Fewer Minnesota children are receiving routine vaccinations during the COVID-19 pandemic — a worrying trend that experts say could lead to new outbreaks of dangerous diseases.
And those outbreaks could in turn expose the most vulnerable kids to health problems, while straining the health care system as the pandemic drags into the winter flu season.
Between March and May this year, doctors gave out about 20% fewer doses of childhood vaccinations, including the polio and measles shots, compared to the same time period last year, according to Minnesota Department of Health data.
The pandemic is contributing to a decline in vaccination rates that were already falling due to disinformation campaigns that scared some people into not vaccinating their children, experts say.
And now some diseases are making a comeback. Twenty years ago, doctors rarely treated pertussis cases, for instance, said Dr. Sheldon Berkowitz, president of the Minnesota chapter of the American Academy of Pediatrics.
“Now it’s not uncommon that every pediatrician will be seeing pertussis in their practices. Kids are hospitalized with pertussis. I know of children who have died of pertussis in the last year,” Berkowitz said. “And for other (infections) where we’re not seeing an uptick, the chance will start to go way up as immunization rates decline.”
Before the pandemic, roughly 8% of Minnesota kindergarteners — about 5,500 students — weren’t vaccinated against serious illnesses. Nationwide, just over 5% of kindergarteners weren’t vaccinated.
“A lot of this is just fear. Some of it is the fear of immunizations that existed pre-pandemic, and perhaps some of it is exacerbated due to the pandemic and general anxiety that lots of people have about going out,” Berkowitz said. “We’re trying to do everything we can to stress the importance of getting immunizations and reassuring that it can be done in a safe way.”
When the pandemic hit, people across the country stopped going to the doctor for fear of contracting COVID-19, including for children’s checkups, said Dr. Marilyn Peitso, president-elect of the Minnesota Medical Association. Providers nationwide saw a drop in demand for childhood and adolescent vaccines, which include immunizations for meningitis, polio, hepatitis, whooping cough, measles, mumps and rubella.
Minnesota Department of Health vaccination data from January through May shows that the decline was most dramatic in April, when providers gave out nearly 30% fewer doses of childhood immunizations than in April 2019.
The effects of the pandemic on pediatric care rippled into the summer as well. A July survey by the Minnesota chapter of the American Academy of Pediatrics found that providers estimated a 35% decline in childhood immunizations and a 45% decline in adolescent immunizations compared to a typical summer, Berkowitz said.
The decline is worrying, especially given Minnesota’s already-low vaccination rates. About two-thirds of Minnesota children ages 19-35 months are vaccinated — the third-lowest rate in the nation, according to the United Health Foundation. The metric is also far below the state’s goal of reaching 80% by this year, although it is a significant improvement from the 43% vaccination rate in 2010.
At roughly one in four Minnesota schools, fewer than 90% of kindergarteners were vaccinated for measles, mumps and rubella in the 2018-19 school year, the most recent data available from the Minnesota Department of Health. “Herd immunity” — meaning a large proportion of a community is immune from a disease, making it less likely to spread — drops significantly when immunization rates fall below 90%, putting unvaccinated children at risk, Berkowitz said.
All states’ school immunization laws allow vaccination exemptions for medical reasons, and 45 grant religious exemptions, according to the National Conference of State Legislatures. Minnesota is one of 15 states that also allows exemptions for parents’ personal beliefs.
In 2018, fewer than 1% of Minnesota kindergarteners had medical exemptions for any vaccine, and roughly 3.5% had non-medical exemptions, according to MDH data.
Despite the improvements in vaccination rates for young children, kindergarten vaccination rates have dipped in recent years. The most dramatic decline was in the diphtheria, tetanus, and whooping cough and polio vaccines: During the 2012-13 school year, roughly 97.5% of kindergarteners received these immunizations, compared to about 92.5% in 2018-19.
Disinformation campaigns by anti-vaccine groups are largely to blame for the decline in vaccination rates in Minnesota and across the country, Berkowitz said. They often target higher-risk populations, like communities of color and immigrant communities, he said.
A Gallup poll found that Americans think vaccines are less important now than they did 20 years ago. In 2001, 94% of people said it was extremely or very important to vaccinate children, compared to 84% in 2019. The survey also revealed a split along party lines: 92% of Democrats said vaccines were important, and 79% of Republicans answered the same.
As a result of disinformation campaigns, there have been several outbreaks of measles nationwide — including one in Minnesota in 2017, attributed to anti-vaxxers targeting the Somali community — and a resurgence in whooping cough cases, Berkowitz said.
As some of the fear of going to the doctor during the pandemic dissipates and families prepare for the first day of school, providers are seeing more families coming in for checkups and vaccinations, Peitso said. Still, she worries that families without insurance or transportation during the pandemic might not be caught up.
Peitso and Berkowitz said it’s especially important for children to be immunized and for both youth and adults to get a flu shot this fall — and it’s safe to go to the doctor for checkups and vaccinations. As some children go back to school, adults go back to work, flu season ramps up and the pandemic continues, providers could see a huge increase in need, Berkowitz said.
“As more and more people are exposed to those other illnesses, getting sick and needing to be seen in clinics — especially clinics that may not be up to full staffing due to the impacts of the pandemic and economic downturn — it’s going to put increased strain on all the clinics and systems,” Berkowitz said.