What most worries a child vaccine expert as immunization rates plummet during COVID-19

When I recently contacted Dr. Kathryn Edwards to talk about childhood vaccines, she said I’d “reached the right person.” The scientific director of the Vanderbilt Vaccine Research Program at Vanderbilt University, she has been studying and evaluating vaccines for children and adults for four decades.

So she was obviously discouraged to learn that youth vaccination rates have dropped significantly during the COVID-19 pandemic, as parents kept their children away from the doctor’s office over fears of contracting the coronavirus.

I spoke to Dr. Edwards by phone about what the long-term consequences of fewer kids getting immunizations might be and what the public health community can do to reverse this trend, even as the pandemic continues. (Her responses here have been edited for clarity and length.)

Q. Were you surprised that childhood vaccination rates had fallen?

A. It wasn’t surprising in that we knew that all of our visits to the hospitals and clinics have been markedly reduced. I think people were certainly heeding the concerns about social distancing and staying away from others.

I also began to hear from colleagues all over the world that they were seeing these same reduced immunization rates, from the fact that people were staying home.

But I think now it’s time we need to focus on getting children vaccinated.

Q. How can we make sure that kids start getting vaccinated again?

A. There are a couple things that are important. Parents can and should talk to their pediatricians or providers, or whoever administers their children’s vaccines, about how to make the vaccination visit safe for the child. What’s being done in our area (Nashville, Tennessee) recently is that well-child and baby visits are being focused on at one particular time, and children who are ill are seen at another time. We don’t want a healthy child to catch something from the other children at the clinic.

There are a number of other practices that can be used, like when the doctor is ready to see the child the child may come in from the car and go right into the patient room.

One thing the pandemic has also taught us is that diseases are an airplane ride away. Certainly we know that measles outbreaks have been a result of importation from populations that are experiencing outbreaks. The diseases that are prevented by immunizations are still around. We need to protect against them.

The vaccinations need to be brought up to higher levels. We need to protect children from diseases other than COVID as well.

Q. Which childhood diseases are you most worried about returning?

A. People are getting really sophisticated about epidemiology these days. Everybody knows the R0 (pronounced “R-naught,” this is the number of new cases that an infected person is likely to cause) for COVID. We know that R0 must be less than one to show that transmission has stopped and as a benchmark to reopen.

The R0 of measles is 15 to 20. One person generally infects 15 to 20 people.

The level for herd immunity for COVID is 65% to 70%. With measles, it’s 95%. Ninety-five percent of kids have to be immunized to keep measles from spreading. It’s always the disease that worries me the most.

Generally our childhood immunization rates in the United States have been 85% to 90%. Certainly we want it to be 100%, but for children who are at risk (because they’re too young to be vaccinated or have compromised immune systems) the more vaccinated people they’re surrounded by, the greater their protection from disease, even for children who can’t get vaccinated (for medical reasons).

Measles is always the one that worries me. It can be a serious infection, and certainly there are children who aren’t being vaccinated in some parts of the world.

Whooping cough and meningitis can also be prevented by vaccinations too. We don’t want to see those come back either.

Q. What other procedures or policies can help bring back the vaccination rates back up after losing ground during the pandemic?

A. Certainly people feel more comfortable if they understand what’s being done in their doctor’s offices and by the public health community as a whole. It’s very reasonable for families to call their doctor’s office: ‘How can I get my 4-month-old vaccinated? I don’t want them to be around other children who are ill.’ If parents have questions or concerns, they need to ask their doctor. If they’re worried, they need to ask about it. They need to feel comfortable with what’s being done (to protect the safety of patients).

Q. How do you plan to track the effects of all the delayed vaccinations in the months to come?

A. We have really good systems to follow the numbers of cases of vaccine-preventable diseases. Certainly we know all about the disease outbreaks (of measles) in New York or New Jersey. When diseases come back, there are reports and we see what the impact is. Fortunately at this point, I have not seen any data that these other diseases have come back.

It could happen whenever children come in contact with the infections that vaccines are designed to prevent. If they were exposed to a child with measles now and they were not immunized, then they could get measles.

If we act promptly and get caught up on vaccinations, we may not have lasting adverse events from the delay. That would be the best result: to get everybody caught up and get everybody as healthy as possible.

Q. Are there any other long-term ramifications of delayed vaccinations?

A. There can be long-term consequences of childhood diseases that are prevented by vaccines. If, for instance, you don’t get the meningitis vaccine and you get meningitis, there can be complications of hearing loss and developmental disability. You want to prevent the disease so you also prevent the long-term side effects of the disease.

Q. Are there any situations where the risk of COVID-19 infection outweighs the benefits of getting childhood vaccinations?

A. We are responding to the pandemic in a graded manner. If you lived in New York City several months ago, you might appropriately have decided not to take your child for immunization. But with the R0 close to 1 or less than 1, immunizations can be safely given. That contagion has decreased. Offices are making arrangements to separate well and sick kids. Immunization appointments need to be restarted again. It’s time to get caught up.