This post looks at examining current trends in routine childhood vaccination in the US and provides recommendations to address long standing disparities to achieve vaccine equity.

Read the Article

Childhood vaccination rates in the U.S. have been declining since the beginning of the pandemic, with Black and Hispanic children, those with lower socioeconomic status, and those in rural areas seeing the most significant declines. In the article, “Achieving Equity in Childhood Vaccination: A Mixed-Methods Study of Immunization Programs, Policies, and Coverage in 3 U.S. States,” researchers from the University of Washington Population Health Initiative used a mixed-methods study to understand immunization patterns across socioeconomic and racial/ethnic groups over 12 years to identify local interventions and policies that contribute to improving immunization equity. They also sought to understand whether any lessons learned from COVID-19 vaccine interventions could be used to improve childhood vaccine coverage.

The project had three areas of focus:

1. They identified three states, and three representative counties within each state that had realized the most progress, least progress, and a median amount of progress in improving childhood vaccination racial equity over the past 12 years. They defined vaccine equity as all eligible children having fair access to routine childhood vaccinations and utilized National Immunization Survey – Child public-use data sets (2007 and 2019) and used logistic regression to calculate the probability of children aged 19 months to 3 years being fully vaccinated to identify trends and geographic areas of interest.
2. They interviewed key stakeholders – such as public health departments, offices for vaccine programming, Vaccines for Children program providers, community-based organizations, and academic researchers – across the three states and nine counties to identify which interventions or public policies were believed to have most effectively improved racial vaccination equity.
3. They analyzed the stakeholder interviews to identify features of interventions, programs, procedures, or policies that offer seemingly translatable benefits to other vaccine-preventable diseases to help inform public health practice.

Study Findings

• Vaccination coverage across the U.S. remained relatively stable between 2007-2019, though race/ethnicity and socioeconomic status influenced coverage.
• Stakeholders identified key qualities of interventions that effectively boosted vaccine coverage, including data quality improvement, developing tailored interventions to target specific populations, leveraging and forming partnerships across sectors (e.g., clinical-community, state and local partnerships between Community based organizations, churches, local health departments, and schools, vaccine clinics), and addressing common barriers.
• State governments wield significant power over the success of routine childhood vaccination, specifically through policies, programming, and funding.  
• Stakeholders identified data limitations as a barrier to improving vaccine coverage and equity. County data are critical to monitoring outcomes and informing efforts to improve equity, so federal, state, and county stakeholders must move beyond outdated approaches to collecting data, implement new standards for collection and reporting at local levels, and disaggregate data to improve outcomes.
• The COVID-19 pandemic has shown that it is practical and possible for states to track race/ethnicity at the state and county level and change these policies when resources and training are provided, offering a roadmap for possible improvements. Local, rural, and small counties in particular require additional resources, funds, and technical support, highlighting the role federal and state agencies play locally in how they allocate resources to improve data tracking.
• Significant data limitations were discovered through the study. The lack of routine childhood vaccination data disaggregated by race and ethnicity limited the study team’s evaluation of the vaccination trends and intervention effectiveness and significantly impacts communities’ ability to address disparities and determine the effectiveness of interventions. In addition, other data discrepancies were found between NIS and state-reported data. These issues highlight the need to improve data collection and standards at the state and the local level.

Recommendations

This study recommends how federal, state, and local government agencies can help address declining childhood vaccination trends. Health agencies should examine their childhood vaccine policies and consider new policies to improve data collection, tracking, and sharing. The findings should encourage public health professionals to learn from the lessons of the COVID-19 pandemic response, including building trusting partnerships, expanding funding and capacity, and improving data quality. Further, state and local agencies must be able to monitor and disaggregate data by race and ethnicity in order to identify and address ongoing disparities. 

Ali H. Mokdad, PhD, is a Professor of Health Metrics Sciences at the Institute for Health Metrics and Evaluation (IHME) and Chief Strategy Officer of Population Health at the University of Washington. Trained as an epidemiologist, he is a renowned expert in health surveys, surveillance systems, and small-area estimation, particularly for risk factor measurement and analysis.

India J. Ornelas, PhD, is interim chair and professor of health systems and population health at the University of Washington. Her research focuses on understanding how social and cultural factors influence the health of Latino and American Indian communities.

Kaitlin (Quirk) Brumbaugh, MPA, is a Research Coordinator at the University of Washington Population Health Initiative, where she works on several investigations of the barriers and potential solutions to improve immunization coverage. She previously worked for a community-based organization, managing various community health programs and conducting community engagement.