RESOURCES:
C.S. Mott's Children's Hospital
Susan B. Meister Child Health Evaluation and Research (CHEAR) Center
Washtenaw County Health Department Pop-up Community Events
TRANSCRIPTION:
Caroline MacGregor: This is 89.1 WEMU. I'm Caroline MacGregor. And today, we're talking about vaccinations. It's been a year highlighted with concerns over an increase in measles and whooping cough cases in Michigan, and there's new research that shows routine childhood and adolescent vaccination rates are declining statewide. Also, completion rates for many essential pediatric vaccines that declined sharply during COVID have yet to recover. Today, I'm talking with Dr. Kao-Ping Chua. He's the director of the Susan B. Meister Child Health Evaluation and Research Center and senior author and researcher at U of M Health C.S. Mott Children's Hospital. We're talking about the new research that appears in the publication, Pediatrics. Thank you for joining me today, Dr. Chua!
Dr. Kao-Ping Chua: Thank you for having me!
Caroline MacGregor: The first question I want to ask you is did the findings of this study take you by surprise?
Dr. Kao-Ping Chua: No, they did not catch me by surprise because there was a lot of evidence, even from other studies nationally and in other states, suggesting that routine child and teen vaccinations have been declining.
Caroline MacGregor: I know that some of the sharpest declines were seen in counties with lower household incomes. This is according to your study and also in counties with higher uninsured populations. Can you explain for our listeners what is behind these trends?
Dr. Kao-Ping Chua: We don't know for sure, but one possibility is that those counties are particularly prone to face barriers to accessing healthcare. And we know that during the COVID pandemic, there were heightened barriers to accessing health care, including the visits needed to get vaccinations. So, in counties with low income and higher uninsurance, that just kind of piled onto an already existing problem.
Caroline MacGregor: Tell me what prompted the study and what years this research was actually conducted in.
Dr. Kao-Ping Chua: Sure. In this study, we analyze trends in routine child and adolescent vaccinations between 2017 and 2023, using data from Michigan's immunization registry. Our primary purpose in doing this was to document, A, that immunization rates have been declining and, B, to show in which counties the rates of declines have been the greatest.
Caroline MacGregor: There's concern among many people who are pro-vaccination, which it seemed to be going that way for many years until recently. Now, there's the emergence of diseases like measles that were previously under control. What other trends are you seeing here that should be of concern to the general population?
Dr. Kao-Ping Chua: So, I think most people have heard about the increasing measles outbreaks, not just in Michigan, but more broadly. I think, last year in particular, there were also several large outbreaks of pertussis in Michigan and in other states. So, that would be another vaccination of concern. One of the things that we found in our study, in addition to those kind of concerning declines, is that the percentage of teenagers who were completing their HPV vaccination series, the human papillomavirus vaccination series, which is the vaccine that prevents cervical cancer, throat cancer, and other things like that. So, the rate of completing that vaccination series in teenagers increased from 2017 to 2023, but it increased at a rate that was slower than what was occurring before the COVID-19 pandemic began. So, what that suggests is that the pandemic interrupted the progress that was being made in increasing HPV vaccination in teenagers.
Caroline MacGregor: I see. And what other vaccines are we seeing falling off today or the parents are hesitant to give their children?
Dr. Kao-Ping Chua: So, we looked at two different, what we call, composite measures of vaccination in young children aged 19 to 35 months and teenagers aged 13 to 17 years. So, these composites are comprised of routine vaccinations like MMR, chicken pox, pneumococcus, polio, meningitis A. And what we found is that, across all of those vaccinations, it wasn't just one, all of them were dropping. It's more broad-based and affects all vaccines.
Caroline MacGregor: I know more people seem to be questioning vaccinations and medicine today. Some of this is politically induced, but there's growing mistrust of the medical profession for various reasons we won't get into. How do we address this, because the fear is that unvaccinated children can pass along diseases or even die from diseases that were previously under control in this country?
Dr. Kao-Ping Chua: Yes, that is the major concern. And of course, that's what we're seeing now is that with these outbreaks of measles and pertussis. These are outbreaks that we previously did not see. Unfortunately, no vaccination is 100% effective. And so, we kind of rely on others to get vaccinated in order to prevent the possibility of exposure in the first place. And when there isn't that kind of herd immunity, it is completely possible that even if one is vaccinated, because the vaccination effectiveness is not 100%, one could still get infected just because there's more exposure. Your question about what to do about this is a complex one. One of the key things, I think, is to restore trust in the medical establishment and in public health. Unfortunately, a lot of that trust was eroded during the COVID-19 pandemic, in part because of the backlash against social distancing measures, shutdown orders, backlash against COVID-19 vaccination requirements. I think that there's a lot of work that needs to be done in order to reestablish medical professionals as the primary source of information about vaccine-related harms and benefits, instead of what is currently seems to be increasingly the case, which is people getting their information on the internet and social media channels.
