Transcript for Vaccine Telebriefing

00:00

Hello and thank you all for standing by. At this time, I would like to inform all participants that your lines are on a listen only mode until the question and answer session of today’s conference. This call is being recorded. If you have any objections, you may disconnect at this time. I will now turn the call over to Mr. Ben Haynes. Sir, you may begin.

00:20

Thank you, Christy, and thank you all for joining us today. We’re joined by Dr. Georgina Peacock, Director of CDC Immunization Services Division and Dr. Sean O’Leary, chair of the American Academy of Pediatrics’ Committee on Infectious Diseases. Both will provide opening remarks about today’s report on pediatric immunization before taking your questions. During that question and answer period, we’ll be joined by Dr. Shannon Stokley, who is the Deputy Director for Science Implementation of CDC’s Immunization Services Division. I want to note that this briefing is embargoed until 1pm, when the report goes live on the CDC website. I will now turn the call over to Dr. Peacock.

01:03

Good afternoon. And thank you for joining us. Today, the CDC is publishing two reports that provide updated information about the impact of the COVID 19 pandemic on routine childhood immunizations, and that also highlight the importance of maintaining high vaccination coverage. The first study shows that while overall vaccination rates among kindergarteners remain high, there were continued declines in vaccinations during the COVID 19 pandemic. During the 2021 2022 school year, National Vaccine vaccination coverage among kindergarten children dropped to 93%. This marks a one percentage point decline since the 2019-2020 school year, and a two percentage point drop since the start of the pandemic. While this might not sound significant, it means nearly 250,000 kindergarteners are potentially not protected against measles alone. And we know that measles, mumps and rubella vaccination coverage for kindergarteners is the lowest it has been in over a decade. This analysis is based on data collected by state and local immunization programs. The second report shows that national coverage by age 24 months remained strong with most vaccines, and even increased among children born in 2018 and 2019, compared to those born in 2016 and 2017. This analysis is based on data from the National Immunization Survey child, or NIS-Child. While we continue to monitor the impact of the pandemic, we are encouraged that this report did not identify a national drop in vaccination coverage among children aged 24 months at the beginning of the pandemic. However, these new findings also revealed persistent – and in some cases, widening – disparities in coverage. For example, the report found that coverage with the combined 7-vaccine series for children living below poverty or in rural areas decreased by four to five percentage points during the pandemic. The report also found the percentage of uninsured children not vaccinated by their second birthday was eight times that of privately insured children. These data add to previous research that highlights the impact of the COVID 19 pandemic on routine childhood vaccinations, as well as ongoing disparities in coverage. In 2022, two communities in the United States responded to outbreaks of measles where children had been hospitalized, and one community reported a case of paralytic polio in an unvaccinated person. These outbreaks were preventable. The best way to prevent these diseases and their devastating impact on children is through vaccination. While overall routine vaccination remains high, these recent outbreaks and data underscore that under= and unvaccinated children are at risk for serious illness. We believe there are multiple reasons for the declines in vaccination, and we are engaging in numerous strategies to address them. We need parents, health care providers, schools, and communities to work together with us and state and local health departments to help reduce barriers, increase access, and strengthen vaccine confidence.  To help address pandemic-related declines in routine immunizations, this week, CDC launched Let’s RISE, an initiative to equip partners and health care providers with actionable strategies, resources, and data to support getting all Americans back on schedule with their routine immunization. More information about Let’s RISE and access to routine immunization resources and data can be found on the CDC website. We also continue to work closely with a wide range of partners on efforts to improve vaccine confidence. Despite challenges caused by the COVID 19 pandemic, we must remain vigilant in efforts to ensure children get the vaccines they need to protect against serious diseases. And now I’ll turn the briefing over to Dr. O’Leary. Thank you.

