Virginia’s childhood vaccinations dropped in 2020. Researchers worry it could be the next public health crisis
- Sabrina Moreno
- Jun 19, 2021
Virginia’s childhood vaccinations among kindergartners and seventh-graders in public schools last fall dropped below the 93% to 95% herd immunity threshold needed to prevent outbreaks, spurring concern among health officials over outbreaks of preventable diseases like mumps and measles as schools prepare to reopen.
State data released last week shows that Virginia’s coverage is at 88%, but eight localities — including Richmond, Petersburg and the counties of Chesterfield and Charles City — are reporting less than 80% for seventh-graders. Hanover and Goochland counties boast percentages above 96%.
Richmond experienced one of the most severe drops, falling nearly 27 percentage points from 2019’s figures of almost 99%. While the city’s current average is 72.4%, immunization rates vary significantly by poverty levels and proximity to medical care.
Among seventh-graders, there’s a divide of 40 percentage points between Binford Middle and Thomas C. Boushall Middle: the most-vaccinated and least-vaccinated schools. Less than half of the students at Binford, which has 90.9% vaccine coverage and is located in the Fan District, are eligible for free or reduced-price lunch — a rough gauge of poverty.
South of the James River at Boushall, where only 50.9% of seventh-graders were sufficiently immunized, more than 65% are in the same category and more than 30% are English-language learners.
Amy Popovich, nurse manager and director of community engagement at Richmond and Henrico’s health districts, acknowledged the overlap between low rates of COVID-19 vaccinations and childhood immunizations — both of which are affected by socioeconomic status and access to medical care, health insurance and resources.
Boushall’s ZIP code, 23234, was one of four in the early months of the rollout that was facing high COVID-19 rates while being farthest from a vaccination clinic.
So was ZIP code 23235, which includes Westover Hills Elementary in South Richmond. Its kindergartners have the lowest vaccination rate in the city, and almost 70% of students are “economically disadvantaged.”
“If we just look at the last year, and the requirements for the pandemic, anecdotally, it explains some of the challenges,” said Popovich, noting how most health care providers weren’t allowing patients to bring additional people to appointments to limit spread. “What about other children? And would you have child care for that? Oftentimes, appointments were also less flexible.”
The health districts are leaning into more community partnerships and mass vaccination events to ramp up the percentages, a critical move as reports emerge of measles and mumps cases in areas of low immunizations, said LaWanda Dunn, a nursing supervisor for population health at Richmond City Health District. Dunn urged parents and children not to wait until the school year begins to get caught up, so the surge doesn’t worsen.
A Centers for Disease Control and Prevention report documenting childhood vaccination coverage in nine states plus New York City in the first six months of the pandemic found a drop substantial enough to potentially derail school reopenings.
The decline varied among age group and vaccine, with the HPV vaccine falling by more than 63% among the 9-to-17 age group. Coverage of 93% to 95% is needed for herd immunity.
Most of the developed countries are averaging close to 100%, said Rajesh Balkrishnan, a social epidemiologist at the University of Virginia who focuses on medical care access. He was among the public health researchers who released an infant immunization report in April that found that between 2009 and 2018, disparities widened by income, education level and race.
Families below the poverty line in 2009 were 9% less likely to receive the full vaccine series than those with an annual income higher than $75,000. By 2018, the figure had jumped to 37%.
Poverty rates in Richmond and Petersburg — where about 72% of seventh-graders are immunized — are more than 2½ times the state average, according to U.S. Census Bureau estimates.
Mothers who hadn’t graduated from high school were nearly 27% less likely to have their child fully vaccinated than mothers with a college degree, according to the April report — 3½ times higher than a previous study’s findings in 2003.
“It is definitely a crisis. Everything has been overshadowed by COVID in the past few months, but otherwise, every year, we do see outbreaks of mumps and measles in this country,” Balkrishnan said. “We really shouldn’t be at the point where, as one of the most developed countries in the world, we see outbreaks of these infectious diseases.”
He said the South is especially at higher risk, as the lack of health care access is inextricably linked to the foothold that poverty and race have on a region reeling from Jim Crow-era policies. With Virginia participating in Medicaid expansion, Balkrishnan estimates that childhood immunizations could improve in the upcoming years.
But eight of the 12 states that have yet to expand Medicaid to poorer residents under the Affordable Care Act are in the South and Republican-led.
Of those eight, half hold the largest populations of Black residents in the U.S., according to the federal Office of Minority Health.
The pandemic also threatened health insurance coverage for Virginia households, added Balkrishnan, after the number of uninsured children from low-income areas was consistently declining for nearly a decade and federal programs were launched to ensure free vaccine coverage to children.
“The COVID pandemic really brings out an important point that we are not done with our fight with infectious diseases yet,” he said, noting the importance of investing in preventive health and in vaccines from early age to build immunity. “We could truly at any point in time become victims of a pandemic.”
To book an immunization appointment through the Richmond City Health District, call (804) 482-5501. For a Henrico clinic, call (804) 501-4651. Clinics will run Monday through Thursday.