In A COVID-19 World Lies Another Threat to the Health of Our Children

BALTIMORE, MD, JUNE 1– In the U.S., our children rarely fall ill to grave infections because they are protected by vaccines. Serious illnesses like measles, mumps, congenital rubella syndrome, chickenpox, diphtheria, tetanus, whooping cough, rotavirus diarrhea, hepatitis (A and B), polio and bacterial meningitis are all preventable through routine childhood vaccinations. 

It is not magic that keeps our children safe from these many serious illnesses, it is vaccines — routine delivery of safe and effective vaccines. What will happen if we stop vaccinating or if we reduce our vaccination rates? These diseases will return. We will have epidemics of these old diseases during an unprecedented pandemic of a new disease. 

Yet, during the pandemic, we have seen a staggering reduction in the proportion of children vaccinated, despite recommendations by the U.S. Centers for Disease Control and Prevention (CDC), the American Academy of Pediatrics and the Maryland Department of Health, agencies that have provided guidance for us to continue to deliver vaccination services to children. 

We all are hopeful that clinical trials of vaccines and therapeutics for COVID-19 lead to licensed products that are safe and effective, but we must not forget to continue to provide child vaccines, the most important protections against infections that we already have available. 

In Maryland alone, there has been a 32% reduction in all vaccines given to children from birth to 11 months of age and a 47% decline in 12 to 23-month-old toddlers. Even more alarming, as we begin a reentry into greater normalcy, after weeks of stay-at-home mandates, Maryland’s pre-kindergarten vaccine rates have collapsed by an astounding 76%. Vaccines for measles, mumps and rubella alone, which critically protect our children from measles, have tumbled 71% In March and April, 15,950 fewer children in Maryland received this vaccine when compared to the same time last year. 

Under-vaccination is widespread in the U.S., not just in Maryland, as reported by the CDC. We are at serious risk for calamitous syndemics of COVID-19 plus other highly contagious diseases, like whooping cough and measles, if we do not return to the rates of protection we had before the pandemic.

Without vaccination of our children, the SARS-CoV-2 virus will win another victory. 

In 2019, when measles hit many communities in the U.S., leading to 1,282 cases, Maryland was spared. Only five of our children were infected and there was no significant person-to-person spread. In 2017 and 2018, there was only a single case of measles in Maryland each year. This year, so far: none. Why? Not magic; we vaccinate. 

Right now, with almost no one traveling and very little personal contact outside the home, these contagious pathogens cannot gain a foothold. But, once people start moving, so do viruses and bacteria. If our children remain unprotected when we fully “reopen,” reemergence of diseases that were once kept at bay by vaccines is inevitable.

Why are we not vaccinating? There are overlapping reasons. Families are sometimes scared to travel to or enter any health care facility for fear of getting COVID-19. Communities have received mixed messages about what kinds of care are essential. There is confusion about whether care providers are open and which hours are for sick or well children. We want to assure families that pediatricians are open, safe and eager to see their children. 

Importantly, in a COVID-19 world, families may feel that the only care warranted is for “urgent” medical problems, like acute illnesses, and they may underestimate the vital importance of vaccines for our children. This is especially true as many providers have come to rely on “telemedicine” for visits that can be done remotely. During these encounters, we may fail to prioritize communications to families about the importance of timely, complete childhood vaccinations. 

We cannot allow COVID-19 to take a greater toll on us than it already has by leading to the unintended consequence of vaccine-preventable disease outbreaks in our communities. Pediatricians, parents, researchers, advocates, educators, officials, and everyone who cares for children need to fix this problem now. We owe it to the children. If we don’t speak up for them, who will? 

By James Campbell, MD, MS Professor of Pediatrics, University of Maryland School of Medicine and Chair, Sub-Committee on Immunizations, Committee on Infectious Diseases, American Academy of Pediatrics

Jay Perman, MD, Chancellor, University System of Maryland, and Professor of Pediatrics, University of Maryland School of Medicine

Albert Reece, MD, PhD, MBA, Dean, University of Maryland School of Medicine, Executive Vice President for Medical Affairs, UM Baltimore, and the John Z. and Akiko K. Bowers Distinguished Professor, University of Maryland School of Medicine

Steven Czinn, MD, Drs. Rouben and Violet Jiji Endowed Professor and Chair, Department of Pediatrics, University of Maryland School of Medicine

Karen Kotloff, MD, Professor of Pediatrics, University of Maryland School of Medicine, Director Infectious Diseases and Tropical Pediatrics

Tina Cheng, MD, MPH, Pediatrician-in-Chief, Johns Hopkins Children’s Center and Director, Department of Pediatrics, Johns Hopkins University

Kwang Sik Kim, MD, Professor of Pediatrics, Johns Hopkins University School of Medicine, Director, Division of Pediatric Infectious Diseases

Kathleen Neuzil, MD, MPH, Myron M. Levine, MD, DTPH, Professor in Vaccinology and Director Center for Vaccine Development and Global Health, University of Maryland School of Medicine

Ruth Karron, MD, Professor, International Health, Director, Center for Immunization Research; Director,  Johns Hopkins Vaccine Initiative, Bloomberg School of Public Health, Johns Hopkins University

Aziza Shad, MD, Ellen W.P. Wasserman Chair of Pediatrics, Chief, Pediatric Hematology/Oncology, The Herman & Walter Samuelson Children’s Hospital at Sinai, Georgetown University School of Medicine,  Professor of Pediatrics & Oncology

Susan Lipton, MD, MPH, Director Pediatric Infectious Diseases, Sinai Hospital of Baltimore and Chair, Committee on Infectious Diseases for the Maryland State Chapter of the American Academy of Pediatrics

Timothy Doran, MD, Chair, Department of Pediatrics, Greater Baltimore Medical Center;

Susan Dulkerian, MD, Chair, Department of Pediatrics, Mercy Medical Center;

Maria Brown, MD, FAAP, President, Maryland Chapter, American Academy of Pediatrics;

Rebecca Carter, MD, Assistant Professor of Pediatrics, University of Maryland School of Medicine, Chair Committee on Immunizations, Maryland Chapter, American Academy of Pediatrics  

Letitia Dzirasa, MD, Commissioner of Health, Baltimore City, and a pediatrician;

Joshua Sharfstein, MD, Professor of the Practice, Johns Hopkins Bloomberg School of Public Health, former Baltimore City Health Commissioner and Secretary of the Maryland Department of Health and Mental Hygiene, and a pediatrician;

Neal Halsey, MD, Professor Emeritus, Johns Hopkins Bloomberg School of Public Health, Former Director of the Johns Hopkins Institute for Vaccine Safety, and a pediatric infectious diseases specialist;

Dan Salmon, PhD, Director, Johns Hopkins Institute for Vaccine Safety

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