NY Times article highlights the effect of COVID 19 on childhood vaccination

Vaccine Rates Drop Dangerously as Parents Avoid Doctor’s Visits

Afraid of Covid-19, parents are postponing well-child checkups, including shots, putting millions of children at risk of exposure to preventable deadly diseases.

Carson Sheffield, 18 months old, was attended to by Dr. Mona Doss of Boston Medical Center, as Priscilla Stout, left, prepared a vaccine for him. The pediatric ambulatory department began sending mobile vaccination units into city neighborhoods last week.

Carson Sheffield, 18 months old, was attended to by Dr. Mona Doss of Boston Medical Center, as Priscilla Stout, left, prepared a vaccine for him. The pediatric ambulatory department began sending mobile vaccination units into city neighborhoods last week.Credit…David Degner for The New York Times

By Jan Hoffman

April 23, 2020
As parents around the country cancel well-child checkups to avoid coronavirus exposure, public health experts fear they are inadvertently sowing the seeds of another health crisis. Immunizations are dropping at a dangerous rate, putting millions of children at risk for measles, whooping cough and other life-threatening illnesses.

“The last thing we want as the collateral damage of Covid-19 are outbreaks of vaccine-preventable diseases, which we will almost certainly see if there continues to be a drop in vaccine uptake,” said Dr. Sean T. O’Leary, a member of the American Academy of Pediatrics’ committee on infectious diseases.

In the last few years, early childhood immunization rates have been slipping in some hot spots around the country, and in 2019, the United States very nearly lost its measles elimination status. While current nationwide vaccine figures are not available, anecdotal evidence and subsets of data are alarming.

PCC, a pediatric electronic health records company, gathered vaccine information from 1,000 independent pediatricians nationwide. Using the week of February 16 as a pre-coronavirus baseline, PCC found that during the week of April 5, the administration of measles, mumps and rubella shots dropped by 50 percent; diphtheria and whooping cough shots by 42 percent; and HPV vaccines by 73 percent.

The doses that states distribute in a federally funded program for uninsured patients called Vaccines for Children have also dropped significantly since the beginning of March. The Massachusetts health department said its doses were down 68 percent in the first two weeks of April, compared with the previous year. Minnesota reported that its doses of measles, mumps and rubella vaccine dropped by 71 percent toward the end of March.

In Washington State, dozens of practices and clinics have had to reduce hours or even temporarily close. The state already had its biggest measles outbreak in nearly 30 years last year.

“We know our vaccine rates were already tenuous, so any additional hit to that is a great worry,” said Dr. Elizabeth Meade, president of the state’s chapter of the American Academy of Pediatrics. Dr. Meade leads calls twice a week with physicians throughout the state about how to maintain immunizations and stay solvent.

The problem is global. National immunization programs in more than two dozen countries have been suspended, which could also leave more than 100 million children vulnerable, a consortium of international organizations, including UNICEF and the World Health Organization, recently reported.

“Internationally, measles and diphtheria will pop up around the world. Even with limited travel, they can make it into the United States,” Dr. O’Leary, an immunization expert at Children’s Hospital in Denver, said.

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According to immunization experts, the optimum rate of coverage for many vaccines, known as herd immunity, is about 90 to 95 percent.

The Centers for Disease Control and Prevention, the American Academy of Pediatrics, and the American Academy of Family Physicians have each been urging doctors to maintain vaccination schedules as rigorously as reasonably possible, particularly for the youngest children. Vaccinate Your Family, a national nonprofit group, is pushing families to set reminders to reschedule canceled vaccine appointments.

Though many doctors note that vaccine-preventable diseases can be more deadly to children than Covid-19 seems to be, parents are understandably focused on the threat at hand. Over the last six weeks, the loud, consistent public message has been to keep children at home, and to take them to the doctor only if necessary.

Initially, medical practices were apprehensive too. In early March, the health clinic in Barre, Mass., called Emily Hoag to say it had postponed her baby’s vaccine appointment for a month to prevent the spread of coronavirus infection. Ms. Hoag felt conflicted: If her baby, Karson, missed his two-month immunization, she feared, he would be susceptible to any number of diseases. But if she took him to the clinic for his shots, they both might be exposed to Covid-19.

A few hours later, Dr. Kristina Gracey, a family medicine physician at the Barre Family Health Clinic, reached out to the new mother: Would she like a house call?

That afternoon, Dr. Gracey showed up at Ms. Hoag’s doorstep. After removing her shoes, meticulously washing her hands and wiping her stethoscope and baby scale, Dr. Gracey gave Karson his shots. Both mother and baby immediately burst into tears.

