Infants and toddlers from lower-income families are more likely to miss important vaccinations in their first three years of life, with more than 25% missing either vaccines or booster shots, according to University of Virginia researchers.
The review of national statistics from 2009 to 2018 shows only 72.8% of small children received the full series of recommended vaccines in the first 35 months of life. That compares with rates of 90% or more in many developed countries, researchers said.
Those Americans less likely to receive the vaccine series include African American children, children born to mothers with less than a high school education and those in families with incomes below the federal poverty line.
That comes despite more people being vaccinated across the country and the creation of federal programs to reduce the vaccines’ costs, researchers said.
“We have seen an increasing trend of childhood vaccinations in this country. It’s risen by almost 30% in the last decade or so, but we still have not reached the levels of other developed countries,” said Rajesh Balkrishnan, of UVa’s Department of Public Health Sciences.
“We are on an upward slope for childhood vaccinations. But what we’re finding is that, much like the COVID-19 vaccine, those in families with low income, low education or of minority race or ethnicity are less likely to receive the vaccinations.”
The researchers reviewed data from the National Immunization Survey conducted annually by the Centers for Disease Control and Prevention. The research team consisted of Ansh A. Kulkarni, Raj P. Desai, Hector E. Alcala and Balkrishnan. Balkrishnan is also a consultant for pharmaceutical giant Merck.
Among vaccines being missed are Hepatitis B and A; diphtheria-tetanus-pertussis; pneumonia; polio and measles-mumps-rubella-chicken pox; and influenza. Some children may get initial shots but miss booster shots, the study showed.
“The childhood vaccines have been around for decades and have had many studies done. They are extremely safe, extremely cost effective and protect an individual against a lifetime of disease and disability,” Balkrishnan said.
“Yet, every year there is a measles outbreak in the U.S., so clearly we have not reached the levels of vaccination and immunity that we need. There is no herd immunity to many of those. We actually have less childhood vaccination in the population than many low- to moderate-income countries.”
The 30% increase in total vaccination for infants during the time frame also saw great demographic disparity develop. In 2009, families below the federal poverty line were 9% less likely to get the full vaccine series than families with annual income above $75,000. In 2018, low-income families were 37% less likely to complete the vaccine series.
Mothers who had not completed high school were only 7.8% less likely to have their children vaccinated in 2009 than those with a college education. In 2018, that figure rose to almost 27%.
Among African Americans, completion of the vaccine series was significantly lower than for children of whites or Hispanics.
“These findings are particularly important in the context of the current COVID pandemic,” Balkrishnan said. “Particular attention needs to be paid to vulnerable populations in ensuring availability and access to important life-saving vaccines.”
Balkrishnan said that, although federal programs make the shots free, doctors often charge administrative costs. That expense can be enough of a disincentive to turn poorer parents away.
“Unless you have Medicaid or health insurance, there is a concern that the doctor’s office visit can cost $150 to $200. For people who don’t qualify for Medicaid or don’t earn enough income to pay for private insurance, they can fall into the gap,” he said.
According to the CDC, access to medical care, including vaccines, can be difficult for minorities and those with lower overall incomes. That has been proven in the pandemic, when lower-income people and minorities have been more likely to require hospitalization, more likely to be need intensive care and more likely to die, officials said.
“Health care access can be limited for these groups by other factors, such as lack of transportation or child care, inability to take time off work, communication and language barriers, cultural differences between patients and providers, not having a usual source of care, and historical and current discrimination in health care systems,” CDC officials said on the organization’s website.
“Some people from racial and ethnic minority groups may hesitate to seek care because they distrust the government and health care systems. This distrust may be due to the roles of the government and health care systems in current inequities in treatment and their responsibility for discriminatory, unethical, and abusive historical events,” the CDC wrote.
In the case of COVID-19, public health officials have reached into neighborhoods to take the vaccine to those who may otherwise lack access to it. That’s something that could be applied to other vaccines, researcher said.
Although results are preliminary, UVa researchers involved in studies of the COVID vaccines in children ages 12 to 15 say the vaccines appear to be highly effective. If that bears out, the COVID-19 vaccines could be made available to younger children. That, researchers say, may give public health officials a chance to address other vaccines at the same time.
“I’m hoping we use it as an opportunity to say, ‘here’s your COVID vaccine, and, oh, you also need your measles-mumps-rubella.’ That’s what we’re trying to do globally with polio. We’re close to eradicating polio and using the [COVID] vaccination as an opportunity for comprehensive health care,” said Dr. William Petri, vice chairman for research for UVa’s Department of Medicine.
“We have problems with access to medical care, as well as people not wanting to receive medical care, specifically vaccines,” Petri said. “I hope the emphasis on safety of the COVID vaccines by the federal government will help people realize that all of the vaccines are under stringent scrutiny for safety.”
Balkrishnan said childhood vaccines, including the HPV vaccine, are effective ways to eliminate some diseases.
“There are some people who still pay attention to widely debunked studies that were completely cooked with manufactured data,” he said. “These [childhood] vaccines are really no-brainers. They protect against a lifetime of diseases from pneumonia to measles. These are vaccines parents should want their children to have.”