Increasing Immunization Coverage

Abstract

has not yet been met, and immunization coverage of adolescents continues to lag behind the goals set forth in Healthy People 2010. Despite these encouraging data, a vast number of new challenges that threaten continued success toward the goal of universal immunization coverage have emerged. These challenges include an increase in new vaccines and new vaccine combinations as well as a significant number of vaccines currently under development; a dramatic increase in the acquisition cost of vaccines, coupled with a lack of adequate payment to practitioners to buy and administer vaccines; unanticipated manufacturing and delivery problems that have caused significant shortages of various vaccine products; and the rise of a public antivaccination movement that uses the Internet as well as standard media outlets to advance a position, wholly unsupported by any scientific evidence, linking vaccines with various childhood conditions, particularly autism. Much remains to be accomplished by physician organizations; vaccine manufacturers; third-party payers; the media; and local, state, and federal governments to ensure dependable vaccine supply and payments that are sufficient to continue to provide immunizations in public and private settings and to promote effective strategies to combat unjustified misstatements by the antivaccination movement. Pediatricians should work individually and collectively at the local, state, and national levels to ensure that all children without a valid contraindication receive all childhood immunizations on time. Pediatricians and pediatric organizations, in conjunction with government agencies such as the Centers for Disease Control and Prevention, must communicate effectively with parents to maximize their understanding of the overall safety and efficacy of vaccines. Most parents and children have not experienced many of the vaccine-preventable diseases, and the general public is not well informed about the risks and sequelae of these conditions. A number of recommendations are included for pediatricians, individually and collectively, to support further progress toward the goal of universal immunization coverage of all children for whom vaccines are not contraindicated.

Collaborative patient-provider communication and uptake of adolescent vaccines

“…This explanation could also contribute to the striking association between communication and HPV vaccination, a behavior marked by significant negative press (Zimet, Rosberger, Fisher, Perez, & Stupiansky, 2013). To the extent that adolescent vaccination is a medical intervention marked by considerable professional consensus (American Academy of Pediatrics & Bright Futures, ; Centers for Disease Control and Prevention (CDC), 2015b; Department of Health and Human Services, 2015; Hammer et al, 2010), provider-driven communication is appropriate for discussions about adolescent vaccination (Braddock et al, 1997; Braddock et al, 1999; Whitney, 2003; Whitney et al, 2004). The lack of a statistically significant association between communication style and uptake of Tdap booster could be attributable to ceiling effects, since national coverage for Tdap booster in 2010 was 74%, 10 percentage points higher than coverage for meningococcal vaccine and 35 percentage points higher than coverage for HPV vaccine (Centers for Disease Control and Prevention (CDC), 2011).…”

Promising alternative settings for HPV vaccination of US adolescents

“…However, the mechanisms by which pharmacists can immunize vary substantially by state (e.g., standing orders vs prescription), state laws may constrain pharmacists to vaccinating only females and some states do not permit pharmacists to vaccinate adolescents younger than age 18 [50]. While efforts to expand pharmacists’ immunization authority are underway in several states, medical associations such as the American Association of Pediatrics have given only limited support to pharmacies as an alternative vaccination setting, endorsing pharmacist provision only if pediatric patients do not have reliable access to a primary care clinic [51]. …”

Paediatric Virology: A rapidly increasing educational challenge

“…Thus, most parents and children have not experienced many of the vaccine-preventable diseases. Moreover, by not being well informed about the risks and sequelae of these conditions (149,150), they are vulnerable to statements that lack scientific evidence, as it was with Andrew Wakefield's theory that linked vaccination against measles mumps and rubella (MMR) with autism in 1998. Wakefield's theory was deemed responsible for the decrease in immunisation rates in the UK from 92% to below 80% after the publication of his study (144).…”