“Karson cried for a minute and then calmed down, and I was just so grateful that Dr. Gracey was there and able to give him the vaccinations he needed,” Ms. Hoag said.

Dr. Gracey, who has a degree in public health and has practiced in Uganda, has no qualms about home visits, which she and her colleagues are making several times a week.

“We have so many women who are struggling with what it feels like to have a child in the setting of Covid-19,” she said. “And especially for a new mom who has concerns about the risks of coming into the office, it can feel comfortable to receive care within the home.”

Dr. Gracey’s colleagues and other medical practices are experimenting with other ways to boost vaccine rates during the outbreak, including setting up a vaccination tent in a field.

Many practices now schedule well-child visits exclusively in the morning and sick visits in the afternoon, so that an office can be decontaminated at the end of the day. Some have families wait in the car and, when an exam room is ready, a gowned nurse escorts parent and child in for the vaccine.

Dr. Jeanne M. Marconi’s practice in Norwalk, Conn., which had been doing flu clinics in parking lots for years, has adapted that procedure for vaccines generally: Parents pull up, briefly roll down a car window, the child extends an arm, and a masked, gowned healthcare worker does a quick jab. Over and out.

“We’re trying to alleviate all of the fears they have and keep up with the care,” Dr. Marconi said.

Last week, the pediatric ambulatory department at Boston Medical Center, which treats nearly 15,000 children, began sending vaccination mobile units into city neighborhoods. It also stationed a dedicated van for vaccines and well-baby checkups in front of the hospital.

In the early weeks of the shelter-in-place orders, doctors concentrated efforts on vaccinating infants up to 2 years old, and waved off the disruption to the schedule for older children as temporary, saying it could readily be addressed once the restrictions lifted. But the longer that the orders continue, the more worried doctors have also become about vaccine protection for older children.

One concern is that if booster shots are missed — for diseases like measles, mumps and rubella for 4- and 5-year-olds, and tetanus and whooping cough, for 11-year-olds — immunity will begin to wane.

At 11, children should also receive their first meningitis vaccine. Preteens are recommended to get the HPV vaccine series, which protects against certain types of cancer.

Beginning next month, Dr. Eleanor Menzin, managing partner of Longwood Pediatrics in Boston, will try to vaccinate older children, when the practice’s waiting rooms will still be relatively empty. “Looking ahead, I think it’s unwise to get behind even on older kids, because of the logistics of catching them up, given what I predict will be a long period of avoiding crowds,” she said.

Many doctors already report that the backlog from canceled appointments for younger children is staggering. But summer appointment calendars are typically filled by older children, who need vaccine documentation for school and college. Pediatricians, who report that visits have dropped by 50 to 70 percent, are laying off staff; they do not know whether they will be able to handle the rush of last-minute visits in a few months.

Some health officials are wondering whether school registration policies will need to be adjusted: Because of these extreme circumstances, will states temporarily ease school vaccination requirements?

Health experts are also worried about day care centers. Licensed centers require proof of vaccination. Even assuming that parents returning to work could swiftly get immunization appointments for their young children, most vaccines take between two and four weeks before providing full protection.

Dr. Menzin, an instructor of pediatrics at Harvard Medical School, said the pandemic was a wake-up call for doctors to rethink their messaging:

“It no longer suffices for us to say, ‘We’re open if you want to come in,’ versus, ‘We want you to come in because this is important. What is keeping you from getting your child vaccinated and let’s solve that together,’” said Dr. Menzin, who has studied bus schedules with patients and helped pick days when the weather forecast suggests that they could walk to the visit.

A common retort to fears about outbreaks of vaccine-preventable illnesses is that transmission will have also dropped because of social distancing. But that assertion leaves many pediatricians shaking their heads.

“They’re at less risk right now, but that risk isn’t zero,” said Dr. Menzin. While sick visits are down, they have not disappeared: Viruses of all sorts are still making plenty of children miserable.

Despite parents’ reluctance to bring in their children to be vaccinated now, several doctors remarked on a noticeable positive shift in attitude toward immunizations, after years of a vocal anti-vaccine movement raising questions in parents’ minds.

“If anything, I’ve noticed a change in families becoming more interested in vaccines,” said Dr. Meade, who practices in Washington, which has large pockets of vaccine-hesitant families. “They’re recognizing how devastating infectious diseases can be.”

Essay Contest for Middle and High School Students

As we are all relying on scientists around the globe to find treatments and create vaccines in the fight against coronavirus, it is a great time to remember, or learn about, Dr. Hilleman! After all, Dr. Hilleman helped to create more than half of the routinely recommended childhood vaccines, and, formally or informally, he mentored many of today’s vaccine scientists. Even for those who did not have the honor of knowing him, his scientific advances are central to the foundation of vaccine science on which we are all counting.