05:37

Thank you, Dr. Peacock. I’d like to highlight a few of the points made by Dr. Peacock and I’ll start by commenting on why it’s important that we look at these rates. As public health advocates, we know that it benefits all of us if every child in our community is vaccinated. Not only does it mean all of the children in our community are protected, but it also means that all of us are more likely to be healthy. Everyone in our community deserves to be healthy. These data show a decline of two percentage points nationwide in the number of fully vaccinated kindergarteners since the start of the pandemic. That translates to hundreds of thousands of children starting school without being fully protected against measles, mumps, whooping cough, and other diseases that can easily spread in classrooms. It’s important to emphasize, again, that this affects everyone in these communities. High immunization rates help everyone to stay healthier. We’re seeing a return of these diseases, with the polio case reported in New York and the measles outbreaks as examples. Outbreaks like this are entirely preventable. These outbreaks harm children and cause significant disruptions in their opportunities to learn, grow and thrive. This is alarming and should be a call to action for all of us. Vaccination throughout childhood is essential because it equips children’s immune systems to recognize and resist disease so they can develop and live healthy lives into adulthood. A healthy childhood contributes to healthy adulthood. Of particular concern in these reports are the disparities described. Children who are poor, who live in rural areas, who lack health insurance, or who are black or Hispanic were more likely to be unvaccinated by age 24 months. This illustrates that we have significant work to do to improve access to care. We know barriers such as lack of access to transportation, health care services, or paid time off work create significant challenges for some families to be vaccinated. These are problems that we can solve. As pediatricians, we’re ready, willing, and eager to answer parents’ questions and work with families to help their children get caught up. My message to parents is that if you’re not sure what vaccines your child may be due for, call your pediatrician or health care provider, and we can help figure it out together. The place where your child usually receives medical care – their medical home -will have their immunization records and is the first place you should go. Pediatricians are eager to have these conversations. Parents can also go to HealthyChildren.org, which is a website for parents from the American Academy of Pediatrics, to find information about their child’s immunizations and prepare for the next visit. AAP has also created resources for pediatricians and other physicians to guide them in hosting vaccination clinics, institute reminder-recall systems, and employ other strategies to make it easier and more convenient for families to access vaccination services. We’ve also been working to educate AAP members on how to have conversations with families to answer their questions and help them feel confident in the decision to vaccinate. AAP has also been supporting work at the state and local levels through immunization grants to implement innovative approaches based on local needs to increase vaccination coverage. For many parents today, they have not seen many of the diseases that we vaccinate children for because vaccines have worked so well over the decades. Personally, as a pediatrician who specializes in infectious diseases, I take care of a lot of hospitalized children. Believe me, as much as we try to make the experience as painless as possible, it’s never fun to have your child hospitalized. Many of these hospitalizations can be prevented by the simple, safe step of keeping your child up to date on recommended vaccinations. Thank you again everyone for joining us today. And I’ll pass it back to our moderator.

09:12

Thank you, Christy, we are ready to open up for questions.

09:19

Thank you. At this time, if you would like to ask a question, please press star one on your phone. Please ensure that your phone is unmuted and state your name and affiliation clearly when prompted. Again, that is star one to ask a question. One moment

09:44

Our first question comes from Erika Edwards of NBC. Your line is open.

09:51

Hi, thank you so much. So I’m not sure if this happened to other reporters on the call, but it dropped several times for me, so I apologize if I’m asking you a question that’s already been addressed, but I’m wondering if you can expand a little bit on why we’re seeing this drop. Certainly, you know, doctor’s appointments were missed during the pandemic, but what other factors? Maybe like vaccine misinformation is at play? What’s to blame? Thank you.

10:17

Hi, this is Dr. Peacock. And I’ll start to answer that question and then probably hand it over to Dr. O’Leary. I think as you said, we know that the pandemic really had a disruption on healthcare systems. And so, I think part of it is that well-child visits maybe were missed, and people are still trying to catch up on those well-child visits. Also, when we look at data from the schools, we know that the schools had a lot of things to focus on. And in some cases, maybe they were not able to gather all that documentation on the vaccinations, or because children were at home for a lot of the pandemic, that may have not been the emphasis while they were focused on testing and doing all those other things related to the pandemic to make sure that children were getting the education that they needed. In addition to that, I mean, we have seen some hesitancy and vaccines during the pandemic related, mostly, I think, to the COVID vaccine. This could, in some cases, have transferred over to routine vaccinations. And that’s something that we’re watching very closely. What we know, though, is that the way to impact that, is for families to have conversations with their trusted doctors, health care providers, about the importance of vaccination. And so I’ll hand it over to Dr. O’Leary to talk about that a little more.

