When Kim Wilson got pregnant three years ago, she joined an online community group for expectant and new moms. Members shared advice and offered support with few disagreements, except when the discussion turned to child immunization. Wilson recalls some moms being dead set against vaccinating their children, having bought into the debunked reports of harm and conspiracy theories. She shared those concerns with her pediatrician who took the time to explain the risks and benefits to her.
“I told her I was scared and she showed me the studies and what the numbers looked like,” says Wilson. “She helped me understand that the risk is so much greater of not being vaccinated.”
That means her daughter, 2-year-old Lauren Grace, is up to date on her immunizations and Wilson has since encouraged other mothers to do the same. But the vaccine debate is heating up again in the online forum, this time for a different reason.
“Some moms still don’t want to get them and others are just afraid to go to the doctor’s office because they fear they’ll catch the virus,” says Wilson.
The Morbidity and Mortality Weekly Report from the CDC detailed a decline in child vaccinations during COVID-19 in the state of Michigan. Fear of contracting the coronavirus has kept many parents from taking their children to doctors for well child visits, which are appointments in which doctors track a child’s growth and development and also carry out preventative procedures.
That trend has been noted in North Carolina, too. N.C. Department of Health and Human Services tracks and documents immunization ordering and vaccines administered in the state’s immunization registry, which shows a dramatic drop.
Public health and infectious disease experts worry that this decline could endanger the 93-95% vaccination rate necessary for herd immunity against diseases such as measles, mumps and whooping cough.
“We are very concerned about the significant drop in immunization rates, particularly for children,” Amy Adams Ellis, NCDHHS public information specialist, wrote in an email. “Vaccinations protect everyone from dangerous and potentially deadly diseases, such as polio, tetanus, and diphtheria. Well child visits and immunizations continue to be important during this time. Families should contact their health care provider to discuss well child visit options during this time and how to keep immunizations up to date.”
Safer patient care
North Carolina has put the force of law behind requiring vaccinations against certain diseases on a recommended schedule. Immunization records are checked when a child enters an early childhood program. Clinics and family practices across the state are working to assuage concerns about the vaccinations and encouraging parents to stay current on their child’s immunizations and maintain regular wellness visits.
The Levine Children’s Hospital in Charlotte has redesigned its care model to minimize the risk of exposure to COVID-19 to parents and children when they visit the hospital. They have implemented enhanced cleaning and everybody wears masks and PPE. Parents and children are also asked to do so. Waiting rooms are now virtual. Patients wait in their cars until they receive a text or email letting them know the doctor is ready to see them.
Dr. Lisa Reed, a family practice physician at the MAHEC Family Health Center in Asheville, says the vaccination rates for kindergarteners in Buncombe are around 95%, which is lower than the rest of the state. The non-vaccination numbers in Asheville and Buncombe County were driven by parental preference.
The pandemic has pushed non-vaccination numbers higher across the state overall, as DHHS numbers show.
Reed describes the coronavirus as “an explosion at the heart of everything that happens in medicine” when nearly all patient care was put on hold.
“For about a month, we had a really big decline in all wellness visits for children,” she said. “We needed to create an entirely new system to do that wellness care, and then outreach to our patients to get them back on the schedule.”
MAHEC has since implemented a blended telehealth model to streamline the process and make the clinic a safe space for wellness visits. Logistical changes for in-person care include a new specialty clinic for pediatric wellness visits. Patients complete the preliminary paperwork by phone so when they arrive for labs, shots or a physical exam, they are escorted into special clean rooms right away. Anyone with a respiratory complaint or fever is seen in a separate area of the clinic.
In the meantime, Reed and her colleagues are playing catch up on immunizing kids who have scheduled vaccines due.
“We’re doing outreach, talking to parents about what the experience will be like and then bringing them into the office in a way that they’re not being exposed to anyone who’s sick,” she said.
Charlotte-Mecklenburg Schools leaders are pushing this as the perfect time to get vaccinations and prevent the mad rush to catch up on immunizations once restrictions are eased.
“Some people have a more relaxed schedule,” CMS School Health Specialist Monica Adamian said in a media release. “They can get out there and go to their doctor’s office or to the health department and get those immunizations now.”
Stay-at-home orders that went into effect in March may have had the unintended effect of reducing the risks of contracting diseases like measles because in-person interactions were greatly limited. But in an op-ed published in the Charlotte Observer, Lavanya Vasudevan, assistant professor in the Department of Family Medicine and Community Health at Duke, warns that won’t continue.
“Now that some states are easing restrictions and allowing people to move about in their communities, there is a fear of outbreaks for diseases like influenza and especially measles,” wrote Vasudevan.
Reed says medical professionals worry that in six months or a year, there will be outbreaks of measles or pertussis because children have fallen behind on their vaccines.
“It’s absolutely imperative that we as a community support these families so that they can get in and get their kids vaccinated,” says Reed. “The health department doesn’t need extra outbreaks. They’re gonna be so busy with this coronavirus outbreak for many months going forward.”