Caroline MacGregor: If you are just joining us, I'm talking with Dr. Kao-Ping Chua. He's the director of the Susan B. Meister Child Health Evaluation and Research Center, and we're discussing a decline in vaccination rates among children and adolescents across the state of Michigan. I know the Washtenaw County Health Department is doing more community outreach. They're taking part in an event downtown where they'll set up a booth and try to foster trust among people by being present and handing out information to try to respond to this mistrust of the medical profession, which, clearly, is something that needs to be addressed if we're going to increase vaccination rates again. What are your thoughts on how this trust can be rebuilt, especially as we've got so much going on politically to undermine the medical professions?
Dr. Kao-Ping Chua: You know, I think it's important for pediatricians and other pediatric clinicians to really take the time to listen to parents, understand their concerns, and even be willing to have a kind of a longer conversation in one visit and bring them back for another visit, just so that we can continue the conversation. I think that sometimes parents feel that they can't bring up these concerns because they fear that they will be dismissed or looked down upon. And I think that if we go in as clinicians with the mindset that parents are just trying to do the best that they can for their children and sometimes just need a little bit more time to be able to talk about some of the concerns about vaccine safety and effectiveness, that we can actually really make a lot of headway if we just take the time.
Caroline MacGregor: It would appear that there is a lot of confusion among young parents because of all the information and misinformation that they're being bombarded with. I'm sure that this makes the job of pediatricians all that much harder.
Dr. Kao-Ping Chua: It does. And I worry about not just the short-term, but in the long-term, these young parents who are having children now, if they have vaccine hesitancy, as their children grow up and become of childbearing age, they're also going to potentially inherit some of those same views, which I think is going to make it even harder over time to convince people of the benefits of these highly effective, life-saving vaccines.
Caroline MacGregor: I know your study was one of the first to examine the recent changes in childhood and adolescent immunizations by county characteristics. And I know we touched on this briefly earlier, but what did you determine with regard to socioeconomic factors when it comes to vaccination rates?
Dr. Kao-Ping Chua: Sure. When we compared counties in Michigan that had lower versus higher household income, we saw that the drop in routine child and adolescent vaccinations was greater in the low-income counties. When we compared Michigan counties with higher versus lower on insurance rates, we also saw greater declines in routine child and adolescent vaccination. And as I mentioned before, I think one of the key reasons for this may be that counties with low income or counties with high uninsurance are likely to be the same counties where access to health care may be the most problematic. And when you layer on the additional barriers associated with the COVID-19 pandemic, such as stay-at-home orders and social distancing measures, that just made it even harder for people in those counties to get routine vaccinations. Those counties ought to be prioritized and potentially given additional resources when it comes to campaigns to increase childhood vaccinations.
Caroline MacGregor: So, to turn this all around, what is the most important thing that we can do now moving forward to reverse this decline in vaccination rates?
Dr. Kao-Ping Chua: We talked before about restoring public trust in the medical profession and in public health more generally. I think another thing that we need to do is to make it easy to get vaccinations. So, that means that the pediatric practices need to be able to do a better job of being flexible about their scheduling. So, oftentimes, we schedule times in the middle of the day when people are working or kids are in school. You know, being a little bit more thoughtful about the types of hours that we can provide, so that there's just fewer barriers to getting a vaccination, I think that's important. And then, I think, as you mentioned, the idea of having more community outreach, people who are out there just willing to kind of meet people where they are and answer their questions and also the idea of having these mobile kind of immunization clinics where county health departments set up vaccination stations in malls and other places where there's a lot of traffic. Just essentially minimizing the barriers to getting vaccinations, I think, will be very important.
Caroline MacGregor: Okay, thank you! I've been talking with Dr. Kao-Ping Chua. He's the director of the Susan B. Meister Child Health Evaluation and Research Center and senior author and researcher at U of M Health C.S. Mott Children's Hospital. We've been taking about new research that shows a decline in childhood and adolescent vaccination rates. Thank you so much for joining me today!
Dr. Kao-Ping Chua: Thank you for having me!
Caroline MacGregor: This is 89.1 WEMU-FM Ypsilanti.
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