Time for School — and to Talk About Childhood Vaccinations

It also means, once again, a return to close quarters indoors and therefore increased potential exposure to the virus that causes COVID-19, as well as other viruses and bacteria. Thankfully, for many of these potential infections, children are protected because they have received routinely recommended vaccines. Thankfully, this now includes COVID-19 vaccines for all children ages 6 months and up. 

As family physicians, we may also be feeling a sense of excitement and anxiety when tackling schedules filled with school physicals and the resulting conversations with families regarding routine childhood vaccines, including COVID-19 vaccines. Because of the pandemic, these discussions may need to take a different shape than in the past. We may need to spend more time emphasizing the importance of routine childhood vaccines while reassuring parents of their safety and efficacy.

The COVID-19 pandemic disrupted lives in uncountable ways. At the beginning, many medical offices were shut down and in-person care became extremely limited (and in some cases, nonexistent). As a result, many preventive health care services, including pediatric wellness exams and immunizations, were put on hold. Some families were — and continue to be — reluctant to return to their primary care physician’s office out of fear of being exposed to the virus that causes COVID-19.

Job loss at the beginning of the pandemic resulted in decreased rates of health insurance across the United States. During the first two years of the pandemic, children in low-income families were more likely to miss a wellness appointment.

Globally, the World Health Organization recently reported that during the pandemic, the world saw the largest decline in childhood vaccination rates for some infectious diseases in 30 years. In the United States, the CDC reported that during the 2020-2021 school year there was a 1% decrease in routine childhood vaccinations from the previous year. While many medical offices have resumed seeing patients in person and much of health care has returned to functioning as in the pre-pandemic days, children are still lagging in catching up on important childhood vaccines.

The invention and distribution of vaccines is widely considered one of the most important and successful achievements in public health. UNICEF estimates that vaccines save 2 million to 3 million lives annually.

Even a few generations ago in the United States, there was still real concern for the threat of children dying from diseases caused by, for example, Haemophilus influenzae and bacteria that can lead to diphtheria. There are still a small number of deaths each year from these vaccine-preventable diseases, but as a result of vaccine mandates and encouragement from trusted health care professionals like us, these rates of disease and death remain extremely low. Vaccine-preventable diseases can not only cause death, but many, such as polio, can result in increased morbidity and long-lasting negative effects on children. These diseases increase health care costs and strain an already pandemic-weary health care system.

So, in approaching this upcoming school year and with our schedules full of return-to-school wellness checks, we need to seize this opportunity to talk with our patients and their parents to remind everyone of the importance of routine childhood immunizations.

The conversations we have with families may at times feel more challenging now than in the past. As a result of the politicization of COVID-19 vaccines, and because of misinformation and disinformation surrounding them, there has been an increase in hesitancy towards other routine vaccines.

The AAFP offers a multitude of resources for physicians on the topic of immunizations and vaccines. There is an Academy fact sheet that I find helpful in referencing when talking with patients about routine vaccines. It recommends using a presumptive approach when discussing vaccines with families, and I have found this particularly useful for the HPV vaccine.

Motivational interviewing can also be used when counseling parents on accepting routine childhood vaccines, including COVID-19 vaccines. In this way, it is important to ask open-ended, non-judgmental questions, and to utilize reflective listening as well.

COVID-19 vaccine discussions with parents, as we may have experienced, can be particularly challenging. Familydoctor.org is a great resource for families on this and many other topics. The site’s COVID-19 FAQs page includes answers to many of the questions we are hearing from parents on a regular basis.

Ideally, we should be encouraging parents to follow the evidence-based immunization schedule created by the Advisory Committee on Immunization Practices. However, the pandemic has caused a delay in many children receiving their vaccines on time. In these cases, consult the ACIP’s comprehensive “catch-up” schedule for guidance in timing of immunization.

As we recognize National Immunization Awareness Month and celebrate a closer to “normal” return to school for most children over the next few weeks, we would do well to prioritize childhood vaccinations, including COVID-19, to maintain the health of each child and to prevent large-scale disease outbreaks. As primary care physicians remain one of the most trusted sources of medical information for patients, we can utilize this season of back-to-school wellness exams to continue to present accurate data regarding vaccines. There are many different techniques physicians can employ when discussing routine childhood vaccines with parents. By being encouraging and open to listening, we will find success in improving routine childhood vaccination rates.

Anne Schneider, D.O., is a practicing family physician for Edward-Elmhurst Health in Naperville, Ill., medical director of the student health center at North Central College in Naperville, and a 2021-2022 AAFP Vaccine Science Fellow.