throughout the pandemic and has but to rebound again to pre-pandemic ranges. Information collected and aggregated yearly by the CDC from state and native immunization packages discovered that, throughout the 2022-2023 faculty yr, 93% of kindergarteners had been vaccinated with all state-required vaccines, together with MMR, DTaP (diphtheria, tetanus, and acellular pertussis), polio, and varicella. That is much like the earlier faculty yr however decrease than pre-pandemic ranges (95%). For the third yr in a row, the MMR vaccination charge fell beneath the Wholesome Folks 2030 “goal” charge of 95%, the extent wanted to stop group transmission of measles, a extremely contagious and life-threatening virus. This implies roughly 250,000 faculty kids had been unvaccinated and unprotected in opposition to measles, and analysis exhibits the extra unvaccinated kids in a college, the bigger threat of an outbreak turns into. Whereas noting that widespread measles transmission threat stays low, the Facilities for Illness Management and Prevention (CDC) reported 97 instances of measles within the first quarter of 2024, which is seventeen instances greater than the quantity within the first quarter of 2023.
Almost three-quarters (37) of states had MMR vaccination charges beneath the “goal” charge of 95% for the 2022-2023 faculty yr, a rise from 28 states throughout the 2019-2020 (pre-pandemic) faculty yr. Additional, 12 states and D.C. reported charges beneath 90% for the 2022-2023 faculty yr; within the 2019-2020 faculty yr, solely three states had MMR vaccination charges beneath 90%. Total, MMR protection charges amongst kindergarteners for the newest faculty yr ranged from 81.3% in Idaho to 98.4% in Mississippi. There will also be variation in vaccination protection inside states, and, when there are clusters of unvaccinated folks inside a particular group, the danger of an outbreak is larger, as occurred in New York Metropolis in 2018-2019.
Adjustments in state vaccination insurance policies can have implications for kids’s vaccination charges. As of 2023, all states and DC require kids to be vaccinated in opposition to sure ailments, together with MMR, with the intention to attend public colleges, although exemptions are allowed in sure circumstances. All states permit a medical exemption, and 46 states (together with D.C.) permit for a non secular or private perception exemption (or each). In recent times, some teams and state legislators have pushed to loosen up necessities and broaden vaccine exemptions for college kids. For instance, some states have proposed requiring colleges to incorporate exemption data in all communications about vaccines, eliminating non-medical exemptions in child-care settings, and establishing a kids’s vaccination Invoice of Rights that emphasizes non secular freedom. Whereas many of those efforts have been unsuccessful or are nonetheless pending, some payments have turn out to be state legislation. Debate and hesitancy over COVID-19 vaccine mandates has spilled over into attitudes in direction of requiring vaccines for public colleges, seemingly growing exemptions and challenges to high school vaccine necessities.
As vaccination charges for kindergarten kids barely declined, the share of kindergarten kids with an exemption from a number of required vaccination barely elevated. The share of youngsters claiming an exemption from a number of vaccinations rose from 2.5% within the 2019-2020 (pre-pandemic) faculty yr to three.0% within the 2022-2023 faculty yr, the very best nationwide exemption charge up to now. Whereas a seemingly very small improve, any will increase in exemptions restrict the general share of youngsters in a position to be vaccinated and make it tougher to succeed in vaccination charge objectives. Non-medical exemptions accounted for many of the exemptions. Non-medical exemptions elevated from 2.2% to 2.8% whereas medical exemptions really declined barely from 0.3% to 0.2% from 2020-2021 to 2022-2023. The 2020-2021 faculty yr was the bottom level for exemptions claimed throughout the pandemic period, with the share of youngsters reporting any exemption dipping to 2.2% earlier than rising to three.0% by the 2022-2023 faculty yr.
Total, most states (36) have skilled a rise within the share of kindergarteners claiming an exemption for a number of vaccines because the pandemic started. Ten states within the 2022-2023 faculty yr had exemption charges over 5%, that means these states couldn’t attain vaccination protection charges at or above 95% even when all non-exempt kids had been vaccinated. Nevertheless, charges proven listed here are for exemptions to a number of vaccines, so probably achievable protection charges might fluctuate by vaccine kind. Within the reporting of this knowledge, the CDC notes they didn’t asses the reason for the rise in exemptions, that means the will increase might imply an increase in vaccine hesitancy or a rise in points accessing vaccines. Increased exemption charges are related to decrease vaccination protection charges, that means states with extra kids claiming exemptions report decrease vaccination protection charges. Research have additionally proven that will increase in exemption charges are related to elevated threat for illness outbreaks.
The affect of the pandemic on vaccination charges for different age teams (past kindergarteners) is extra blended, however knowledge present widening disparities. The most recent knowledge from a CDC survey of teenagers ages 13-17 (Nationwide Immunization Survey (NIS) -Teen) exhibits that vaccination protection charges have lagged for some beginning cohorts however not others. The most recent knowledge for younger kids (aged 24 months) from one other CDC survey (NIS – Baby) exhibits that general vaccination charges remained secure throughout the pandemic however disparities endured, with the hole in vaccination charges between kids residing beneath poverty and kids with larger family incomes widening. One other literature assessment discovered pandemic-related declines in routine vaccinations throughout quite a lot of age teams and famous that the pandemic exacerbated present disparities in vaccination charges.
What are latest developments in COVID-19 and flu vaccination charges?