Read on to find ways to remember and honor Dr. Hilleman during this time.

2020 Maurice R. Hilleman Essay Contest now open!
• Have a middle or high school student who is looking for things to do during social distancing?
• Know an educator teaching online?
The 2020 Maurice R Hilleman student essay contest is a great opportunity for students and teachers. Submissions are now being accepted from 6-12 grade students. Participants are invited to learn about Dr. Hilleman’s life and accomplishments and submit a 500-600 word essay that answers the question, “How was Dr. Hilleman’s integrity important to his success, and how is integrity important to you?” Entries are being accepted through June 12, 2020. Complete details and entry form are available at HillemanFilm.com/contest.

What better way for students to spend some of their home-bound time than learning, and writing, about this scientific icon? Not to mention, they might win cash and a trip to Philadelphia this fall!

Essays will be judged on adherence to submission guidelines as well as grammar and language, originality, relevance to writing prompt, factual accuracy, and organization. Judging will take into consideration author’s age. Each of three winners will receive a $1,000 cash prize and a trip to Philadelphia from October 22 to 24, 2020, which will include:
• Round trip transportation to Philadelphia for each winner and chaperone*
• Hotel room for each winner and chaperone to share for two nights in Philadelphia*
• Breakfast and private tour at the Mütter Museum of The College of Physicians of Philadelphia
• Lunch and attendance at celebratory event during which winners will read their essays and receive their cash awards
• Tour of labs at Children’s Hospital of Philadelphia Research Institute
* Transportation and accommodations coordinated through Children’s Hospital of Philadelphia

Get details and application

Bonus for teachers
As a bonus, the teacher named in each winning entry will receive a signed copy of Pandora’s Lab: Seven Stories of Science Gone Wrong, written by Paul A. Offit, MD.

View HILLEMAN full film and excerpts at home
With many of us sheltering in place, now is a perfect opportunity to rediscover the inspiring story of Dr. Hilleman’s life and work.
• Watch this clip from HILLEMAN telling how, in 1957, Dr. Hilleman was the first scientist to avert an influenza pandemic.
• Stream the film, available with closed captions in multiple languages including Spanish, Portuguese, Romanian, and English. (Fee)
• Obtain the full film on DVD or Blu-ray, available with Spanish, English, or Romanian captions. (Fee)
• View the film trailer and explore other excerpts of the film, including how Dr. Hilleman developed vaccines for mumps and hepatitis B.

Resources related to COVID-19
The Vaccine Makers Project provides many materials related to infectious diseases and vaccines. Explore some of our popular resources that help answer questions or provide context and information related to the current coronavirus pandemic:
• Visit “The Coronavirus Pandemic – Answering Your Questions” page on the VMP website. This page will be updated throughout the pandemic with new information and answers to some of the questions we receive about the current situation.
• Discover the VMP high school lessons, called “How Diseases Spread.” Lesson 1 explores the different ways that diseases spread. Lesson 2 offers a case study of the 1918 influenza pandemic, looking at how non-biological factors can contribute to the spread of disease.
• Watch VMP animations that demonstrate viral infection and reproduction, such as A Virus Attacks a Cell and How do Viruses Reproduce?
• Explore the VMP high school lesson about Vaccine Safety (HS Unit 2, Lesson 5), which includes resources to help evaluate online information, including website evaluation “pocket cards,” “Logical Fallacies and Vaccines” and “Evaluating Information.”

Stay in touch!
Questions about the essay contest, the Hilleman film, the Vaccine Makers Project or other Vaccine Education Center at Children’s Hospital of Philadelphia projects, programs, or resources? Please contact us at vacinfo@email.chop.edu.

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The Vaccine Mom Explains Cloth Face Masks during the Coroanvirus Pandemic

The Vaccine Mom Explains Cloth Face Masks During the Coronavirus Pandemic
Apr 10, 2020

Cloth face masks are now recommended by the CDC to slow the spread of the novel coronavirus disease (COVID-19). The Vaccine Mom, a molecular biologist and mother of two, discusses the CDC recommendation and explains what you should know about when, how, and where to use cloth face masks during the COVID-19 pandemic.

•CDC: Use of Cloth Face Coverings to Help Slow the Spread of COVID-19
•CDC: Prevent Getting Sick During a Coronavirus Outbreak
•CDC: If You Are Sick or Caring for Someone
•VYF: Up-to-Date Coronavirus Information (Directly from CDC)
•The Vaccine Mom: U.S. COVID-19 Updates

Like this video from The Vaccine Mom? Watch more of Taryn’s videos on Shot of Prevention.

