Parents and pediatricians across the US are not vaccinating their children during the coronavirus pandemic, leading experts to warn that such delays could cause outbreaks of preventable diseases later in the year.
“Immunization is an essential health service which may be affected by the current Covid-19 pandemic,” the World Health Organization said recently in a statement. “Disruption of immunization services, even for brief periods, will result in increased numbers of susceptible individuals and raise the likelihood of outbreak-prone vaccine preventable diseases (VPDs) such as measles.”
Amid the Covid-19 public health crisis, some parents who normally support vaccinations are recoiling at the idea of taking their kids to a doctor’s office. Meanwhile, providers are figuring out whether they can safely treat all their young patients in-person, and if not, which children take priority.
Lauren Begen’s son was supposed to go for his six-month vaccines in mid-April. But, as Boston barrels toward the apex of its Covid-19 outbreak, their family is staying at home as much as possible to avoid exposure to the virus. They’re making decisions they never thought possible, including delaying their baby’s booster vaccinations after speaking with their doctor.
“I don’t love it, but I think honestly it was kind of obvious,” Begen said. “I mean, they’ve put a lot of practices in place to protect themselves and patients, but the reality is you can only do so much.”
The risk of prevention
It’s a series of calculations that will, at best, cause short-term delays in some children’s immunizations and at worst could lead to outbreaks or even a potential epidemic, experts say. The extent of the problem depends on how long vaccinations get pushed back and whether children who have missed a dose or two can get on their doctors’ calendars before returning to school or daycare.
Doctors in the US are supposed to administer doses of the same vaccine every few months to the infants in their care. Such inoculations ward off serious conditions such as rotavirus, pertussis (aka whooping cough), tetanus and polio, according to the recommended child and adolescent immunization schedule for 2020.
“Could we see an outbreak, let’s say, six months from now? Yeah, I think we can,” said Leila M Iravani, a pediatrician at Total Pediatrics of Orange County in Costa Mesa, California. “I think so. We’ll see sicker kids because they were not immunized.”
Iravani usually examines between 15 and 18 children every day for check ups. But during the coronavirus pandemic, that number has more than halved due to cancellations and no-shows. She estimated that up to 60% of those missed appointments are for vaccines, and probably 50% of those are younger than 2 years old.
“We can do telemedicine for the development, but those vaccines are gonna be the thing that’s gonna protect them,” Iravani said.
Her practice is trying to chase down its patients who are most at risk if they don’t get their vaccinations on time. Parents of two-month-olds are still largely coming to their check-ups, she said; older babies, less so.
Sometimes, parents claim they forgot their appointment and reschedule, only to flake a second time. It’s an unprecedented turn of events for Iravani, who’s been practicing medicine for 17 years.
“This just speaks to the worry that a lot of parents have. They just don’t want to risk coming out,” she said.
Even before the Covid-19 pandemic, the US has been dealing with isolated outbreaks of preventable diseases as states saw a decline in the number of vaccinated young children due to misinformation and fear of inoculations. In April 2019, the Centers for Disease Control and Prevention (CDC) announced the greatest number of measles cases in the country since 2000, when the ailment was eliminated domestically.
Youngest get top priority
Other healthcare providers the Guardian contacted said they haven’t experienced the same dramatic dip in visits as Iravani has seen. But they in turn have had to change whom they allow into their offices – and, as an extension, which children get their vaccinations as expected.
In the face of Covid-19, the American Academy of Pediatrics (AAP) has said that “immunizing the youngest children is top priority”. So, at Cook Children’s Pediatrics in Trophy Club, Texas, check ups for healthy kids who are older than 18 months have been temporarily postponed. Justin Smith, the pediatrician there, said he’s asking families to call back in May for an update or to reschedule.
Likewise, Mary’s Center, a community health center with locations in Washington DC and Maryland, has decided to cut off immunizations right now at 15 months, knowing they’ll have to do a big push this summer to bring kids in who missed their vaccines.
“A lot of our patients have to take three or four buses” to reach the medical centers, said Jessica Schroeder, director of pediatrics for the group. “There’d be a lot of exposure to try to get to the clinic.”
Last week, Vaccines for Children – a federally funded program that gives free immunizations to families who can’t afford them – reached out to the nurse manager at Mary’s Center about the drop in their orders and use of vaccines, Schroeder said.
“It’s a fine line,” she said. “You don’t want to put kids at risk for getting sick, yet you don’t want a pertussis outbreak, either.”
In New York, Tova Bourque got a call from her 8-month-old son’s doctor cancelling his hepatitis B vaccine for later this month. She was frustrated with the situation of the pandemic, but understood her doctor’s actions.
“I like things on schedule, so I’m kind of not happy about it,” Bourque said. “But at the same time, like, I don’t want to go to some germ fest.”
Pediatricians are being careful, limiting the number of people attending visits, taking everyone’s temperature before letting them inside, funneling patients straight to exam rooms and asking providers to wear masks. Some offices are having virtual sick visits or moving sick care to the afternoons only.
But not all people who are Covid-19 positive show symptoms, and some screening methods – such as asking whether other family members are sick – rely on the honor system. At the same time, pediatricians are fielding different risks depending on how many coronavirus cases are confirmed in their area and whether they have the luxury of converting one of their offices to care exclusively for sick patients, said Kate Williamson, a pediatrician in Ladera Ranch, California, and spokesperson for AAP.
“Call your [healthcare] provider,” advised William Schaffner, medical director of the National Foundation for Infectious Diseases and a professor at Vanderbilt University School of Medicine. “Have a discussion with people in the office. Listen carefully to their instructions about what it is to do, and how we can do this with maximum safety.”
O’Hagan Blades, a new mom to Arthur, said she felt better after learning his doctor’s practice wasn’t seeing sick kids in the office anymore. Neither she nor Arthur has ventured beyond their home in Brooklyn, New York, since the first week of March, a stark contrast to her fantasies of picnics in the park with her newborn.
But on Thursday, Blades will don a mask, cover Arthur in his stroller and walk 40 minutes to his pediatrician’s office.
“I have concerns about leaving the house with him obviously, but I think that getting the vaccines are more important,” she said. “It would be stupid to get a preventable disease because we’re trying to avoid Covid.”
