Improving Childhood Vaccination Rates

Recently, the mother of a young child confessed to me that she didn't know any parents who were following the recommended immunization schedule for their children. She said that when she told her pediatrician she'd like to follow an alternative schedule, the physician had simply acquiesced, leading her to assume that the recommended schedule had no advantage over the one she suggested.

Despite the phenomenal success of childhood vaccination, thousands of U.S. parents refuse selected vaccines or delay their administration. Some choose not to vaccinate their children at all. These parents are not a homogeneous group: some object to immunization on religious or philosophical grounds, some are avoiding an apparently painful assault on their child, and others believe that the benefits of at least some immunizations don't justify the risks. Since parents today have little or no experience with vaccine-preventable diseases such as polio, Hemophilus influenzae type b, or measles, they can't easily appreciate the benefits of vaccination or the risks of not vaccinating.

In 2010, California reported over 9000 cases of pertussis — more than the state had seen since 1947. Of these, 89% occurred among infants younger than 6 months, a group too young to be adequately immunized and largely dependent on herd immunity for protection from infection. Ten of these infants died from their infection.

At first glance, U.S. vaccination rates appear reasonable: coverage among children entering kindergarten exceeds 90% for most recommended vaccines. A closer look, however, reveals substantial local variation. In Washington State's San Juan County, for example, 72% of kindergartners and 89% of sixth graders are either noncompliant with or exempt from vaccination requirements for school entry. Only 52.5% of kindergartners and 4% of sixth graders were adequately immunized against pertussis for the 2010–2011 school year.1 Not surprisingly, the county also has one of the state's highest incidence rates of pertussis.

Continued outbreaks of pertussis, measles, and H. influenzae type b indicate that U.S. vaccination levels are inadequate. Some physicians have taken matters into their own hands, refusing to see children whose parents won't allow them to be vaccinated. Others encourage alternative vaccine schedules in an effort to accommodate worried parents. Neither of these represents an adequate solution.

Cited from NEJM.org