If you had asked me when our baby was born in November, how likely I would decide to postpone his vaccinations for a few months against the doctor’s recommendations, I would have told you there was absolutely no chance.
I report on global health; I know that vaccination in the United States has pretty much been eradicated, but it still costs the lives of far too many children internationally. I know that those diseases can come back in any community where vaccination rates are dropping. I know that some parents in impoverished parts of the world walk for days hoping to get their children vaccinated, and I am grateful that I live in a country where – until a few months ago – I could access vaccines for granted .
Our older child, now 3 years old, was vaccinated on time. That will not be the case for our second child, born last November.
He received his four-month vaccinations two months late and we are not sure when he will receive his next vaccinations. And we are not unique. In the United States, vaccination rates have plummeted as social coronavirus distance measures make people reluctant to leave the house and visit the doctor. Critical public health and vaccination programs have been canceled throughout the world during the pandemic.
That sets us up for a potential public health disaster on the road. As the immunized portion of the population declines, infectious and deadly childhood diseases – many of which are already experiencing a resurgence due to anti-vaxxers – may return and kill both children and adults. We live free of fear of deadly infectious diseases for a long time and vaccination is a big part of why. But the coronavirus has confused that progress, and even if a coronavirus treatment or vaccine is ultimately developed itself, it can take a long time to undo all the complex damage it has done.
In our case, our baby eventually got his pictures, albeit a few months late. But it was a nerve-racking ordeal. We live in a house with 10 people, some of whom are at increased risk of the coronavirus. The doctor’s office required us to come to the central hospital instead of opening outpatient clinics or making house calls. Our insurance refused to get coverage elsewhere. We felt adrift, without enough information to compare the risks we had to take: how bad was it to delay the baby’s shots? How dangerous was it to go to the hospital? The doctor’s assurance that it would be safe to show up did not completely satisfy us – We understood that the risk was low, but our home situation made even low risk a serious concern for us.
In the end it went fine. My partner wore a mask, took the baby to the hospital, gave him his photos and came home. The hospital screened them at the entrance for symptoms of coronavirus; everyone wore masks; the corridors were deserted. Neither my partner nor the baby got sick.
We will have to do this again in a few months; maybe the hospital will be set up for something with lower exposure by then, or maybe we’ll take our chances again. But it doesn’t have to, and there are ideas – from support for home visits by doctors to drive-through clinics – that can help ensure that every family can continue to vaccinate during a disaster.
A drop in vaccinations is well underway – and it can be disastrous
Once you have contracted an illness, you usually cannot contract it for a while because your body remembers how to fight it. Vaccinations try to elicit this immune response without making you sick in the first place. The most common approach is to introduce dead or attenuated viruses or important parts of bacteria into your system. Your immune system will learn how to fight them, but there is little risk of getting sick.
In the US, children are vaccinated against hepatitis B, whooping cough, rotavirus, diphtheria, tetanus, measles, polio and chickenpox, among other diseases. Researchers have estimated that for every year that children receive all recommended childhood vaccinations, some 20 million diseases and 40,000 deaths are prevented.
Vaccinations are simply one of the most transformative technologies in human history. In the 19th century, historians estimate that more than a third (and in many places more than half) of children died before they turned 5. Infectious diseases were the leading cause of death. Only smallpox hundreds of millions killed; we were able to wipe it out with a huge worldwide vaccination program.
Vaccinations have fallen sharply during the coronavirus crisis, both here and abroad. A May 15 study with authors from the Centers for Disease Control and Prevention (CDC) used the order data from the federal Vaccines for Children program to track exactly how much they declined. As this chart from their study shows, the answer is that they have fallen very sharply around the time of many state breaks in mid-March:
The pandemic has also disrupted vaccination programs internationally. The World Health Organization estimates that more than 100 million children globally could be vulnerable to measles because of the disruption of mass vaccination programs. At least 24 countries have interrupted or postponed their mass immunization programs.
The declines are putting us on the brink of a public health crisis. If there is a significant population of unvaccinated children, highly communicable diseases such as measles (which has a so-called R0 estimated to be between 12 and 18, meaning that the average sick person infects 12 to 18 additional people) can spread easily.
The arrival of the coronavirus exacerbates a problem that has grown in recent years. Vaccination rates are already declining, because misinformation about vaccination risks has led many parents to choose not to immunize their children. The anti-vaxx movement, backed by misinformation and social media, has convinced more and more families to postpone vaccinations, leading to disease outbreaks in communities that had previously eliminated the disease. Plunging vaccinations as a result of the pandemic will make the problem much worse, especially if many of those children never catch up.
