The number of childhood and adolescent vaccines administered in Colorado dropped 19% during the first six months of the COVID-19 pandemic compared with the same period last year, confirming fears of alarmed pediatrics experts who believe the state is now vulnerable to devastating outbreaks of once-controlled diseases like measles.
The gap puts added pressure on state regulators to write tougher rules under a 2020 bill the legislature passed to make it harder for parents to claim nonmedical exemptions for school-required vaccinations, health leaders said. Those rules will be drafted and voted on by the state Board of Health this fall.
Colorado health leaders said they had begun to make good progress on raising the state’s worst-in-the-nation vaccination rate for childhood measles before the pandemic hit in March. Since then, proponents of vaccination say they’ve seen the vaccination deficit grow to over 40% year-over-year in some months, and continuing to linger at dangerously low rates.
“It’s extremely concerning,” said Stephanie Wasserman, executive director of Immunize Colorado and a master of science in public health. “In 2018, 11,000 kids were hospitalized or went to the ER in Colorado for a vaccine-preventable disease, and that was before a pandemic. It’s a health burden issue, a societal burden issue, and a cost burden issue. It’s so critically important that families stay vigilant.”
Families at first stayed away from scheduled vaccination shots because of pandemic fears that shut down much of Colorado. They told providers they were fearful virus spread and lack of sterilization in busy offices. Those concerns linger, despite what public health leaders call heroic efforts by medical offices to promote safety and reassure families.
But added to those concerns is a “why bother” effect resulting from so many school districts starting the 2020-21 year online.
“I think what’s happening is that more parents are saying they can wait because their kids won’t be in person,” said Dr. Hector de Leon, a pediatrician for Kaiser Permanente Colorado and assistant medical director of pediatrics for the system’s 600,000-patient region.
Kaiser’s system is showing 200 to 300 fewer infants are receiving scheduled vaccinations each week compared with the same week last year, de Leon said. That’s enough to threaten crucial community vaccination thresholds that approach “herd immunity” sought by public health officials — so many children are shielded that a virus can’t penetrate into the whole group.
“Once you start getting a large group of kids that aren’t getting immunized, if you fall below the 90% rate, that’s when you see vaccine-preventable diseases start popping up again,” de Leon said.
The public health leaders said the gap in regular vaccinations combines with the ongoing threat of COVID-19 and the fall start of flu season to create a triple threat more concerning than the pandemic’s start in the spring.
“We’re clearly backsliding,” Wasserman said. “We need to prioritize this. And now we’re entering flu season, so it’s critically important that children and families get their flu vaccine this year as well.”
State officials who oversee a vaccine registry recording every dose administered by Colorado pediatricians say the 19% gap from last year is highly troubling and they are trying to counteract public concerns.
“The department is launching a statewide media campaign to increase both MMR and flu vaccinations. The campaign runs September through December and will include materials to share with a variety of partners,” state health department officials said in a written statement, adding they were too busy with the COVID-19 response to conduct an interview.
State and other health leaders also said the bill passed to make it harder for Colorado families to claim exemptions from school vaccine mandates should begin helping when they take full effect in 2021. They must write rules to implement the vaccine law, and advocates will push them to give the new restrictions as much impact as possible; some public health advocates said during the bill’s debate that Colorado was still being too lenient and letting too many families exempt themselves. They believe some families drop out of the vaccination schedules because of misinformation about side effects, and others never get around to appointments and then take advantage of the past lenient exemptions.
The law requires families seeking a nonmedical exemption to school-required vaccines to either get a pediatrician to sign an official form or watch an online education course about the safety and efficacy of vaccines in children’s health. Wasserman said the state is designing the online course to be interactive and demand parents’ attention, rather than a video they can roll through and ignore.
When a safe and effective COVID-19 vaccine becomes available, expected sometime next year, it will reheat the debates over what to require for school attendance and how easily to give exemptions. A large number of Americans are already telling pollsters they are skeptical of taking any COVID-19 vaccine either out of fears the virus is a hoax or that it will have been rushed through approvals.
Colorado reported the lowest vaccination rates in the nation for kindergarten last year, after years of public health worries that the state was falling to the bottom of successful-vaccination lists. Public health officials say the ideal herd immunity levels for highly contagious diseases like measles are 94% to 95% of schoolchildren with protection; last year under 89% of Colorado children got the MMR shot, or “measles, mumps and rubella.”
Busy pediatric offices like Kaiser Permanente’s have taken extraordinary steps to reassure families that shots and other pediatric wellness visits can be safe in-person. They are frequently sterilizing offices and equipment, separating healthy and ill children by location or by timing, and sending medical professionals to new locations to reach patients.
Kaiser has drive-through shots available at its Colorado locations, with providers using overflow tents in parking lots left over from peak COVID-19 case counts. Parents drive up, and children can stay in the car or sit in a nearby folding chair for their shot.
Longer term, Kaiser’s de Leon said, doctors have found it most effective to boost their one-on-one conversations with parents during wellness visits.
“We’ve been having this conversation with vaccine hesitancy for at least the last 10 years; it’s an example of politicization of something that doesn’t need to be political. It’s a public health matter,” de Leon said.
“For some reason vaccines have been an easy target for misinformation for people. So we’ve thought about how we can be more effective. Sometimes it’s not about the data and science, it’s more about families and parents feeling a little overwhelmed by all the information and not knowing what’s true.”