11:52

Thanks, Dr. Peacock. And I think you’ve summarized it very well. I think, you know, it’s complicated  why we’ve seen this drop. I see, in the data, a lot of encouraging signs as well. So you know, certainly misinformation is a problem, it has always been a problem. And we’re still trying to understand the extent to which misinformation around COVID vaccines has spread to misinformation about other childhood vaccines. But we know that has been a problem for many years, for routine childhood vaccines. And the encouraging things I’m seeing in the data, for example, are that we’re not seeing exemptions. So for example, non medical exemptions for vaccination, those aren’t going way up in the kindergarten report. And the other encouraging thing I think I see in these data is, if you look at the number of children, or the percentage of children in the younger series in the 24 month report, who’ve received no vaccinations, that number has actually gone down. So you know, parents are still getting their children vaccinated. The vast majority are, certainly there are some who have questions or who are resistant to vaccines, but for the most part, parents are still vaccinating their children. And to me, what I gather from these reports, looking at the data, is that the things we really need to focus on are addressing access and child poverty.

13:22

Next question, please.

13:26

Thank you. Our next question comes from Andrew Joseph of STAT. Your line is open.

13:35

Hi, thanks so much. Sorry, I was just about to withdraw my question. I had the same question as Erika, thanks

13:40

Thank you. Our next question comes from Alexander Tin of CBS. Your line is open.

13:48

Hi, thanks for calling on me. Can you address kind of the trends that we’re seeing in this decline? I mean, is it even across the board? Or did some states have a larger decline than others? And then separately, can you talk a little bit more about MMR vaccines? Obviously, that’s a big focus of the report and the goal. You know, why is it important for kindergarteners specifically to have those two doses? Thanks so much.

14:11

So I’ll start at a high level and then I’ll hand it over to Dr. Stokley. So what we have seen over the last two years is a one percentage drop each year in that national coverage for the kindergarten assessment. This is the lowest that we’ve seen in the last decade. And so that is something to be concerned about. Our Healthy People 2030 goals are to keep that at 95%. And we are below that. So I’ll turn it over to Dr. Stokley to talk a little bit more about the trends.

14:47

Thanks. So when we look at the data by state, we do see a wide variation in terms of change and vaccination coverage, and so looking at MMR, or the Measles, Mumps, Rubella vaccine, we see that can range from – the biggest drop in vaccination coverage was 5.4 percentage points. But then we also had states that had an increase in vaccination coverage. So it’s not that every state had a drop. You know, it did change from state to state.

15:27

And the reason it’s important for children entering kindergarten to have the MMR is because we know that measles spreads very quickly, as seen by two outbreaks that we had last year. And so the important thing is that all children can be healthy at school, and they aren’t being exposed to diseases or vaccine preventable diseases in the school setting.

15:56

Next question, please.

15:59

Thank you. Our next question comes from Mike Stobbe of the Associated Press, your line is open.

16:07

Thank you for taking my question. And for doing this briefing. As you mentioned, there’s two reports, one is on kindergarteners and one’s on younger kids. And the kindergarten one showed the one percentage drop as you said, and then you said the other one didn’t show a decrease? Can you say a little bit more about why there was a drop in the kindergarten age but not in the younger kids? And I have a second question about the younger kids. So you found that actually flu vaccination rates increased in these younger kids? Is that also true? And what do you think was happening there? Thank you.

