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Even as hopes for ending the COVID-19 pandemic hinge on a vaccine, Oregon saw a "sharp reduction" in the number of other vaccines administered to children and adults, according to an official tally by the state.
For the first half of 2020, the number of immunizations fell as doctors' offices closed to nonemergency care for a more than a month and Oregonians stayed home even after those clinics reopened.
Compared with 2019, doctors administered 45% fewer doses of the measles-mumps-rubella vaccine to 2- to 9-year-olds in the first half of 2020, according to figures from Oregon Health Authority. And there were 20% fewer immunizations for the combined tetanus, diphtheria and pertussis vaccine, known as TDAP, among women of childbearing age—"the most vulnerable [newborns] at risk without passive immunity gained from immunization of the mother," OHA officials said.
Other vaccines also saw drop-offs, if less marked.
The number of patients getting routine vaccines has not yet resumed to normal levels. Parents and children haven't made up yet for past vaccines missed during the lockdown.
"The impact could be devastating," says Nadine A. Gartner, founding executive director of the vaccine education nonprofit Boost Oregon. "Our public health departments are not prepared to deal with multiple pandemics at once. If we all of the sudden have to treat a large number of people for vaccine-preventable diseases that's just going to further handicap our ability to defeat COVID."
The lower vaccination rates are part of a trend nationally: Americans have avoided medical treatments for fear of contracting the novel coronavirus. And that presents a complication for public health officials looking to respond to the pandemic: Other health care needs, neglected amid COVID-19, could overwhelm the system in the future.
Even as the United States has failed to bring COVID-19 under control, public health officials worry about a new worst-case scenario: an outbreak of another preventable disease at the same time, including flu, measles or some other disease that can be vaccinated against.
"We're playing with fire when we talk about not taking our kids to get the vaccines that are already recommended," Dr. Rahul Gupta, senior vice president and chief medical and health officer at March of Dimes, a nonprofit focused on mom and baby health, told the National Press Foundation's Vaccine Boot Camp webinar on Aug. 7.
"I do think that we have to have a concerted effort moving forward to ensure that those rates do not fall," Gupta adds, "because the outbreak of those diseases will not only complicate our efforts but actually be very expensive."
Oregon doesn't generally do well at making sure kids get all their vaccines when compared with other states. Ranked by the rate of kindergartners who had received two MMR vaccines, Oregon was tied for the nation's 15th-lowest rate, 93%, in 2018-19 (not including Alaska, which did not report data that year).
Among the reasons for the decline in childhood immunizations was concern from parents about visiting doctors' offices—an issue that public health officials say can be mitigated with communication along with the care that doctors' offices are taking to keep patients safe.
"What I have been impressed by with the health care I have received during the pandemic is that the health care facilities that are open are actually using really good infection control practices and trying to ensure that those who are coming in are actually able to get the health services they need without being exposed unnecessarily," says Dr. Julie Morita, executive vice president of the Robert Wood Johnson Foundation. "And the vaccines are critical."
Oregon Health Authority school immunization coordinator Stacy de Assis Matthews says the agency is working with doctors' offices to ensure they call parents who have missed vaccines as well as try to get the word out to parents that vaccines for Oregon children are free.
"Immunizations are really important," she says. "We know that vaccine-preventable diseases can occur when we have pockets of low immunization rates. The 2019 measles showed us that."
Rachel Monahan reported this story with the support of the Dennis A. Hunt Fund for Health Journalism, a program of the USC Annenberg Center for Health Journalism's 2020 National Fellowship.