Maine Vaccination Law Survives Referendum

A Maine law that imposes strict vaccination requirements survived a referendum on Tuesday, with voters keeping the measure that eliminates religious and philosophical exemptions.

Gov. Janet Mills (D) had strongly urged Mainers not to reject the law, set to take effect September 2021, citing the spread of the coronavirus. After the virus was first identified in China, she noted that “one of the first things that public health officials did was begin to work on a vaccine because vaccines save lives,” The Associated Press reported.

State lawmakers passed the measure last year after a surge in whooping cough cases in the state, which has one of the nation’s highest rates of nonmedical exemptions from vaccination. Medical officials had warned that the vaccination rate for the measles, mumps and rubella vaccine had dropped below 94 percent, the threshold for herd immunity, among kindergarteners.

The law would apply to students and public and private schools and universities, including nursery schools, as well as employees at health care facilities. It earned the support of every major medical organization in the state.

Those in favor of the referendum called the law a giveaway to large pharmaceutical companies. Supporters of the law noted that while vaccines account for billions in sales, they make up only a small fraction of drug company revenues.

Three Things I’ve Learned Since Losing My Son to the Flu (1/23/2020 Shot of Prevention Blog)

While people’s fear of the new coronovirus outbreak in China and its potential spread to other countries is completely understandable, the risk of becoming seriously ill, hospitalized or dying from the flu should be even more concerning to all families in the U.S.

According to the CDC, there have been at least 13 million flu illnesses, 120,000 hospitalizations and 6,600 deaths – including 39 children – from flu this season. And it’s not over yet.

Even if the flu vaccine isn’t perfect, getting the flu vaccine every year is still very important and has a lot of benefits. Getting the flu vaccine can:
•Help you get back on your feet sooner if you do get sick with the flu.
•Reduce the risk of children dying from flu.*
•Reduce the risk of serious flu complications like hospitalization for children and adults.
•Help protect people around you, including those who are more vulnerable to serious flu illness and complications due to age and/or certain chronic health conditions.
•Protect women during and after pregnancy.

In honor of the 39 children who have already died from flu this season, we are reposting Serese Marotta’s guest blog post – 3 Things I’ve Learned Since Losing My Son to Flu – from October 2017 below.


3 Things I’ve Learned Since Losing My Son to Flu

By Serese Marotta, Chief Operating Officer, Families Fighting Flu

Today is a hard day for me – it’s been eight years since I lost my five-year-old son, Joseph, to the flu.

I’m not the same person I was eight years ago. Today, I see things through a different lens as a bereaved parent. I am more compassionate, more empathic, and (generally) more understanding and patient. Losing a child is devastating, but I feel it’s my responsibility to pass on some of the lessons I’ve learned through this personal tragedy. So here’s what I want every parent to know:

1. Every parent wants what’s best for their children.

I’ve come to realize that vaccination is a sensitive issue for many people. Some parents believe in vaccination, while others do not. But what we all agree on is that our decisions are motivated by our desire to protect our children.

Whether it’s a post on social media, or a televised interview on the news, we often witness a difference of opinions regarding the risks and benefits of vaccines. However, we all make the choices we do with the information we have because we want to do what we THINK is best for our children. The disconnect occurs when we don’t agree on the validity of the information that’s available to us.

It’s not really the people that are divided, it’s actually the incorrect information on vaccines that we have allowed to divide us.

As parents, we are so overwhelmed with the sheer amount of information out there, that sometimes it’s difficult to determine what’s true and what’s false. That’s why when I have conversations with people who are hesitant, or even opposed to vaccines, I find it’s best to listen to their concerns and start a mutually respectful dialogue. Attacking one another won’t help. We need to combat vaccine misinformation by providing the correct information. I don’t want a single parent to risk their child’s life, or their own, simply because they didn’t have the correct information about vaccines.

So here’s what I know for sure; across the globe, millions of children have died due to infectious diseases and continue to do so. Sadly, most of these deaths could be prevented with vaccines. My son’s death certificate states “complications of H1N1”. I know for a fact that my child died from influenza. I also know, based on the available data from the Centers for Disease Control and Prevention (CDC), that 1,472 children have died from influenza in the United States since 2004. And I know that the flu vaccine has been safely administered in the U.S. for more than 50 years.

How do I know this? Because I made sure I got the facts and I trust the science.

2. Flu vaccines save lives.

We have vaccines for a reason. Vaccines are not created for common, non-life-threatening ailments. The fact that there is even a flu vaccine should be enough to indicate the dangers of flu. Before Joseph died, I never would have thought in a million years that flu was a threat to my healthy child. I have always vaccinated myself and my children, including for flu. Joseph passed away due to H1N1 flu, which was not included in the seasonal vaccine in 2009. The H1N1 vaccine did not become available in our community until two weeks after Joseph passed away. I do believe that if he had been vaccinated for H1N1, Joseph would likely still be here today.

