A post-pandemic drop in kindergarten vaccinations is making public health officials very nervous

A small but worrisome decline in kindergarten vaccination rates nationwide that started in the pandemic is continuing, federal health officials warned on Thursday, with covid-related stress on the public health system driving the trend.

State and local laws require four shots — ones for measles, tetanus, polio and chickenpox — before starting kindergarten, bedrock inoculations that prevent outbreaks of illness and ensure the public’s health. Although nationwide vaccination rates for children who started school in 2021, typically 5 years old, were still high at around 93 percent, that is short of a nationwide goal of 95 percent, and the standard before covid.

“While this may not sound particularly significant, it means nearly 250,000 kindergartners not potentially protected against measles,” said Centers for Disease Control and Prevention immunization official Georgina Peacock, who spoke at a briefing on the findings. The report from 49 states and the District of Columbia (Montana did not report statistics) covered 3.5 million children. “Measles, mumps, and rubella coverage for kindergartners is the lowest it has been in a decade,” she said.

The effects of insufficient vaccination rates have become apparent over the last year, with a polio outbreak emerging in New York — the most notable spread of the disease in the U.S. since 1979, the year the country officially eliminated the virus. Meanwhile, several counties in Ohio are still battling an ongoing measles outbreak in which many of the victims have been preschool-aged children. Whooping cough has also made a return in vaccine-hesitant school settings across the country.

The drop in kids getting their shots in kindergarten continues a decline that started in the pandemic. The coverage rates were lowest for poor and rural kids, where parents had the hardest time arranging shots, such as Alaska, Idaho, Minnesota and the District of Columbia.

“We’re seeing a return of diseases,” said infectious disease expert Sean O’Leary of the American Academy of Pediatricians, noting recent polio and measles outbreaks. “This is entirely preventable. These outbreaks harm children and cause significant disruptions in the ability to learn, grow and thrive.”

Rather than an increase in kids claiming exemptions for their children, a feared effect of anti-vaccine misinformation that spread widely in the pandemic, the missed shots seem most tied to an overburdened public health system still struggling with its pandemic workload. Public health experts had expected to see a rebound in childhood vaccination rates when in-person schooling returned nationwide last fall. Instead, roughly 4 percent of schoolkids just didn’t get their shots. Rather than an increase in anti-vaccination sentiment, flexibility in school reopening policies seems to have let more kids through follow-up procedures meant to ensure they received their shots, said the CDC’s Shannon Stokley.

Back to routine

More encouraging, a second report released by the CDC in contrast finds that vaccination rates for 2-year-olds born in 2018 or 2019 have remained steady, at around 93 percent, basically pre-pandemic levels. That reflects shots for the youngest kids, the ones most at risk from infectious diseases, being a priority during the pandemic, said Stokley.

Still, the report found a 4 to 5 percent drop in vaccine coverage for rural and poor children in that age group, she added, pointing to more disruption caused by the pandemic. Children with private insurance had the best coverage rates for the seven shots recommended for 2-year-olds.

“We are encouraged that as we all return back to routine activities, as we get children back in school, as we get everyone back to in-person learning, that schools will be able to provide the follow-up that’s needed to encourage families to get back up to date,” said Peacock.

Rather than any kind of widespread parental increase in resistance to vaccines spurred by the pandemic, pediatricians are seeing a much more mixed picture overall, with sentiment going in all directions, added O’Leary. “There’s a lot of talk about hesitancy and exemptions and refusing, but we are not seeing those things,” he said. Some parents who had resisted shots are bringing in all their kids now to get caught up.

“There’s probably been some impact of the pandemic on attitudes,” said O’Leary, “but I think it’s a lot more complicated than some of the reports we’ve seen about hesitancy.”

Thanks to Lillian Barkley for copy editing this article.