As hospitals and clinics across the country limit "non-essential" healthcare services to stem the spread of the coronavirus, experts worry that the postponement of routine immunizations could lead to an outbreak of vaccine-preventable diseases after social distancing practices begin to relax.
Last month, the World Health Organization's issued guidance recommending countries temporarily suspend their mass preventive immunization campaigns, suggesting they design "strategies for catch-up vaccination" after the outbreak.
Measles immunization campaigns in 24 countries have already been delayed due to COVID-19, according to the Measles & Rubella Initiative, a partnership that includes the WHO, American Red Cross, the U.S. Centers for Disease Control and Protection, UNICEF, and the United Nations Foundation. The group issued a statement on Monday warning that more than 117 million children in 37 countries were currently at risk of missing measles vaccines due to the pandemic.
In the U.S., signs indicate fewer children may be getting their routine vaccines as individuals and providers practice social distancing.
The CDC's Vaccines For Children program, a federally funded program that provides free immunizations to families who are unable to pay, reported a 4.5% drop in MMR vaccine orders from local and state health departments during March compared to the same month last year, according to Dr. Melinda Wharton, director of the CDC's immunization services division.
While the short-term ordering decrease doesn't necessarily translate to a decline in vaccinations, Wharton acknowledged the CDC was recommending limiting pediatric visits to prioritizing newborn care and vaccinations of infants and young children.
Similarly,the American Academy of Pediatrics issued guidance in March that recommended people balance the benefits of getting immunizations with the risks of exposure to the virus. AAP recommended clinicians continue with routine immunization schedule but might opt to prioritize children under 24 months.
CDC is monitoring if the pandemic causes disruptions in routine vaccinations and will work with health departments to catch up if needed, Wharton said.
The decrease in VFC orders can be directly tied to some program providers shutting down as a result of the pandemic. If those services remain closed until stay at home orders are lifted, it could lead to an even more substantial decline in vaccine orders.
Chicago's five walk-in immunization clinics receive vaccines through the VFC to provide free vaccinations to low-income residents They have been closed for several weeks as part of a citywide social distancing order, as have many of the city's in-person services.
In an email, a Chicago Department of Public Health spokesperson said the city had a "catch-up" strategy to ensure that children receive necessary vaccinations once the clinics can re-open.
Dr. Sean O'Leary, associate professor of pediatric infectious diseases at the University of Colorado School of Medicine and a member of AAP's Committee on Infectious Diseases, said many clinical practices have opted to hold off on giving older children their booster vaccinations for now, but acknowledged that many will probably consider having them come in for shots the longer social isolation is in effect.
"We don't want to trade one problem for another," O'Leary said.
Some experts contend catching people up on their vaccinations could take months. In the meantime, a sudden outbreak of a highly contagious disease like measles could put many unprotected children at risk.
Dr. David Hardy, adjunct professor of medicine in the division of infectious diseases at Johns Hopkins University School of Medicine, said providers should be looking into how to safetly vaccinate children now and keep them on their immunization schedules, such as a drive-thru system similar to COVID-19 testing.
"This has got to be a priority to find a way to give kids vaccinations and to give the adolescents and older people boosters because we're not going to be in lockdown forever," Hardy said. "You still have to plan for what's going to happen post-COVID-19."
If too much time lapses between some vaccine doses, children may have to start the entire series over again, he said.
"If this goes on another six months then that's going to be a problem," Hardy said.
There have been 12 confirmed measles cases in the U.S. this year as of April 5, according to the CDC. Last year, more than 1,200 cases of measles were reported, marking the largest total in a single year since measles was declared eliminated in the U.S. in 2000. Signs indicate the country has lost some ground on immunization efforts in recent years as more parents opt not to vaccinate their children.
"The only way we've ever dealt with being able to prevent or stop pandemics of viral illnesses has been through vaccination," he said. "The whole COVID-19 experience will hopefully remind people that not getting those vaccines for illnesses for which we do have vaccines is a really bad idea."