Flu does not discriminate – it does not care if you’re young or old, rich or poor, healthy or immunocompromised. It’s important for people to know that flu can be a serious, even deadly, disease for anyone. Before Joseph died I was more scared of him getting hit by a car or kidnapped by a stranger. Death from flu was not even on my radar. Now I know more about flu than I ever wanted to.

During the 1918 flu pandemic, 20 to 50 million people lost their lives. Every year in the U.S., upwards of 56,000 people lose their lives due to flu, including approximately 100 children. As parents, we do everything we can to keep our children safe. So why wouldn’t we protect them from the flu, too? The flu can kill even a healthy individual. But those who are vaccinated are much less likely to die from flu.


3. Grief is not a linear process.

As a bereaved parent, my lessons would not be complete if I didn’t address grief. As bereaved parents, we often hear “you’re so strong” and “I don’t know how you do it”.

The simple answer is we weren’t given a choice.

One of the important things I’d like people to know about grief is that it’s not a linear process. There are days when I feel gracious, like I can accept Joseph’s loss, move on, and even work towards saving other children from the same fate. But then there are days when I feel like life is just unfair. Grief is a spiral and you can be anywhere on that spiral on any given day. There is no right way to grieve. For those of you that are a bereaved parent, be gentle with yourself and reach out to others for help and support. The Compassionate Friends was very helpful to me after Joseph’s death. And for those of you that know a bereaved parent, reach out to them! Speak their child’s name in conversation, ask how they are – even if it’s years after the loss. Our biggest fear is that our child will be forgotten by others.

So today, I am choosing to remember Joseph as a happy five-year-old in his Spiderman costume, zooming around our house, just happy to be alive and free. Eight years later, do I think about what Joseph would look like, how tall would he be, what sports would he be playing? Of course. But I accept that my responsibility is to educate others about the dangers of flu and the importance of annual flu vaccinations for everyone six months and older. If I, along with all the other bereaved parents who lost children to flu, don’t continue to tell our stories, then we will be doing a disservice to others.

Let our stories be YOUR lessons.

Because of my experiences, and those of many other families who have lost loved ones to flu, you can now learn how dangerous flu can be without having to suffer a similar tragedy. I am thankful that our children’s stories could potentially save your child’s life. So please share Joseph’s story, and all the family stories available on the Families Fighting Flu website, with your friends, neighbors and loved ones.

animated-fight-flu-arm-flexAnd please, remember to get your flu vaccine this year, not only to protect yourself, but also to protect your loved ones and your community. By doing so, you may just save a life and it may even be the life of your own child.

Of course, if you have questions or concerns that are keeping you from getting your family vaccinated, talk to your healthcare provider or check out the online resources from Families Fighting Flu or the CDC.

States Ranked by Percentage of Vaccinated Children

Anuja Vaidya (Twitter) – Thursday, January 23rd, 2020 Print | Email

Massachusetts has highest percentage of children who have been vaccinated, according to the most recently available data from the Kaiser Family Foundation.

The foundation analyzed data from HHS and the CDC’s National Center for Immunization and Respiratory Diseases.

Here is the percentage of children between the ages of 19 months and 35 months (roughly 1 to 3 years), who were vaccinated in all 50 states and the District of Columbia in 2017 (the most recent data available):

Note: The list includes ties and results in a numerical listing of 43.

1. Massachusetts: 82.1 percent

2. Tennessee: 79.3

3. New Hampshire: 78.9

4. North Dakota: 78.8

5. Nebraska: 77.9

6. Delaware: 77.1

Virginia: 77.1

7. Florida: 76.2

8. Illinois: 75.4

9. Connecticut: 75.3

10. Maryland: 75.2

11. South Dakota: 74.7

West Virginia: 74.7

12. Rhode Island: 74.4

13. District of Columbia: 74

Vermont: 74

14. Iowa: 72.8

15. Maine: 72.7

16. Wyoming: 72

17. New Mexico: 71.9

18. Nevada: 71.3

19. Alabama: 71.2

Missouri: 71.2

20. Colorado: 71

Kentucky: 71

21. North Carolina: 70.9

22. Pennsylvania: 70.4

23. Oregon: 70.3

24. Louisiana: 70

25. Michigan: 69.9

Washington: 69.9

26. Hawaii: 69.8

27. Alaska: 69.5

Kansas: 69.5

28. Arkansas: 69.4

29. New Jersey: 69.3

30. Idaho: 69.2

Wisconsin: 69.2

31. Mississippi: 68.7

32. California: 68.6

33. Utah: 67.9

34. Texas: 67.8

35. New York: 67.5

36. Oklahoma: 67.3

37. Arizona: 66.5

38. Ohio: 66.4

39. Indiana: 66.3

40. Montana: 66.2

41. Minnesota: 66.1

42. South Carolina: 66

43. Georgia: 65.6

More articles on rankings and ratings:
States ranked by annual healthcare cost per smoker
States ranked by adults with fair, poor health
How 29 physician specialties rank on happiness outside of work