In the past few months, when the ramifications of the pandemic hit the U.S. severely, many doctor’s offices have focused only on neonatal admissions, assuming it wouldn’t be a problem to drop boosters for older kids. But as it becomes clear that normality may last a year or more, so are they forced to reconsider. The CDC study found that vaccination declines for older children’s vaccines were much greater, likely because of the focus on younger children. However, while most vaccines for older children can be delayed by a few months, they cannot be delayed indefinitely without risking widespread outbreaks of infectious diseases as the social distance narrows.
“American children and their communities are more at risk of outbreaks of vaccine-preventable diseases,” the study concludes.
To vaccinate children in a pandemic, we need a more flexible health system
What can be done to ensure that children receive the vaccinations they need during the pandemic?
“Parents’ concerns about potentially exposing their children to COVID-19 during child visits could contribute to the declines noted,” the study said May 15. “As far as this is the case, it is crucial to remind parents that their children must absolutely be protected from serious diseases that can be prevented by vaccination, even if the COVID-19 pandemic continues.”
My experience trying to vaccinate our baby suggests that the problem is less that parents don’t understand the essential need to protect their children and more that they need options during a pandemic crisis. In our case, we had to bring our child in for his four-month wellness check, but we had a few questions for the doctor: Can we go to a clinic instead of the central hospital campus, a building complex that also treats our city’s coronavirus patients? Could a nurse pick us up from our car and give the baby his shots through the car window without taking him to the hospital? What about a home visit?
Each time, the answer was no: the hospital had not established procedures for such alternatives. They said they might do that one day, but meanwhile they insisted the hospital be safe. But at that stage of the spread of the virus, and when we were living in danger with a few roommates, we really didn’t feel comfortable taking the risk.
We looked at our other options for a while. Our insurance only covers the vaccination of the baby in the hospital. We could find providers who are not covered by our insurance and who would at least be willing to vaccinate him in an outpatient clinic rather than a hospital – for $ 500. We ended up taking him to the hospital, but I can do not blame the parents who have chosen to stay at home in the hope that a safer solution would eventually come.
Many individual consulting rooms make heroic efforts, including drive-up vaccine clinics and home visits – to fill the chasm. But not many others paralyzed by insurance rules or cuts (a lot of pediatricians and their staff have been fired as the coronavirus crisis makes doctor appointments rarer) or the rate at which the coronavirus situation and local laws have changed in recent months.
So that’s one area we can focus on: providing pediatricians home visits and drive-through vaccination clinics, and if they can’t afford that, the government should step in to give them the funding to make this possible. Of course, home visits are expensive and can endanger doctors themselves, and drive-through clinics are not a good substitute for a full wellness check under normal circumstances. But in exceptional circumstances, more options mean more flexibility for families.
More importantly, we can scale up the testing so that the doctors who see him are regularly tested for the coronavirus when we have to take our baby back for his next round of shots. We can also cover vaccinations for all children regardless of their health insurance, as we recognize that many people may need non-network providers to access vaccinations.
In developing countries, public health organizations face difficult choices between the risk of spreading the coronavirus or ensuring millions of preventable deaths among children. Better data on how the coronavirus spreads will help them identify low-risk ways to resume life-saving surgery.
Ultimately, the way to solve these issues is, of course, to successfully address the coronavirus crisis – either with extensive testing, contact tracking and isolation, as countries such as South Korea and Taiwan have done, or with an effective treatment or vaccine, although such a solution is gone for years.
However, regularly scheduled immunizations are too important to wait for the victory over the coronavirus. We should not ask parents to find out for themselves the risks of the coronavirus, or to accept the risk of their families being exposed to one disease to prevent others.
And even under normal circumstances, giving parents and doctors flexibility has great benefits. Home visits and drive-through clinics not only reduce the risk of coronavirus, they also help parents who don’t have childcare, parents who can’t easily get off work for doctor’s appointments, and parents who don’t have a good way to get to the nearest doctor. Covering vaccinations, regardless of a child’s health insurance, helps uninsured children out there millions.
Time and time again, the coronavirus pandemic has exposed the flaws in systems that were already a problem. Vaccination in the US was already under threat, putting us in a position where further declines in vaccinations put us at great risk. It is now more urgent than ever that we fix it.
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