Sarah Y. Kim
When the COVID-19 pandemic first hit, children across the country fell behind on routine vaccinations for diseases like measles and varicella. But kids in the D.C. region were especially hard hit.
While coverage rates for the country fell from 95% to 93% during the pandemic, Maryland’s plummeted by more than 10%, all the way down to 87.6%, according to CDC data. In D.C., which already had a lower vaccination rate than average, MMR coverage was at 78.9% during the 2020-2021 school year.
Three years later, vaccination rates are improving in much of the region. (Virginia’s remained at around 95% throughout the pandemic). But D.C.’s numbers continue to lag far behind the national average and recommended target rates, according to a recent report from the CDC.
The recommended national target for the MMR vaccine is 95%. Both Maryland and Virginia have rates surpassing that target, at 96.7% and 95.8% respectively. In Maryland, rates are near or at 100% at the vast majority of schools across both Montgomery and Prince George’s Counties, according to data from the Maryland Health Department. (The Virginia Health Department told DCist/WAMU it does not have more localized data for childhood vaccinations available at this time).
D.C., on the other hand, had an 87.5% MMR vaccination rate. Coverage was similar for other diseases – at 85% for diphtheria, tetanus, and acellular pertussis (DTaP), 87.8% for polio, and 86.8% for varicella.
Dr. Emily Smith, an epidemiologist and assistant professor at the Milken Institute of Public Health, says these rates are “too low.”
“I am concerned about that number,” she says. “We need a lot of people or most people to be vaccinated to prevent the disease from having outbreaks in our community.”
In fact, Smith says, vaccination rates must be at least 90% to fully protect a community against outbreaks of extremely infectious childhood diseases. “Below 90% – for measles, for example – is one of these magical thresholds where you start to feel nervous that you could have measles outbreaks,” Smith says. “We’ve seen this in different parts of the country in the last 10 years.”
(In 2019, the U.S. had its largest measles outbreak since 1992, with 1,274 cases across 31 states — the vast majority in unvaccinated individuals. This, despite the U.S. having declared the measles to be “eliminated” in 2000. Cases went down in 2020, but have been steadily increasing again in the last few years).
Unlike in Maryland, D.C. had low vaccination rates before the pandemic. In 2019, D.C. health officials were sounding the alarm about vaccination rates being below the national 95% target. At the time, the latest CDC data showed that kindergarteners (the sample used for the annual CDC reports) had an 81.3% vaccination rate for diseases in D.C., compared to 98.6% in Maryland and 95.5% in Virginia. Overall, the District ranked lowest in the nation compared to other states (Smith said that while the District is not a state, it can still be useful from a “tactical perspective” to compare with states as opposed to cities, noting that the District has a “sizable population” — 671,803 as of July 2022 — and its own health department).
The District was still last in 2020-2021, DC Health’s Immunization Division Chief Heather Burris says.
“That was an alarm to us,” Burris says. “We’ve done a lot of work in the last 18 months to improve our rates.” The District was able to increase vaccination rates by about 10% over the last three years, an achievement that Burris says is “a true testament to the strength of collaboration amongst health and education sectors.”
Burris says she doesn’t know if there’s “anything that’s super unique to D.C.” that has kept its numbers below national averages. But she says it wasn’t until three years ago – in response to the alarmingly low rates – that the District began putting a “heavy emphasis” on enforcing routine childhood vaccinations.
Initiatives have included school-based clinics and incentives like gift cards for schools with higher vaccination rates. Data collection has also improved – Burris noted that DC Health has been transitioning into a new immunization information system. (In 2019 the Washington Post reported that immunization experts noted poor record-keeping may have contributed to low rates in the District.)
Exemptions for vaccinations remain low across the country, though the District saw a small increase in exemptions (as did 40 states) by 0.8 percentage points. Burris attributed that increase in part to long wait times for vaccinations – though most of those children went on to get vaccinated.
The COVID-19 pandemic has brought on additional challenges that deter people from getting care. Burris says the surge in turnover among healthcare workers due to extreme working conditions and burnout have made pediatric services less available in D.C. and across the country. When scheduling her children’s health care appointments in D.C., Burris says it can be 30 to 90 days before she is actually able to see the pediatrician.
And under lockdown, people fell out of practice in getting preventive care for themselves and their families.
Dr. Mark Johnson, professor and the chair of the Department of Community and Family Medicine at Howard University, said parents who haven’t gotten their children up-to-date on their vaccines fall into two categories: those who deliberately refuse to get their children vaccinated because they think it’s unhealthy, and those who are “overburdened by life.” Johnson says people are more likely to be in that second category when they are in lower-income communities where transportation and primary care are less accessible.
For these parents, Johnson said getting children vaccinated might not seem like a priority because diseases like measles are less common today – and usually, children recover.
“The issue is that when we do have a child get a serious complication of measles and they have to be hospitalized, then they can get severely ill and even die,” Johnson says. “It’s a tragedy because it could have been prevented.”
Johnson says initiatives like mobile vaccination clinics can be helpful, but they are not as effective as a long term solution.
“By doing that you are also preventing the patient from establishing a relationship with a single provider,” he says. Johnson says having a trusted primary care provider can reduce hesitancy and ensure people get preventive care in the long run.
“We don’t support poor primary care enough in this country,” he says. Johnson also wants the District to put more pressure on Medicaid managed care companies in D.C. to get their children vaccinated, requiring them to reach target rates of 95%.
Emily Smith from the Milken Institute of Public Health says “mop-up campaigns” – in which healthcare workers bring vaccinations and other services to communities – have proved effective in boosting immunization rates globally. “A school vaccination day could have a big impact,” Smith says.
Increasing community outreach, Burris says, will be key. The immunization division has a community engagement team that she says would be taking a more grassroots approach going forward.
“Getting everyone back in the habit is an uphill battle,” she says. “It’s something that we’re working towards.”
This post has been updated with information about vaccine mandate enforcement by D.C. Public Schools.
