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Falling Childhood Vaccination Rates Threaten Herd Immunity in the U.S.

A young girl holds her dad's hand and is comforted by her mom in the doctor's office while she gets a vaccine.

 Marko Geber / Getty Images

Key Takeaways

  • Around 40% of parents say that their kids have missed vaccinations due to COVID-19, according to data from the Blue Cross Blue Shield Association.
  • The data also showed that the United States may lose herd immunity against measles and whooping cough as childhood vaccination rates fall this year.
  • Outbreaks of preventable diseases could use up limited capacity at hospitals, which are already overwhelmed with COVID-19 cases.

There’s no doubt that COVID-19 has been the most pressing public health concern this year. In the U.S. alone, there have been over 13.4 million cases of the disease and 267,302 deaths, as of December 1. 

While the direct impacts of the disease have been devastating, the ripple effects of the pandemic—particularly fears of COVID-19 keeping people away from health facilities—may continue to impact public health for years to come. New research from the Blue Cross Blue Shield Association (BCBSA) has found that a steep drop in childhood vaccination rates is putting the U.S. at risk of losing herd immunity against highly contagious diseases, including polio, whooping cough, and measles.

What’s more, outbreaks of vaccine-preventable diseases could pose a threat to hospital capacity at a time when it’s already stretched to the limit.

Here’s what to know about the latest findings on childhood vaccination rates during the pandemic and the impact it may have on herd immunity.

Low Vaccination Rates During the Pandemic

BCBSA released a series of data on November 18 which looked at how childhood vaccination rates have fallen during the pandemic. It found that childhood vaccinations could be down by 26% (or 9 million doses) by the end of this year compared to 2019 rates.

If those estimates pan out, BCBSA says the U.S. may not meet herd immunity requirements for certain diseases after 2020. It predicts this year’s vaccination rate for whooping cough will only be about 79%—nearly 13 percentage points lower than the rate the Centers for Disease Control and Prevention (CDC) says we need to maintain herd immunity. 

Measles is another major concern. BCBSA says falling measles vaccination rates could cause the country to miss the CDC’s herd immunity benchmark for that disease by nearly 5 percentage points.

According to the CDC, there are still tens of thousands of cases of whooping cough every year. In 2019, there were 1,282 cases of measles. “These are winter diseases, so the fear is that there will be a great incidence of those diseases [in the coming months],” says Dr. Paul A. Offit, an expert in virology and immunology as well as director at the Vaccine Education Center at the Children’s Hospital of Philadelphia.

And even though BCBSA expects the country to exceed the CDC’s herd immunity requirements for polio by about 3 percentage points, it notes that the vaccination rate for that disease may be down by as much as 16% since 2019.

The findings from BCBSA build upon CDC research released in May, which also found that routine pediatric vaccinations dropped significantly during the first month after the president declared a national emergency.

Why Kids Are Missing Vaccines

Around 40% of parents say that their kids have fallen behind on vaccines due to the pandemic, according to a survey of 2,000 people BCBSA conducted in September.

Part of the problem has been people avoiding doctors appointments out of fear that they or their children could catch the coronavirus at a medical facility, says Dr. Purvi Parikh, an allergist and immunologist with the Allergy & Asthma Network, who is also a principal investigator on COVID-19 vaccine trials at New York University Langone Health’s Vaccine Center.

Dr. Purvi Parikh

If you want to know what it’s like for kids to skip childhood vaccines, the pandemic shows us what it’s like.

— Dr. Purvi Parikh

“Initially with the pandemic, we were asking everyone to stay home unless they had some acute reasons to see their doctors,” she explains. “People missed out on a lot of routine care, and we’re seeing the ill effects of that with vaccines, heart disease, allergies, asthma, and more.”

Fear of COVID-19 isn’t the only reason child vaccination rates have fallen this year, though. Dr. Parikh says that the economic fallout of lockdown measures and the lifestyle changes people have made during the pandemic may also be creating new challenges for people to keep up with basic preventative care.

“A lot of people lost their jobs, and they may have lost access to health insurance. Many people have also moved and haven’t found a new pediatrician yet,” she adds.

