Evelyn Twentyman, MD, MPH, senior advisor for vaccine strategies at CDC’s National Center for Immunization and Respiratory Diseases, spoke with Pharmacy Times® about the importance of keeping children vaccinated on schedule and overcoming vaccine hesitancy. Twentyman discussed the crucial role of health care providers and pharmacists in building trusting relationships with parents and guardians, and the importance of continued, strong vaccination recommendations. She also emphasized equity in vaccine distribution and introduced CDC’s Vaccines for Children program.
Pharmacy Times: What are some of the most common questions parents ask about childhood vaccinations?
Evelyn Twentyman, MD, MPH, Senior Advisor, Vaccine Strategy, CDC: Thank you for your question. And I want to thank all the health care professionals who are listening to this talk and this call, because your advice is so important to health care professionals. One of the questions we hear a lot is why it’s important to follow the recommended schedule, especially when a particular vaccine schedule includes multiple vaccines. So let’s start there. By the way, most parents follow the recommended vaccine schedule for their children, but some of them have questions, “Is this safe? Do I need all of these?” So let’s go through those. Are these vaccines safe? Of course they are. CDC has tracked these vaccines through the most thorough vaccine surveillance in the history of the United States. We’ve learned from vaccinating hundreds of millions of children with these routine vaccines. So now is a great time to benefit from that knowledge and get our children the vaccines they need.
Now, let’s think about schedules, especially when multiple doses of a vaccine are recommended to protect against certain diseases. These schedules have been very carefully designed to make sure that children get the protection that they need when they need it. In other words, they keep in mind both the development of children and when they are more likely to be exposed to these diseases. The great thing is, if parents can stick to that schedule, they can ensure that their children get optimal protection from life-saving vaccines. If they can’t stick to the schedule, any delay reduces the amount of protection from these vaccines. So that makes the advice of health care professionals, such as pharmacists, and others listening to this call even more important to really maintain optimal protection for our children.
Key Takeaways
Vaccines are safe, effective, and essential to protect children from serious diseases. CDC has an extensive surveillance program to monitor vaccine safety and effectiveness. Healthcare professionals, especially pharmacists, play a key role in educating parents, addressing their concerns, and strongly encouraging vaccination of children. It is important to build trust and keep the conversation going. CDC’s Vaccines for Children Program ensures equitable access to life-saving vaccines regardless of a family’s ability to pay. The program has had a significant impact and has distributed more than 1.3 billion doses since 1994.
Pharmacy Times: How can vaccinators prepare to answer these questions and provide clear explanations to people asking questions about childhood vaccinations?
Twentyman: Again, just their ability to answer those questions carefully is very beneficial. In fact, we know that health care providers are the most trusted communicators by parents when it comes to childhood vaccines. So their role is crucial. So there are a few things they can do. They can answer parents’ and guardians’ questions and make strong recommendations. Using those strategies can increase the trust of parents and guardians. They can take the time to listen to parents and guardians and build trust over time. And also, they can’t give up if the initial conversation doesn’t go well. So, for example, let’s talk about how this conversation might go. First, the health care provider wants to introduce the topic of vaccinations, assuming that the parent is going to get vaccinated. The health care provider can tell them which vaccines are needed for their child at that particular appointment or pharmacy visit. In that case, they’re going to assume that the parent is willing to get vaccinated at that point. And many parents will. If the parent isn’t ready to vaccinate, the health care provider can just communicate a strong recommendation. Because health care providers are in a very unique and special position as the most trusted source of information for parents and guardians, a strong recommendation is very important for vaccine acceptance, and we see this again and again. And parents can really listen and respond to their concerns. Even though research supports that most parents in the United States support vaccines and accept vaccination of their children, health care providers encounter patients with questions and concerns. So when parents seem hesitant to follow the recommended schedule, it doesn’t necessarily mean they won’t accept the vaccine. Some parents just want their questions answered, some parents just want you to refer them to additional information, like cdc.gov. And in any case, keep the conversation going. What we’ve seen time and time again, before the pandemic, during the pandemic, and after the pandemic, is that some parents need to be encouraged to vaccinate their children multiple times, and some parents who previously refused the vaccine are now accepting the second or third recommendation. So to all the health care providers on this call who are making these recommendations, thank you so much. Don’t give up. Keep the conversation going.
Pharmacy Times: What are some strategies to increase retention rates for the second or third vaccination?