16:51

Okay, hi, this

16:52

This is Dr. Stokley, thanks for that question. And one thing that’s important to point out is that these two different reports have two different data sets. So with the young childhood data, that comes from parents, and then we reach out to health care providers to validate the vaccination history, whereas the kindergarten data, that’s an aggregate report that the schools, submit to the state, and then the state submits to CDC. But one thing to point out is when there are different vaccines recommended at different ages. And we know during the pandemic, that while there was disruption in health care services, there was a prioritization to make sure that our youngest children, our most vulnerable children, were able to receive the preventive care that they needed so that they could get started and have some protection against these serious diseases. And so what we’re seeing in our childhood reports, is that indeed, parents were coming in and getting their children vaccinated to make sure they have a great start in life. As the child ages to become four to six years of age, there’s additional vaccines and booster doses that they need to make sure that they are fully protected. And so the kindergarten report is really assessing that, you know, do those children get those booster doses before they started school, and so that does require additional visits. And right before the school year, starting school, there’s been additional challenges for parents to get our kids in for those booster doses or getting that documentation to provide to the school to make sure they’re compliant with the requirements.

18:45

Next question, please. Thank you.

18:49

The next question comes from Dan Vergano of Grid News. Your line is open.

18:57

Thanks very much, Dan Vergano of Grid News, I had two questions. The first one is, did the sort of disparities in states you know, with the vaccination rates for the kindergarteners reflect like the pandemics effects on those states? Were states that were hit harder by the pandemic have a bigger drop? And would that serve as any kind of explanation? And the second question is maybe related, which is, you know, would you expect this to rebound, as the pandemic hopefully, you know, becomes less of a factor in our lives, or are you more worried this might be the start of a trend if you let it slide. Thanks very much.,

19:37

Thanks. This is Dr. Stokley. Again, we haven’t really looked at it at that level to see if there was an association between when the pandemic hit hardest, versus what we’re seeing in these coverage levels. I think we know the pandemic affected everyone in this country across the board. So you know, I don’t know that it’s one state versus another one. But we are encouraged that, as we’re returning back to routine activities, as we’re getting children back in school, and to in-person learning, that schools will be able to provide the follow up that’s needed for when they identify children that may not be up to date on their vaccinations and get back to, you know, encouraging families to get caught up. And I know there’s a lot of activities our partners are doing to encourage families to go back to their medical offices to make sure their children are up to date. Dr. O’Leary, do you have anything to add to that?

20:41

Yeah, you said it very nicely, Shannon. I think it’s a little hard. I think the analysis regarding the state- by-state coverage is a little hard to say. And, you know, to be clear, a lot of times the confidence intervals overlap between the states. So it’s a little bit hard to make those comparisons. But absolutely, you know, if the AAP and I know, colleagues with the American Academy of Family Physicians, have been working really hard to try and bring these kids in to get kids caught up to date and ready for school.

21:18

Next question, please.

21:21

Thank you. Our next question comes from Meg Wingerter of Denver Post, your line is open.

21:29

Oh, sorry. Someone already asked mine, so you can skip me. Thank you.

21:36

Our next question comes from Stephanie Enos of The Arizona Republic, your line is open.

21:46

Hi, thanks for taking my question. I just wanted to double check, you said that the decline in vaccination coverage for kids was not due to an increase in non-medical exemptions. And I asked that because, you know, in past years, that has been the reason for declining vaccination coverage. So I just wanted to clarify whether that is, in fact, different. And it’s not due to an increase in non-medical exemptions. Thanks.

22:16

Hi. Yes, this is Dr. Stokley again.

22:18

So yeah, you know what’s really interesting, and what we found in this report, is that we did see an increase in children who are attending school that had no documentation at all, so meaning, no documentation of vaccination, but often documentation of an exemption. And so many of these children are attending school under a policy that’s considered a grace period, or also called provisional enrollment. And this is allowing the family to have time to either get their paperwork submitted to the school, or if the child is in the process of getting their vaccines, giving them enough time to complete all the vaccination series, because there’s some time, you know, needed to complete the entire series. And what we’re seeing is that there was an increase in those children who are attending school under these policies. So it’s really not exemptions that are driving this decrease. I think it’s a flexibility with the policies that the states may be enacting because of the pandemic, or for other reasons. But really, I wouldn’t say that exemptions are driving this decrease at this time. And, Dr. O’Leary, you may want to speak to what you’re seeing in the practice as well.