Another reason that immunization rates have been falling in recent years is vaccine skepticism. Social media has helped spread many myths about vaccines that have convinced growing numbers of parents to delay their child’s immunizations or forgo them altogether.

“Unfortunately in this day and age, there’s lots of vaccine hesitancy and suspicion among the anti-vaccine movement,” explains Dr. Parikh. “Certain illnesses that haven’t been around in 20 or 30 years are emerging again, and it’s a direct consequence of vaccine suspicion.”

Importance of Childhood Vaccines and Herd Immunity

Childhood vaccines play an important role in the health of individual kids, as well as the community at large.

Children’s bodies generally don’t know how to produce antibodies against infectious diseases, since their immune systems haven’t been exposed to many viruses and bacteria yet. As a result, kids are often more susceptible to severe forms of some diseases, says Dr. Parikh.

“It’s the same as how we’re all unprotected against COVID-19. If you want to know what it’s like for kids to skip childhood vaccines, the pandemic shows us what it’s like,” she says.

Vaccines give kids’ immune systems exposure to the pathogens that cause deadly diseases, like measles and mumps. That allows their body to build up defenses against certain bacteria and viruses, thus helping them avoid getting sick.

While it’s always worth finding ways to keep preventable diseases at bay, staying healthy is especially important right now while hospitals across the country are overwhelmed with COVID-19 cases.

“An outbreak of one of these diseases would be terrible for hospitals,” says Dr. Parikh. “We see kids in the ICU [intensive care unit] on ventilators and life support for weeks or months when there’s a measles outbreak. It would strain an already strained system.”

Maintaining herd immunity against deadly diseases is also important for public health in general. Some people can’t get vaccines due to their age, certain health conditions, or other factors. Making sure that everyone who is eligible for vaccines gets them helps build up herd immunity in the community, providing a level of protection for vulnerable people who can’t get immunized.

What This Means For You

Hospitals across the nation are already overwhelmed by the latest surge of COVID-19, and an outbreak of a preventable disease could make the situation even worse. Plus, vulnerable members of the community who can’t get immunized due to age or health conditions may be susceptible to catching serious illnesses if herd immunity goes away.

Pediatricians have implemented a range of safety measures to prevent the spread of COVID-19 at their offices. If children in your family have fallen behind on vaccines, consider making an appointment to get them caught up as quickly as possible.

Catching Up on Kids’ Vaccines

Have your kids fallen behind on vaccines during the pandemic? Consider making an appointment with their pediatrician to get caught up as soon as possible.

Most pediatricians have implemented a range of safety measures, such as staggering appointments, making visits as quick as possible, and requiring masks and hand washing, to prevent the spread of COVID-19 at their offices, says Dr. Offit. Call your pediatrician to understand the preventative protocols they’ve put in place to protect families.

Dr. Paul A. Offit

Physicians could do an even better job of trying to reassure parents that when they come to get their kids’ vaccines, they will be in the safest position possible.

— Dr. Paul A. Offit

“Until we get on top of this, physicians could do an even better job of trying to reassure parents that when they come to get their kids’ vaccines, they will be in the safest position possible,” explains Dr. Offit.

If you’ve lost your job and health insurance, you may still be able to get your kids caught up on their vaccines for free or very low cost through the government. The Vaccines for Children Program offers all recommended vaccines to children under age 19 who meet certain qualifications for absolutely no cost. Some state health departments also offer similar initiatives.

Federally funded health centers are another option—they offer immunizations and other preventative services on a sliding fee scale based on your income.

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Article Sources
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  2. Centers for Disease Control and Prevention. Whooping cough is deadly for babies. Updated June 29, 2017.

  3. Centers for Disease Control and Prevention. Measles cases and outbreaks. Updated November 5, 2020.

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  5. Puri N, Coomes EA, Haghbayan H, Gunaratne K. Social media and vaccine hesitancy: new updates for the era of COVID-19 and globalized infectious diseasesHum Vaccin Immunother. 2020:1-8. doi:10.1080/21645515.2020.1780846

  6. Centers for Disease Control and Prevention. Who should NOT get vaccinated with these vaccines?. Updated April 2, 2020.

  7. U.S. Department of Health and Human Services. How to pay. Updated June 2020.

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