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Overcoming vaccine hesitancy and access issues has become even more critical because of the COVID-19 pandemic, public health experts argued at a recent webinar hosted by the National Academies of Sciences, Engineering, and Medicine.

“Strengthening vaccine access and confidence today is more important than ever because … all across the globe we are dealing with the [COVID-19] pandemic,” Nancy Messonnier, MD, director for the CDC’s National Center for Immunization and Respiratory Diseases, said at last week’s event.

The pandemic has interrupted and delayed routine vaccinations for many people, including children, Messonnier noted.

Robin Nandy, MPH, principal adviser and chief of immunizations for UNICEF, added that a “substantial setback” in immunizations is expected. He highlighted a study from UNICEF, the World Health Organization, and others estimating that 80 million children across 68 countries were at risk for preventable diseases due to disruptions in care resulting from the pandemic.

Discussing the prospect of a COVID-19 vaccine, Messonnier said she hopes some will be available this fall, with more arriving in the winter, but expressed concern that a large number of Americans won’t be willing to be immunized.

One in four U.S. adults said they were not interested in getting a coronavirus vaccine, a recent Reuters/Ipsos poll found. Ongoing research suggests that, at a minimum, 70% of the U.S. population would need vaccine-based immunization, or infection with the virus itself, to achieve herd immunity.

In addition, vaccine confidence levels vary across different ethnic and socioeconomic groups, Messonnier noted.

“It’s very concerning to us that overall confidence in vaccines is lower in Hispanic and black communities, lower in those [of] lower income, and lower in those with lower education,” she said, citing research from the Pew Research Center.

These are also some of the same groups that are disproportionately impacted by COVID-19.

“Vaccinating With Confidence

Messonnier noted that even parents who report that they are less confident in vaccines are more likely to get their children vaccinated when they have “easy access.”

To that end, the CDC and other public health experts are working on plans for the distribution of a coronavirus vaccine, to monitor the impact of such a vaccine, and on gaining a better understanding of public perceptions of the coronavirus vaccine in order to develop effective messaging.

The anti-vaccination movement is powerful. According to recent research, anti-vaxxers have greater influence on social media than pro-vaccine activists.

However, experts know that the impact of fear as a motivator “doesn’t last very long,” Messonnier said.

As a result, the CDC is pivoting toward a strategy of “vaccinating with confidence,” which involves identifying pockets of low vaccination, working to improve vaccine access, and taking steps to try to stop misinformation.

A child’s doctor is still the “most trusted source of information” for most parents, Messonnier said, adding that, in some cases, the reassurance of those doctors has been enough to get vaccine-hesitant parents to change their minds. Strengthening the conversation between parents and providers will be a critical part of the plan to increase vaccine uptake.

Vaccine Uptake and Access

Immunization rates among U.S. children are strong overall, with more than 90% of those under 2 years of age having received their “primary series,” Messonnier said. High rates are due in part to the Vaccines for Children (VFC) program, which has also reduced disparities in coverage and reduced incidence of vaccine-preventable diseases.

The program provides vaccines for more than half of the children in the U.S., many of whom are uninsured or underinsured, she noted, adding that despite the availability of the VFC program, children without access to health insurance are nine times more likely not to have received a vaccine by the time they’re 2 years of age.

Vaccine uptake among adolescents is a “mixed picture,” said Messonnier, with 86% receiving their Tdap (tetanus, diphtheria, and pertussis) immunization, but only 52% receiving a flu shot, and only 68% receiving one or more doses of the HPV vaccine.

Only about 60-64% of adults receive their routinely recommended vaccines, and somewhere between 35-68% of adults receive the annual flu vaccine.

There are also vaccination disparities related to race, ethnicity, and location. American Indian and Alaska Native children have the lowest MMR (measles, mumps, and rubella) vaccination rates for children under 2 years. Urban-dwelling children are more likely to receive one or more MMR doses versus those in rural areas, according to a 2019 Morbidity and Mortality Weekly Report.

While school vaccination requirements have helped to protect students from vaccine-preventable illnesses, “grace periods” that allow parents to enroll their children in school, with a pledge to visit the doctor for an immunization at a later date, have proven challenging.

The number of kids who fall into these grace periods across different states is anywhere from 0.2-6.7%. Some of these children do eventually get vaccinated, while others may be children of vaccine-hesitant parents who are taking advantage of this loophole in schools’ policies. Most counties and schools lack the staff and resources to follow up with families and determine which children ultimately did receive a vaccine.

If all non-exempt children who fell into these grace periods went on to be vaccinated, most states would see a 95% MMR coverage rate, Messonnier said.

Vax “Drop Off

Messonnier said she’s worried about the “dramatic drop off” seen in rates of healthcare providers ordering routine vaccinations after March 13, when the White House declared the novel coronavirus pandemic a national emergency. This was particularly true for routine measles vaccination across all ages, with kids under age 2 faring slightly better than other groups, she added.

Parents are worried about exposing their children to COVID-19, and haven’t been going to the doctor, which is an “appropriate concern,” Messonnier stated.

But the CDC and the American Academy of Pediatrics want parents to know that it’s safe to go back to the pediatrician’s office, and are urging healthcare providers to encourage “catch-up vaccinations” through outreach to parents.

Many practices are implementing special preventive measures to help reduce the risk of viral spread. For instance, some are having “well child” visits in the mornings and seeing sick children in the afternoon.

The CDC is also urging public health officials and clinicians to disseminate information regarding the VFC program as there may be more families who are eligible for the program given the increasing unemployment rates, Messonnier said.

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