Source: https://www.kff.org/other/state-indicator/percent-who-are-immunized/?currentTimeframe=0&sortModel=%7B%22colId%22:%22Percent%20Who%20Are%20Immunized%22,%22sort%22:%22desc%22%7D

Support for Vaccines Continues Downward Trending in US, Poll Shows (Medscape 1/16/2020)

A new Gallup survey shows that support for vaccination in the United States is declining, particularly among parents of young children.

The survey, conducted in December 2019, shows that 84% of Americans feel it’s extremely or very important that parents vaccinate their children. That matches Gallup’s prior reading in 2015, but is down 10% from 2001, when 94% of Americans felt this way.

“Widespread public support for childhood vaccines creates a wall preventing contagious diseases like measles and polio from spreading in the US, but a breach in that wall appeared in 2015 and it has not been repaired,” Gallup said in a news release.

Among parents of children younger than 18 years old, 77% feel vaccination is important in 2019, down from 92% in 2001.

The decline in Americans’ belief in the importance of vaccinating children between 2001 and 2015 occurred among almost all subgroups of the public.

Highly educated Americans with postgraduate degrees is the only group that has maintained its 2001 level of support for vaccines; 90% of this subgroup continues to believe vaccination is important, essentially unchanged from the 92% in 2015 and 2001. Perceptions of the importance of vaccination declined by at least 5 percentage points among all other education subgroups, Gallup reported.

Public Awareness Campaigns Working?

Most Americans say they are aware of the advantages and disadvantages of vaccines. In the latest survey, nearly 9 in 10 (89%) say they have heard “a great deal” or “a fair amount” about the advantages of vaccinations, up from 83% in 2015 and 73% in 2001

More than three quarters (79%) say they have heard a great deal or a fair amount about the possible disadvantages of vaccines — up modestly from 73% in 2015 but a substantial increase from 39% in 2001.

“Pro-vaccine public awareness campaigns appear to be working to the extent that more Americans — now a majority for the first time — report having heard a lot about the medical advantages of vaccines for children,” Gallup reports.

“However, more have also heard about the disadvantages. While they are not as pervasive and are being exposed as untrue, these counterarguments are still getting through, perhaps explaining why public support for vaccines remains lower than at the start of this century,” they point out.

Uncertainty on Vaccine-Autism Link Persists

Although many Americans who oppose vaccinations argue that they are more dangerous than the diseases they prevent, the vast majority of Americans (86%) continue to disagree. This is unchanged from the 87% who felt that vaccines were less dangerous in 2015 and only modestly lower than the 90% in 2001.

Currently, 11% of US adults think vaccines are more dangerous than the diseases they prevent.

Although the vast majority of Americans see vaccines as less dangerous than the diseases they prevent, only 62% feel the federal government should make all parents get their children vaccinated. In a 1991 Princeton survey, 81% felt the government should require vaccination.

Despite the well-publicized and debunked claim that vaccines cause autism, 10% of US adults still believe that vaccines cause autism in children, marking a modest increase from 6% in 2015. Nearly half (45%) do not think vaccines cause autism, up modestly from 41% who said the same almost 5 years ago, whereas 46% still aren’t sure. In 2001, 94% of Gallup survey respondents were unsure whether vaccines cause autism.

Americans with more formal education were more apt to say vaccines do not cause autism. The figure is 73% among those with postgraduate education, falling to 61% among those with a college degree only, 42% of those with some college, and 28% of those with no college experience.

Lesser-educated Americans were much more likely to have no opinion than to say they believe vaccines do cause autism. The percentage making the causal connection tops out at 12% among Americans with no college education vs 5% of postgraduates.

There was also a partisan split in opinions, with 55% of Democrats saying vaccines do not cause autism, compared with 37% of Republicans, according to Gallup.

The results are based on telephone interviews with a random sample of 1025 adults, aged 18 and older, from all 50 US states and the District of Columbia, with the margin of sampling error of ±4 percentage points.

Dr. Peter Hotez, New York Times Op-Ed 1-9-2020

You Are Unvaccinated and Got Sick. These Are Your Odds.

Comparing the dangerous effects of three diseases with the minimal side effects of their corresponding vaccines.

