Supporting Infant & Child Immunizations During the COVID-19 Pandemic: A Q&A With Michael Warren

April 29, 2021 | Katrin Patterson

In recognition of National Infant Immunization Week, ASTHO and the Association of Maternal and Child Health Programs (AMCHP) interviewed Michael Warren, MD, MPH, FAAP, and Associate Administrator of the Maternal and Child Health Bureau (MCHB) at the Health Resources and Services Administration (HRSA), for his thoughts on how we can protect our infants and children from vaccine-preventable diseases during this extraordinary time.

MCHB, HRSA and HHS at-large helped sound the alarm about dropping infant and child vaccination rates last summer, especially through your #WellChildWednesdays social media campaign. What has happened with the rates of well-child visits and pediatric immunizations since then?

WARREN: As state and territorial health officials know well, reduction of vaccine-preventable diseases through immunizations is one of the top public health accomplishments of modern time. The onset of the COVID-19 pandemic and the subsequent public health emergency declaration resulted in a decrease in both well-child visits and immunizations.

While rates for both have improved somewhat since last summer, there are still deficits for both. Delays in immunizations put children at risk for infectious diseases, like measles. Getting children caught up on routine immunizations helps to keep them—and the people around them—safe and healthy. Well-child visits are opportunities for parents and children to talk with their child’s provider about a variety of physical, mental, and behavioral concerns—as well as to screen for a variety of risk behaviors and connect families to needed resources.

Thinking about COVID-19 vaccine rollout and uptake for school-aged children, what benefits and challenges of school-based vaccine campaigns are you anticipating?

WARREN: School-based campaigns have a variety of great benefits and in some communities they have worked well, but they also provide plenty of challenges. One benefit is their ability to quickly reach large populations of children to help accelerate uptake of the COVID-19 vaccine. Additionally, they can help reduce barriers to immunization — like transportation and scheduling—which can help ensure vaccine equity. School-based campaigns can also help reach parents—not just children—in community settings. Making vaccines available to parents can help increase access and promote vaccine equity.

Community-based vaccination events also create opportunities for partnering with other community service agencies—like diaper banks, organizations that register children and families for insurance, and food banks—with families in need.

On the other hand, community vaccination sites, including schools, need to be sure to document in immunization registry systems so that there is continuity of care with the child’s primary care medical home. Parents often have questions for their child’s primary care provider about routine immunizations and they can’t always get answers at large-scale events. Public health systems and schools will need to be sure to provide accurate and easily accessible information to address hesitancy and promote vaccine uptake.

Finally, let’s remember that there is no “one size fits all” approach. Not all schools offer health services or have health providers on staff. State, territorial, and local health departments will need to partner with school systems to ensure that vaccine administration staff are knowledgeable and competent around important protocols including:

• Management of adverse vaccine reactions;
• Availability and usability of equipment and supplies (i.e.: refrigeration, computers, etc.).
• Proper documentation in immunization registry systems.

How can we encourage continuity of care, including maintenance of routine immunizations, for school-aged children who may receive the COVID-19 vaccine from a provider other than their primary care physician or pediatrician?

WARREN: When the COVID-19 vaccine is available for children, the most important goal will be to ensure children receive the vaccine. If it’s not possible to obtain the COVID-19 vaccine in the child’s medical home, it will be important for other vaccine providers to log vaccines into immunization registries so that primary care providers will have access to those immunization records. Parents should also keep their child’s immunization card as a backup and share that with the child’s primary care provider at their next visit.

While we’re giving lots of attention to COVID-19 vaccines, and rightfully so, it is important to remember routine pediatric immunizations. Given the current deficits—particularly in measles-containing vaccines—it is more important than ever that all children are up-to-date on routine immunizations. If parents have questions, they should check with their child’s medical provider.

Vaccine hesitancy continues to be a concern for public health. With the public square rife with vaccine mis- and dis-information, what innovative interventions have you seen that build trust and encourage vaccination for our families and communities?

WARREN: Building trust is based on who is sharing the message and how they are sharing it. Trusted messengers matter. These include primary care providers, whom families often turn to with vaccine questions, and community-based organizations, including faith-based partners. Both can be important messengers, particularly if families lack trust in government agencies. State and territorial health officials can partner with these trusted messengers to help encourage COVID-19 vaccinations.

Encourage partners to listen to the concerns of families, be honest and provide factual and up-to-date information. Parents want to know that you care about their child—and it makes a difference when they feel heard. Repetition is also important. Work to get immunization messages out through a variety of media, and through multiple messengers. HHS offers great resources for this through its COVID-19 Community Corps.

What can state and territorial health officials do to support improved vaccination and well child visits right now?

WARREN: Now is a great time to remind families of the importance of routine immunizations and well-child visits. State and territorial health officials can encourage families to schedule routine/back-to-school immunizations. Infectious diseases don’t pay attention to the school calendar!

Children who are behind on routine vaccinations are at risk now for diseases such as measles. As schools and childcare centers re-open, kids need to be up-to-date on their jurisdiction’s school/childcare entry vaccination requirements in order to return to the classroom. Spring and summer are often slower times for many primary care practices—so this may be an easier time to find a convenient appointment.

COVID-19 vaccines for adolescents may be available in the coming months. Since the COVID-19 vaccine cannot currently be given at the same time as other vaccines, waiting until the traditional back-to-school vaccination visit for routine adolescent vaccinations will mean adolescents and their families may further delay those routine vaccinations.

State and territorial health officials should consider connecting with:

• Their state Title V/MCH Director: Many states have selected performance measures related to medical home, well-child visits, and immunizations, and are well-poised to partner with state and local stakeholders to encourage immunizations and well-child visits.
• Maternal, Infant and Early Childhood Home Visiting Programs: Home visitors can help provide families with important information about immunizations and well-child visits and help families with referrals to health care services.
• State Medicaid programs: Medicaid provides coverage for well-child visits and immunizations. State Medicaid programs and/or managed care organizations can provide outreach to members and providers.
• Other public health programs like WIC and Family Planning: Every encounter with a trusted messenger is an opportunity to promote well-child visits and immunizations! Share messaging with public health program staff and ask them to help spread the word.