Twentyman: One of the things they can do is talk about the advantage to parents and guardians of their children if they follow the recommended schedule. It gives them optimal protection from the diseases that the vaccines are designed to prevent. This is really powerful. For example, if a parent follows the CDC recommended vaccination schedule from the time their child is born until they are two years old, that is, by their second birthday, that child is protected from 14 serious diseases. So following this vaccination schedule is really powerful for children. I think all parents really care about their children, so I think it’s helpful to mention the impact of really following the schedule. And as I said before, the schedule is designed to give children the right protection at the right time. So it’s designed according to the development of the child and when the child is going to be exposed to, you know, the diseases that the vaccines are designed to protect them from. Some diseases require multiple doses of a particular vaccine. Other diseases require just one dose. In all of these cases, I think it’s important to emphasize the power here, which is the benefit to the child. And if necessary, it is useful to consider the costs to your child of not following a vaccination schedule — suboptimal protection. And it’s important to take the time to build relationships, to build trust, to keep the conversation going.
Pharmacy Times: What efforts has the CDC made to increase childhood vaccination rates?
Twentyman: This is something we all have to work on together. Public health is truly a team sport. Thank you for having Pharmacy Times as part of our team. One of the things that CDC has recently recognized is that childhood vaccination programs have become so successful that many of the diseases that once really threatened children in the United States and elsewhere are not even in our common vocabulary. Diseases like diphtheria, mumps, and rubella, which were once serious threats to children, are now rarely heard of. CDC wants to keep it that way. So, CDC has launched a new initiative called “Keeps it That Way,” which encourages parents to learn more about vaccine-preventable diseases and how vaccines can help keep their children healthy and protect them from these diseases.
Overall, the CDC recommends protection against a variety of diseases, including whooping cough, polio, measles, Hib, and meningococcal infections. All of these diseases can make children seriously ill and life-threatening. That’s why we urge parents to visit the CDC website to see which vaccines are recommended. Talk to your child’s health care provider about vaccinations. Talk to your child’s pharmacist about vaccinations. Follow the recommended schedule to keep your child healthy and in school.
Pharmacy Times: In this regard, what are some of the key initiatives of the CDC’s Vaccines for Children program?
Twentyman: Oh, thank you. Now, as you probably know, health equity is a very important issue for CDC. It’s very important to us at CDC that everyone has an equal opportunity to achieve optimal health. So providing these important vaccines that save lives is important for all children, not just the children of parents who can get the vaccine. So the Vaccines for Children (VFC) program was established for exactly this purpose. The VFC program has been helping families protect their children since 1994. It recently celebrated its 30th anniversary, or, to put it a little more fun, its 30th anniversary. VFC covers the cost of vaccines for children whose parents or guardians may not be able to afford them, and thereby provides childhood vaccinations to children across the United States.
We are prioritizing underserved communities to improve vaccine equity, health equity, and health equity. And we are doing this on a pretty massive scale. For example, in 2022 alone, VFC distributed more than 71.5 million doses of pediatric vaccines to participating health systems. And from 1994 to 2021, VFC provided more than 1.3 billion doses of non-flu vaccinations to eligible children across the country. So this is a very exciting effort to be a part of, and I’m really grateful to the health systems that have heeded this call, spread the recommendations, and connected children who need vaccines under the Vaccines for Children program to this program.
Pharmacy Times: Is there anything else you’d like to add?
Twentyman: Absolutely. I want the audience to know that vaccines have been saving people’s lives for over 100 years and are essential to protect all of us from deadly diseases. A recent CDC study found that routine vaccination of children born between 1994 and 2003 prevented about 508 million illnesses, avoided more than 32 million hospitalizations, and saved more than 1.1 million lives. All of this combined saves societal costs by more than $2.7 trillion. And the reason I bring this up is because vaccines don’t just save lives. They don’t just help us reach optimal health. Vaccines are also very economically wise. By the math I just explained, every dollar spent on vaccinating children saves $11. So we need to continue this teamwork effort to help our communities, protect our children, and protect our families. We need to continue that teamwork effort, especially through the leadership of health care workers like our listeners here who are out there advocating for routine immunization, having those important conversations, and continuing those conversations even when the initial recommendations don’t work. All of this works together to save money, prevent illness, prevent hospitalizations, and save lives. So, to all of you who are joining us on this call and listening to the recording, I really appreciate your cooperation.
