- Dr. Lewis First
Childhood diseases haven't gone away simply because our attention is focused on COVID-19. Unfortunately though, the pandemic has reduced the number of children receiving routine immunizations, raising fears that Vermont could see a resurgence of vaccine-preventable illnesses.
As Dr. Lewis First, chief of pediatrics at the University of Vermont Children's Hospital, explains, keeping kids on schedule with the mandatory immunizations required for attending K-12 public schools has never been more important. Not only will routine vaccines protect the health of your own child and fellow Vermonters, they will also help ensure the strength and resilience of the state's health care delivery systems.
KIDS VT: What impact has COVID-19 had on childhood vaccination rates?
LEWIS FIRST: When the pandemic arrived, it resulted in stay-at-home orders that reduced medical visits to essential care only. As a result, annual checkups and routine vaccinations initially weren't a top priority. We know that, in Vermont and around the country, vaccination rates for all diseases dropped. The good news is, once we started to reopen and medical offices adopted suitable precautions against COVID-19 transmission, vaccine rates rose again, but they're still not where they were a year ago in Vermont. That's a problem.
LF: Vaccinations prevent serious diseases and literally save lives. Health-wise, children are faring well with the coronavirus pandemic, and we don't want to see unnecessary illnesses and deaths because we became lax on routine vaccinations. I can't emphasize enough how important it is that we keep vaccination rates at or above 95 percent, which is where we were in 2019. When rates drop below 95 percent for a recommended vaccine, we open the possibility that children are going to get these diseases. This has happened with outbreaks of measles and whooping cough in areas where people chose not to get their kids vaccinated. According to the Vermont Department of Health, more than 95 percent of K-12 students had all their required vaccines as of 2019. But some schools had immunization rates below 95 percent. So, there's still work to be done.
KVT: Why is this so important now?
LF: Thanks to rapid advances in telehealth, we can do a lot of routine screenings and health assessments without having children and their caregivers come into the office. But we still need to find a way to get children vaccinated, meaning they need to be seen in-person to receive their immunizations so that, in the midst of the pandemic, we're not using up health care resources on illnesses that are entirely preventable and could really overwhelm the health care system.
Consider the 1950s and early '60s, before the measles vaccine, when there were more than 500,000 measles cases in the United States and hundreds of childhood deaths. By the 1970s, there were zero deaths. We thought measles was finally eradicated by the turn of the 21st century, until measles vaccination rates dropped and cases of measles returned.
Now, think about the coronavirus pandemic. Here we are with millions of cases worldwide and in the United States. If we get a vaccine, hopefully soon, we'll see an end to this pandemic and the many thousands of people dying from COVID-19. The suffering and deaths that could be caused by children missing routine vaccines could be far greater than COVID itself. We don't want to trade one health care crisis for another.
KVT: Some vaccine skeptics claim that giving children too many vaccines simultaneously overwhelms their immune systems and makes individual vaccines less effective.
LF: Those claims are simply not true. The number of germs targeted by vaccines, though important ones, are only a tiny percentage of the number of germs the immune system fights every day.
Secondly, the immune system stays strong after receiving a vaccine and can rev up to fight whatever comes its way. In other words, one vaccine or multiple vaccines don't weaken the immune system.
KVT: Why do children receive multiple vaccines simultaneously?
LF: We give multiple vaccines when children are at an age when infections that we are trying to prevent with vaccines tend to flare up and are at greatest risk. The Centers for Disease Control and Prevention and the American Academy of Pediatrics, who set the recommended vaccine schedule, find that if you delay vaccines or stagger them, you're losing precious time, during which your child can become infected. At the same time, we find that many parents who want to stagger the vaccine schedule and give only one at a time never return to complete the vaccine series because they lose track or the visits become too costly and time-consuming. Nowadays, we're immunizing children against 16 different diseases. So being able to cover many of those diseases with multiple vaccines in a single visit is well worth the investment to protect them from debilitating and deadly illnesses.
KVT: What about the flu vaccine, which often isn't as effective as others?
LF: No vaccines are 100 percent effective. But if they're 80 or 90 percent effective or higher, which many of them are, then you're dramatically reducing the likelihood of children contracting those diseases. Each year, vaccine developers develop the flu vaccine to protect against strains with the most likelihood of occurring within our country. Even if they choose the wrong strain for that season, there is still thought to be cross-reactivity, meaning that if you get the flu with a strain of the virus not covered by the vaccine and received a flu shot, it tends to be milder than if you didn't get the vaccine.
Also, flu symptoms look very similar to COVID-19. So, if we see more people contracting the flu because they did not get the annual flu vaccine, that will require more people getting tested for COVID. That could deplete limited testing resources, slow down the time to get results back and possibly even take up hospital beds. Finally, the ideal timing for children to receive the flu vaccine has not changed. We still want children to get vaccinated by the end of October, before peak flu season arrives, but the vaccine can be given throughout the fall and winter season and still make a difference.