By Peter J. Hotez
Dr. Hotez, a vaccine scientist and pediatrician at the Baylor College of Medicine, is the author of “Vaccines Did Not Cause Rachel’s Autism.”

Jan. 9, 2020 [nytimes.com/2020/01/09/opinion/vaccine-hesitancy.html]

Vaccines prevent diseases, and being unvaccinated carries a risk. Last year, the World Health Organization ranked vaccine hesitancy, a “reluctance or refusal to vaccinate despite the availability of vaccines,” among the top 10 health threats worldwide, alongside Ebola, H.I.V. and drug-resistant infections.

To state it bluntly, being unvaccinated can result in illness or death. Vaccines, in contrast, are extremely unlikely to lead to side effects, even minor ones like fainting.

As vaccination rates have fallen, highly contagious illnesses like measles have resurged globally. For instance, measles is now widespread in several European countries. In Samoa, a Pacific island nation of about 200,000 people, almost 5,700 measles cases have been recorded since September, resulting in at least 83 deaths. Almost all of those who died were young children.

These deaths did not have to happen. In the United States, vaccine hesitancy is contributing to three public health threats: the return of measles, deaths from influenza and needless future cases of cervical cancer.

Some legislators and religious leaders question the safety of vaccines, despite scientific evidence to the contrary. In New Jersey, an effort in December to pass a bill that would end religious exemptions and require students enrolled in any school or college, public or private, in the state to be vaccinated failed to get enough votes; supporters say they will try again in the next few days to pass the bill.

Often, skeptics do not appreciate the vastly greater dangers of the diseases that vaccines prevent.

We accumulated and evaluated data from leading medical journals, the most recent edition of the reference work Plotkin’s Vaccines and the Centers for Disease Control and Prevention to compare the risks of becoming ill with measles, flu or cervical cancer to the minute chances of experiencing side effects from their corresponding vaccines.

Here is what your odds look like.

Measles Risks: Pneumonia, Infection, Death

The United States eliminated measles in 2000, but in 2019 the number of cases increased greatly, largely because of public resistance to receiving the measles-mumps-rubella vaccine.

When the disease was imported from abroad and spread across the country, unvaccinated children (and some adults) got sick. Outbreaks were concentrated in New York, Michigan, Oregon, Texas, California, Illinois, Georgia, New Jersey, Pennsylvania and Washington. In some or all of these communities there was a rise in vaccine exemptions.

In reality, the risks of side effects from a measles-mumps-rubella vaccination are vanishingly small, especially compared to the devastating effects of measles.

The measles virus is highly contagious, and is often the first childhood infection to return after vaccinations decline. And measles is a serious disease. The 2018-2019 measles epidemic in New York City resulted in 52 hospitalizations, including 16 admissions into an intensive care unit (there were no deaths). About 95 percent of those sickened were unvaccinated, incompletely vaccinated, or did not know their vaccination status.

Moreover, new research reveals that, even when patients recover, the measles virus can suppress the immune system, rendering children susceptible to serious infections like pneumonia and the flu.

In the first nine months of 2019, nearly 1,250 measles cases were reported nationwide, the highest number in 27 years. Among those cases, 89 percent were in patients who were unvaccinated or had an unknown vaccination status.

Why did this happen? Starting in the late 1990s, some parents refused the measles-mumps-rubella vaccinations for their children because of fears that vaccines can cause autism, a central tenet of the anti-vaccine lobby.

This misinformation spread after an article implying a link between the measles vaccinations and autism was published in The Lancet in 1998; it was retracted in 2010 over concerns about the validity of the results and the conduct of the study. Nevertheless, the false claim that vaccines cause autism continued to circulate on the internet and social media.

The truth is that we have overwhelming evidence from at least six studies involving more than one million children that measles-mumps-rubella vaccinations do not cause autism.

Scientists are also learning about the genetic causes of autism and have identified more than 100 genes linked to the disorder. I’m the parent of an adult daughter with autism. Through one of the most extensive genetic tests available, whole exome sequencing, we’ve now identified her autism gene. Evidence points to neurodevelopmental processes leading to autism that begin in pregnancy, well before children receive their first vaccine.

Flu That Sickened 1 in 7 Americans

The 2017-18 influenza epidemic was an especially bad one, resulting in an estimated 45 million illnesses nationwide, according to the C.D.C. An estimated 810,000 people were hospitalized and 61,000 people died, including 643 children. The majority of children who die from influenza have not received the flu vaccine.

Even though influenza ranks among the leading killers of Americans, many choose not to vaccinate, believing that the vaccine is dangerous or that it can even cause flu. (The flu vaccine cannot cause the flu because it contains only inactive or, in the case of nasal spray vaccines, weakened viruses, or is made with proteins from a flu virus.)

