Louisville, Kentucky —
On his first day at Newcomer Academy, Michael Tejeda was escorted into the school library, and the seventh-grader didn’t know why.
He quickly learned what this meant: he had received a booster vaccination. Five times.
“I don’t have a problem with that,” said the 12-year-old, who emigrated from Cuba earlier this year.
Across the library, city, state and federal officials gathered to celebrate the school clinic and the city’s success. At a time when the U.S. pediatric vaccination rates are below goals, Louisville and its state were being hailed as success stories. Kentucky’s kindergarten vaccination rates increased by 2 percentage points in the 2022-23 school year over the previous year. Jefferson County, home to Louisville, saw its vaccination rate increase by 4 percentage points.
“Progress is success,” said Dr. Mandy Cohen, director of the Centers for Disease Control and Prevention.
But that progress was short-lived. Kentucky’s school entry vaccination rates dropped last year, as did Jefferson County’s rates. And both the county and state rates remain well below the target thresholds.
This raises the question: if this is successful, what about the country’s ability to stop imported infections from becoming community transmission?
Local officials believe they can reach that level of herd immunity but acknowledge challenges include a lack of funding, misinformation and well-intentioned bureaucratic rules that discourage doctors from vaccinating children.
“We’re closing the gap,” said Eva Stone, who has managed health services for the county school system since 2018. “The gap is hard to close.”
Declining vaccination rates
Public health experts are focusing on vaccination rates among kindergarten children because schools can be breeding grounds for germs and a starting point for the spread of infection in the community.
These rates have been high for many years, largely due to laws that required major vaccinations as a condition of attending school.
FILE – Vaccines are prepared for students during a pop-up vaccination clinic at Newcomer Academy in Louisville, Kentucky, on Aug. 8, 2024.
But in recent years, that trend has been declining. When COVID-19 began to spread rapidly in the United States in 2020, schools closed, pediatrician visits declined, and vaccination records were no longer kept. Meanwhile, more parents began to question routine childhood vaccinations that had previously been automatic. Experts blame this effect on misinformation and the political divisions that have sprung up over COVID-19 vaccines.
A Gallup poll released last month found that 40% of Americans say it is extremely important for parents to vaccinate their children, down from 58% in 2019. Meanwhile, a recent survey of 1,500 people by the University of Pennsylvania found that about 1 in 4 U.S. adults believe that the measles, mumps and rubella vaccine causes autism, despite the lack of medical evidence to support this belief.
That has prompted an increasing number of parents to request exemptions to school vaccination requirements. Though the CDC has not yet released national data for the 2023-24 school year, the percentage of U.S. kindergarteners who received an exemption from school vaccination requirements in the previous year reached a record high of 3%.
Overall, 93% of kindergartners have received required vaccinations for the 2022-23 school year, up from 95% in years prior to the COVID-19 pandemic.
Officials are concerned that declining vaccination rates could lead to disease outbreaks.
Nearly 250 measles cases have been reported in the U.S. so far this year, the most since 2019, and Oregon’s largest outbreak in more than 30 years.
Kentucky is experiencing its worst outbreak of whooping cough, another vaccine-preventable disease, since 2017. Nationwide, about 14,000 cases have been reported this year, the highest number since 2019.
Convincing parents
The whooping cough surge is both a warning sign and an opportunity, said Kim Torrey, a California historian who wrote a book last year about vaccinating U.S. school-age children. Ms. Torrey called for an “all hands on deck” public information campaign to improve vaccinations.
Much of the discussion about increasing vaccination rates has centered on campaigns to educate parents about the importance of having their children vaccinated, especially those who are unsure about whether to vaccinate their children.
But experts are still considering what messaging will be most effective: Is it better to say “vaccinate” or “immunize,” for example?
Much of the messaging was influenced by feedback from small focus groups. One takeaway is that some people trust health authorities and their own doctors less than they did before. Another is that they strongly trust their own feelings about vaccines and what they see in their internet searches or hear from other sources.
“Their overconfidence is hard to shake, and that’s hard to correct,” said Mike Perry, who ran the focus group on behalf of a group called the Public Health Communications Collaborative.
But many people seem to have more trust in the older vaccines and are at least curious about information they didn’t know, such as the history of vaccine research or the risks of the diseases the vaccines were designed to combat, he said.
Improved access
Dolores Albarracin has studied strategies to improve vaccination in 17 countries and has repeatedly found that the most effective strategy is to make it easier for children to get vaccinated.
“The reality is that most people aren’t getting vaccinated simply because they can’t afford to ride the bus or have other challenges getting to an appointment,” said Albarracin, director of communication sciences at the University of Pennsylvania’s Annenberg Public Policy Center.
It’s a problem in Louisville: Few doctors vaccinate kids on Medicaid, officials say, and even fewer who don’t have health insurance. An analysis from a few years ago found that one in five children, or about 20,000, were missing vaccinations, most of them poor, said Stone, the county’s school health director.
A 30-year-old federal program called Vaccines for Children pays for vaccinations for children who are eligible for Medicaid or who don’t have insurance that covers the shots.
But in a meeting with the CDC director last month, Louisville health officials lamented that few local doctors are participating in the program because of paperwork and other administrative issues, and it can be difficult for patients to find the time and transportation to visit the dozens of participating Louisville doctors.
The school system has been trying to fill that gap, applying to become a VFC provider in 2019 and gradually setting up vaccine clinics.
Last year, the association held clinics at nearly 160 schools across the nation and is doing the same this year, starting with Newcomer Academy, where many immigrant students have fallen behind on vaccinations and are beginning to receive them through the school system.
Stone said this is difficult: There is very limited funding, bureaucratic obstacles, and a growing influx of children from other countries who need to be vaccinated. It requires multiple visits to doctors and clinics to complete the vaccinations. Plus there is opposition: announcements for vaccination clinics tend to spark hateful comments on social media.
