California’s vaccination rates for children took a nosedive just a few weeks after Gov. Gavin Newsom issued a statewide stay-at-home order in March to slow the spread of COVID-19, causing concerns among health professionals about the potential for outbreaks of other diseases during the pandemic.

In April, vaccinations for children decreased by more than 40 percent compared to the same month the previous year, according to the California Department of Public Health. The department looked at immunizations for children up to 18 years old, including 10 legally required for children to attend school in California.

Immunization rates have dropped across the country since the pandemic began. A study by the Centers for Disease Control and Prevention shows that the number of vaccine doses ordered by doctors in the United States began to decline the week after the COVID-19 national emergency was declared on March 13.

“Certainly, that is a major concern,” said Sen. Richard Pan, D-Sacramento. “We don’t need an outbreak of other diseases at the same time as the coronavirus outbreak. Last year, there were a record number of measles cases, and we don’t need to have another outbreak of measles because immunizations are low.”

Children who have not received vaccinations for childhood diseases like chicken pox or measles are more likely to end up in an emergency room or a hospital where they could be exposed to COVID-19, he said.

Pan, who also is a medical doctor, authored two pieces of legislation in recent years that greatly strengthened California laws, which require that all children be vaccinated at grade-level checkpoints before being admitted to school. A 2016 bill eliminated personal belief exemptions and another piece of legislation, in 2019, requires a state review if a child’s doctor has written, or a school has accepted, numerous medical exemptions. 

Checking the numbers

Vaccination numbers across the state have increased since the personal belief exemption was eliminated. In 2018, the most recent year data is available, 78 percent of traditional public schools reported that its students had all required vaccinations necessary to protect the community, while only 68 percent of private schools and 57 percent of charter schools met that goal, a 2019 EdSource analysis of California Department of Public Health data reveals.

Pan fears the lack of vaccines could mean that patients with measles and other diseases would overwhelm hospitals if there is a surge of coronavirus cases. California had 148,855 cases of COVID-19 and 5,063 deaths as of June 13. The state’s first confirmed case of the coronavirus came in January.

“We have been working hard to keep capacity in hospitals in case we have more COVID patients show up,” Pan said. “The last thing we need is to have more people in there with measles. You wouldn’t want COVID patients catching measles. It is highly contagious.”

Many California children have not received one or more doses of their routine immunizations in recent months, according to the California Department of Public Health. Because most immunizations are given before age 6, this is likely to impact schools at the kindergarten and first-grade levels, according to department officials.

Students are required to get their second dose of the MMR (measles, mumps and rubella) vaccine before kindergarten, so there could be a decrease in the number of children with all their immunizations at that grade level this school year, said Leah Russin of Vaccinate California, a parent advocacy group. 

Children who are not fully vaccinated can only attend school in California if they have a medical exemption, are homeless or are admitted conditionally while catching up on vaccinations. Students admitted conditionally must adhere to Centers for Disease Control's catch-up schedules, while homeless students must receive all required immunizations as soon as possible after beginning school.

State law

State immunization law requires documentation of vaccines at certain checkpoints: upon entering child care, transitional kindergarten/kindergarten or seventh grade, or when transferring into schools or child care from out of state or out of the country. Otherwise, schools are not checking the immunization status of students.

Communities can guard against disease outbreaks by having a sufficient portion of residents vaccinated. The concept, referred to as herd or community immunity, also protects newborns and those with chronic illnesses who can’t be vaccinated. Ninety-five percent of children at a school must be immunized to prevent transmission of disease in a community, according to the California Department of Public Health.

The recent decline in vaccinations is likely due to parents’ fear their child could be exposed to the coronavirus if they visit a hospital or clinic and health providers limiting immunization services during the pandemic, according to state health officials. Medical providers in some areas of the state scaled back on wellness checkups, which generally include immunizations, during the state shutdown. Many primary care practices were financially impacted and have had to lay off staff, further limiting services, Pan said. Many are contemplating closing.

Initially, people thought they would be sheltering in place for just a few weeks, said Russin of Vaccinate California. But that has turned into months and many children still haven’t been vaccinated. 

“A week or two is not a big deal, but a delay of six months or more means we have an entire microgeneration of kids that are behind on their vaccines,” Russin said.

Russin gave birth just a few days after California residents were told to shelter in place to keep COVID-19 from spreading. Like all parents she had concerns about exposing her baby to the disease by taking her to the doctor for her wellness checkup and accompanying vaccines. She did it anyway.

The ‘risk of coronavirus'

“I don’t want to take her to urgent care during a pandemic because I’m worried about something I could have taken care of with a well-child check,” she said. “Risk of coronavirus at urgent care is dramatically greater or worse than a well-child check with a pediatrician working overtime to mitigate and separate sick children visits from well child visits.” 

Parents should call their doctor and ask how they are keeping children safe from COVID-19 when they come in for wellness checkups and immunizations, Pan said. Many medical offices are separating wellness visits from sick visits, either by having them at separate locations or at different times of day and are requiring personal protective equipment for all staff. Some health care providers are offering drive-up sites for vaccinations, according to the California Department of Public Health.

Families with children behind on their immunizations should contact their health care provider to ask about a plan to catch up on their shots, according to the California Department of Public Health.

Families without insurance can get free immunizations for children through age 19 through the Vaccines for Children program.

The easing of stay-at-home orders means more parents may feel more comfortable going to the doctor, but it also means that unvaccinated children may begin to interact with more people and travel, which could spread disease.

“It’s really important for people to get their vaccinations,” Pan said. “Covid shows us what it is like to live in the world with a serious contagious disease that we don’t have a vaccine for. Get a vaccine. Let’s not have a measles outbreak. Let’s not have a whooping cough outbreak at the same time we are having COVID.”

Story originally published by EdSource.