The risk of a severe reaction from the flu vaccine, such as Guillain-Barré syndrome (an autoimmune condition of the peripheral nervous system that can cause tingling, limb weakness or paralysis) is tiny, roughly equal to the likelihood of being hit by a lightning strike. Influenza itself can bring on Guillain-Barré syndrome; the vaccine is more likely than not protecting you from this condition.

Deadly Cervical Cancer vs. Fainting

Australia is positioned to effectively eliminate cervical cancer over the next two decades, through a vaccination campaign and increased cervical screenings. The United States is not even close to that goal because the rates of vaccination for HPV, or human papillomavirus, among teenagers has been low in many states compared to other common vaccines. Reasons for this low vaccination rate include cost and lack of access, especially in rural areas.

The HPV vaccine has also been a target of a misinformation campaign, with books and internet posts asserting that the vaccine causes teenage depression and suicide. But there is no evidence of such links. Social conservatives also claim that the vaccine encourages sexual promiscuity, but the evidence does not support this.

The actual risk? Fewer than 1 in 10,000 vaccinated people, mostly adolescents, will faint, perhaps related to fear of the injection. There is also a risk of allergic reaction, as with most vaccines — but again, this is no more likely than being struck by lightning.

Sources: Based on publicly available information from the Centers for Disease Control and Prevention and other federal agencies, with information from Plotkin's Vaccines, 7th Edition, and more than a dozen studies published in leading journals identified on the National Center for Biotechnology Information PubMed data base. These studies involve approximately 1 million human subjects. Other sources: Dr. Daniel A. Salmon and Dr. Matthew Z. Dudley, Johns Hopkins University Bloomberg School of Public Health; “The Safety of Influenza Vaccines in Children: An Institute for Vaccine Safety White Paper,” National Center for Biotechnology Information, National Institutes of Health; World Health Organization; National Safety Council (lightning deaths); Clinical Infectious Diseases (Guillain-Barré Syndrome and influenza); ReliefWeb (Samoa figures)

Thousands of young women in this country are being condemned to cervical cancer (and both men and women to throat, anal and other cancers) by being deprived of the HPV vaccine, which is both highly effective and safe.

As a vaccine scientist, pediatrician and the parent of an adult daughter with autism, I meet regularly with pediatricians, nurses and worried parents. Parents want to do what’s best for their child, but too often they become the victims of anti-vaccine misinformation campaigns.

Medical professionals need to find a way to counter the anti-vaccine media empire by mounting a vigorous pro-vaccine advocacy response that rebuilds public trust.

In my experience, once I explain how vaccines save lives with minimal risk, it is possible to overcome the fears and apprehensions that parents have about vaccines.

As New Jersey legislators return to work, I hope that they will consider the true risks of religious exemptions for vaccines. Our children’s lives are on the line.

Peter Hotez (@PeterHotez), a pediatrician and the dean of the National School of Tropical Medicine at Baylor, is the author of “Vaccines Did Not Cause Rachel’s Autism.”
Bill Marsh is a graphics editor for the Sunday Review. After 14 years with The Philadelphia Inquirer, he joined The Times in 2001, working on the Science desk and later for the Week in Review.

CDC Pink Book Webinars


Pink Book Webinar Series

Epidemiology and Prevention of Vaccine-Preventable Diseases Pink Book cover

This online series of 15 webinars provides an overview of the principles of vaccination, general recommendations, immunization strategies for providers, and specific information about vaccine-preventable diseases and the vaccines that prevent them. Each one-hour webinar explores a chapter from the 13th edition of “Epidemiology and Prevention of Vaccine-Preventable Diseases,” also known widely as “The Pink Book.”

2019 Pink Book Webinar Registration


Immunization providers: Physicians, nurses, nurse practitioners, pharmacists, physician assistants, DoD paraprofessionals, medical students, state and local immunization programs, etc.

Continuing Education

Continuing education will be available for each event.

2019 Webinar Schedule & Archives

(All events begin at noon eastern time.)

2018 webinar schedule with presentation information
Date Topic
June 5 Principles of Vaccination
June 12 General Best Practice Guidelines, Part 1
June 19 General Best Practice Guidelines, Part 2, and Vaccine Safety
July 10 Immunization Strategies
July 17 Vaccine Storage and Handling and Vaccine Administration
July 24 DTaP/Tdap
July 31 Rotavirus and Hepatitis A
August 7 Meningococcal Vaccines
August 14 Measles, Mumps, Rubella
August 21 Polio and Hib
August 28 Varicella and Zoster
September 4 Hepatitis B
September 11 HPV
September 18 Pneumococcal Vaccines
September 25 Influenza