Flu vaccination charges for kids are over thrice larger than COVID-19 vaccination charges. Whereas each the flu and COVID-19 vaccines are included within the Advisory Committee on Immunization Practices (ACIP) really helpful pediatric immunization schedule, they don’t seem to be required for college attendance, and a few states have even banned scholar COVID-19 vaccine mandates. The cumulative share of youngsters ages six months by means of 17 with a flu vaccine throughout the 2023-2024 season was 54% whereas share with the up to date 2023-2024 COVID-19 vaccine was 15%. A few of this variation in uptake could replicate parental views and issues. KFF’s COVID-19 Vaccine Monitor from September 2023 discovered most dad and mom mentioned they’d not get their little one the brand new COVID-19 vaccine together with six in ten dad and mom of youngsters (these between the ages of 12 and 17), and two-thirds of fogeys of youngsters ages 5 to 11 (64%) and ages 6 months to 4 years outdated (66%). Bigger shares of fogeys mentioned they had been assured within the security of each the flu vaccine (68%) and the RSV vaccine (63%) in comparison with the COVID-19 vaccine (48%). Additional, general kids’s flu vaccination protection declined throughout the pandemic and has but to rebound again to pre-pandemic ranges.
What elements are contributing to latest developments in kids’s routine vaccination developments?
There are a selection of things contributing to latest vaccination developments, together with shifts in public opinion and rising vaccine hesitancy, probably fueled by vaccine misinformation. A KFF Well being Misinformation Monitoring Ballot in March 2024 discovered that about one in 5 dad and mom had heard the false declare {that a} measles vaccine is extra harmful than getting the measles. Whereas many of the public appropriately seen the declare as most likely or undoubtedly false, a majority expressed a minimum of some uncertainty. This echoes findings of earlier KFF analysis and highlights the pervasiveness of false and inaccurate data and its affect on vaccination charges. Whereas confidence in vaccines remained excessive, KFF polling in September 2023 discovered that three in ten adults mentioned dad and mom ought to have the ability to determine to not vaccinate their kids in opposition to MMR, even when which will create dangers for others. This was up from 16% who mentioned the identical in an October 2019 Pew Analysis Middle ballot. Whereas vaccine hesitancy has at all times been a problem, early knowledge present misinformation associated to the COVID-19 vaccine elevated vaccine hesitancy and could also be impacting broader vaccine uptake.
Views and refusal of childhood vaccines have additionally turn out to be extra partisan because the COVID-19 pandemic. The identical KFF ballot discovered 40% of Republicans mentioned dad and mom ought to have the ability to determine to not vaccinate their kids (up from 20% in 2019), in contrast with 14% of Democrats. Additional, former Republican President Donald Trump is the primary president to brazenly assist anti-vaccination attitudes and share vaccine misinformation. In his latest campaigning, Trump has continued to share anti-vaccine attitudes and said he won’t “give one penny to any faculty that has a vaccine mandate” (his marketing campaign later mentioned he meant COVID-19 mandates solely). Unbiased candidate RFK Jr. additionally has a protracted document of opposing immunizations and spreading vaccine misinformation, making candidate vaccine attitudes one in all many key subjects this election.
Along with rising vaccine hesitancy, disruptions that led to missed or delayed preventive care appointments early within the pandemic seemingly contributed to declines in vaccination charges. For instance, for kids enrolled in Medicaid or CHIP, well-child go to charges declined throughout the pandemic, and declines in vaccination charges could also be, partially, related to declines in well-child visits. Even earlier than the pandemic, many kids in Medicaid or CHIP didn’t obtain a well-child go to inside a yr interval, signaling kids can also be experiencing boundaries to accessing care.
What are coverage choices to extend vaccination charges?
There are a selection of coverage choices and methods that can be utilized to extend vaccination charges, together with media outreach, incentives, parent-friendly web sites, school-based vaccination clinics, and college vaccination necessities. Preventive care visits are additionally an necessary element when addressing routine vaccination charges, and efforts to advertise entry to care and improve well-child visits might probably enhance vaccination charges. To extend entry to vaccines, some states have expanded the scope of pharmacists’ observe to incorporate administration of routine vaccinations for kids, and others are working to handle rural well being workforce shortages. Establishing and fostering belief between dad and mom and suppliers, group leaders, and public well being departments also can assist to fight vaccine hesitancy. KFF polling has discovered pediatricians are thought-about extremely trusted sources of data by dad and mom, and robust supplier suggestions may also help scale back disparities in vaccination protection. Faculty vaccine mandates and limiting exemptions will also be a instrument to extend vaccine uptake, although latest developments present extra states are working to loosen exemption necessities.
Medicaid covers 4 in ten kids within the U.S., together with 8 in 10 kids residing in poverty and over half of Black, Hispanic, and American Indian and Alaska Native (AIAN) kids, making Medicaid an necessary instrument for facilitating entry to vaccines for kids and lowering disparities in vaccination charges. There have been quite a lot of latest state and federal actions geared toward bettering entry to care in Medicaid and CHIP, which might in flip assist present well timed entry to vaccines. This consists of provisions to strengthen entry to complete well being providers, broaden Medicaid protection of school-based care, and promote secure protection for kids. The federally funded Vaccines for Youngsters program (VFC) offers vaccines for free of charge for kids who’re uninsured or underinsured, AIAN kids, and kids with Medicaid, and Biden’s newest price range additionally proposes increasing this system to kids in separate CHIP packages.
