Fear of exposure to Covid-19 appears to be exacting an unexpected toll on public health: Childhood vaccination rates have plummeted, leaving millions at risk for other life-threatening illnesses.
"We're seeing a general drop in paediatrician visits of 70% to 80% – and that's very concerning," said Dr Sara Goza, president of the American Academy of Pediatrics (AAP). She added that the pandemic has prompted many parents to skip "well visits" for their little ones.
Babies under age two traditionally get check-ups this time of year, and older kids get vaccinated for summer camp. But not this spring, she said.
Dr Sean O'Leary, an associate professor of paediatrics-infectious diseases at the University of Colorado, in Aurora, agreed. "Most practices are seeing a huge drop," he said.
Public health disaster
The US Centers for Disease Control and Prevention is trying to get a handle on the pandemic's effect on childhood vaccine rates.
"We are currently examining the impact on a national level," said Dr Melinda Wharton of the CDC's National Center for Immunization and Respiratory Diseases. The agency's findings and additional guidance will be published in the next several weeks, she added.
Evidence of a potential public health disaster is already more than anecdotal. The New York Times reported last week on a paediatric vaccine survey by the Physician's Computer Company (PCC), a paediatric electronic health records firm.
PCC contacted 1 000 independent paediatricians to collect pre-Covid vaccine numbers as well as current vaccination rates. Vaccine figures from the week ending on 16 February were compared to those from the week ending on 5 April.
The upshot: Diphtheria and whooping cough shots were down 42%, human papillomavirus (HPV) shots fell 73%, and vaccination for measles, mumps and rubella (MMR) dropped 50%, according to the Times.
The recent drop-off is worrisome, because it follows a wave of vaccine resistance dating to the late 20th century. The refusal of some parents to vaccinate their kids on health and religious grounds has led to a return of infectious diseases that had been eradicated or nearly so.
High vaccination rates
"This really is an impending crisis," O'Leary said.
The MMR shot is a must-have paediatric vaccine, experts say. It's a two-dose immunisation, with the first shot given between 12 and 15 months of age, followed by a second round between four and six years of age. The idea that thousands of kids are missing their shots is very troubling, O'Leary said.
"For decades, the US has maintained very high vaccination rates overall, despite the impression you might get from recent coverage about certain pockets of the country refusing to get their children vaccinated," he said.
To prevent disease outbreaks, vaccine coverage must be high. Typically, more than 90% of people must get their shots for so-called "herd immunity" to kick in. For the most part, O'Leary said, "that's what we've been able to do".
Now, Goza said, that society-wide protection is at risk.
"The fear is that our whole vaccine structure can crumble if parents don't bring their children in," she explained.
Patient visits down
Goza and O'Leary said several forces are keeping recent vaccine rates down: Parents are worried about going out during the pandemic; like other businesses, some paediatric offices have had the financial rug pulled out from under them; and some now offer only emergency care.
O'Leary noted that the CDC and AAP have advised paediatricians not to stop vaccinating.
But with patient visits down, some practices are struggling to pay their staff and might not even be able to afford vaccines, he pointed out. "A lot of practices are struggling or simply shutting their doors," O'Leary said.
So what's the prescription?
Some point to a renewed interest in physician house calls, or even drive-by vaccinations. But both Goza and O'Leary said the imperative must be to restore parental confidence in the safety of child-treatment facilities.
"Paediatricians are going above and beyond to make our spaces safe," Goza said. "We're constantly cleaning between patients, and using personal protective devices as needed. We're triaging with sick patients via telehelp, to keep them outside of the office, or even seeing them in the parking lot."
Afraid for 'little ones'
Staggering sick-patient appointments and well-visits is another tactic, she said, as is maintaining separate care spaces or entrances.
Like hospital emergency departments, paediatric offices also operate under the assumption that anyone can be a Covid-19 spreader, O'Leary said.
"Nobody wants their staff or patients to get sick, and everyone has quickly ramped up to do what needs to be done to provide safe care – all of which means the likelihood of Covid transmission in a paediatrician's office is actually very low," he said.
Goza said she's afraid for the little ones whose shots are getting skipped.
"We have to get the message out, because I worry about the young children, the babies," she said, recalling the days before vaccination was available for the brutal and sometimes deadly disease meningitis. "I remember those days. And I don't want to go back," Goza said.
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