23:41

Yeah, I think it’s complicated. Basically, I think, you know, there’s a lot of talk about hesitancy and exemptions and refusing. But the fact is, we’re not actually we’re seeing things move in different directions. So, for example, I’m hearing from some pediatricians who are saying they’re seeing an increase in parents who don’t want to vaccinate, and I’m hearing from a lot of other pediatricians who are saying that they’re actually seeing parents who have never vaccinated before coming in and wanting to get all their kids all caught up. So I think there probably has been some impact of the pandemic on attitudes around vaccines, but I think it’s a lot more complicated than some of the reports we’ve seen around you know, increases in hesitancy.

24:26

Christy, we have time for two more questions, please. Thank you.

24:31

Our next question comes from Erika Edwards of NBC, your line is open.

24:36

I appreciate that. Thank you so much. So I have two questions regarding that 1% drop last year. How many kids are we talking about who are under vaccinated? Hundreds of 1000s? Do you have a ballpark figure? I am still unclear about the second report showing an increase in younger kids vaccinated because they were born in 2018. They may be five now, right? So are these also incoming kindergarteners? How do we interpret the second report? Thank you.

25:16

So I’ll start out, and then I’m going to hand it over to Dr. Stokley to add.

25:17

So, you know, when we look, for example, this year at the number of children that appear to be unprotected against measles, that’s about 250,000 children. You refer to the report that happened last year. And one of the things that happened last year is we had a decreased enrollment in kindergarten. So we had about a 10% drop in kindergarten on last year’s report. And so when we look at sort of the number of children that are in kindergarten each year, we have to look at each year separately, because we don’t know that those children last year who didn’t attend kindergarten, we don’t know if they went to first grade or if they went to kindergarten, or, you know, those would be the two most likely things. So I think a good number to focus on, is that 250,000 children are potentially unprotected against measles entering kindergarten in the school year in this study.

26:25

And this is a good segue, I think, to clarify between the two reports, they are different populations. So one report, or the NIS-Child report, looked at children who were born during 2018 and 2019. They were surveyed around 2021. And so we’re assessing their vaccination status at the time they turned age 24 months of age. The kindergarten report is specifically about children who entered kindergarten during the school year of 2021. So those children were roughly five years old in 2021. So I think that means they might have been born around 2016. But again, the vaccines that are being assessed in the series are slightly different because the vaccine recommendations do differ by age. So for the very young child report, we’re looking at the primary vaccination series for the kindergarten report. It’s looking at the, you know, the primary and their booster doses that you would get when you’re between four and six years of age.

27:40

And our last question, please. Thank you.

27:44

Our last question comes from Rachel Daniel of Fox, Carolina News. Your line is open.

27:52

Hi, thank you. I have two questions. One, Dr. Peacock, I was wondering if you could go over those COVID-19 and measles numbers at the beginning of your talk. And I was also wondering, is there a way to either read or listen or, again, look at the numbers somewhere else after this call was over?

28:19

I’m sorry. Can you repeat that second part of your question?

28:23

Of course, I was wondering if, after this call is over, is there a way to look at this report?

28:33

Somewhere on the CDC website?

28:36

Yep. So I can answer that and will start with that question first. So these reports that we’re giving you information about will go live online at1 pm, they actually probably are already live. I haven’t checked the website, but they’re probably out there. And just to reiterate what we presented at the beginning. So during the 2021-2022 school year, the national vaccination coverage among kindergarteners dropped to 93%. And so that’s a one percentage point decline since the 2019-2020 school year. And then the other report that we’ve been talking about is one that shows that national coverage by 24 months remains strong with most vaccines and even increased among children born in 2018 and 2019, compared to those born in 2016 and 2017.

29:30

Great, thank you.

29:32

Thank you, Dr. Peacock, Dr. Stokley and Dr. O’Leary for joining us today, and we appreciate all the reporters that called in. For follow up questions, please call the CDC press office at 404-639-3286 or you can email media@cdc.gov. Thank you.

29:54

This does conclude today’s conference. You may disconnect at this time. Thank you and have a good day.

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