Immunization Trends and Vaccine Hesitancy

Reluctance or refusal to vaccinate is threatening decades of progress in the global fight against infectious diseases. Vaccines have been developed to prevent more than 20 life-threatening diseases, helping people of all ages live longer, healthier lives.
Top threats for global health, World Health Organization, 2017

Early Childhood Immunization Trends

The overall early childhood vaccination rate among U.S. children continues to improve, but more progress is needed for children enrolled in Medicaid. Among children born in 2017-2018 who were covered by traditional health insurance, 78.3 percent completed the ACIP-recommended vaccines by 2020 (CDC, 2021). By comparison, 65.6 percent of children in the same age group who were enrolled in Medicaid completed the ACIP-recommended vaccines in that time period (Ibid.).

Among all children born in 2017-2018, an estimated 70.5 percent received the ACIP-recommended vaccines. Texas lagged behind the national average with 65.9 percent of children receiving the full series, according to the National Immunization Survey, 2018-2020.

Nationally, some vaccines remain below optimum levels to ensure herd immunity in the population, including diphtheria, pertussis and measles. Diphtheria may need vaccination rates as high as 86 percent to ensure herd immunity in the population. Pertussis and measles may require rates as high as 94 percent. The U.S. vaccine rate for pertussis is 81.6 percent and measles is 91.6 percent for infants born in 2017-2018 (National Immunization Survey 2018-2020).

Adolescent Immunization Trends

Immunization rates are significantly lower for adolescents than for children. In general, adolescents are less likely to have annual preventive medical checkups, which are prime opportunities for vaccine administration.

The 2020 National Immunization Survey-Teen, released in 2021, found that Texas adolescents ages 13 through 17 years trailed the national average for all immunizations except one.

Vaccine	U.S. National Average	Texas Average
HPV, one dose	75.1 percent	72.8 percent
HPV, up to date	58.6 percent	54.9 percent
Measles, mumps, rubella (MMR), two doses	92.4 percent	85.9 percent
Meningococcal (MenACWY), one dose	89.3 percent	91.2 percent
Tetanus-diphtheria-pertussis (Tdap)	90.1 percent	84 percent
Hepatitis A	82.1 percent	87.1 percent
Varicella	91.9 percent	86.7 percent

When physicians recommend and explain vaccines, it boosts immunization rates. Yet, one study found that a striking 65 percent of parents reported not receiving a recommendation from a health-care provider for immunizations (American Academy of Pediatrics, 2017).

Did you know?

The ACIP schedule includes immunizations beyond those required for school attendance. The ACIP child and adolescent immunization schedules can be viewed online or downloaded. Texas Health Steps providers should follow ACIP recommendations and administer recommended immunizations during preventive medical checkups.

Approximately 42,000 adults and 300 children in the United States die each year from vaccine-preventable diseases (American Association of Colleges of Pharmacy, 2023). Issues that affect vaccine rates include:

Missed preventive medical checkups

Vaccination rates vary widely throughout the country at both the state and local levels, but missed preventive medical checkups are a primary reason children are under-vaccinated. Family mobility, lack of transportation and lack of health insurance are often cited as reasons children miss regular preventive medical checkups. Health-care providers can stress to patients and families the importance of participating in preventive medical checkups.

Vaccine refusals and hesitancy

The World Health Organization (WHO) list of top threats to global health includes vaccine hesitancy, which is the reluctance or refusal to immunize despite the availability of vaccines. While the reasons for hesitancy are complex, WHO identified complacency, inconvenience in accessing vaccines and lack of confidence as key reasons. As the most trusted advisor and influencer of vaccination decisions, health-care providers must offer consistent, dependable and credible information about vaccines.

Lack of access to routine preventive care

Texas leads the nation in the number of uninsured and underinsured children. Approximately 3 million Texas children and adolescents receive health care through Medicaid. Texas Health Steps providers play an essential role in ensuring that these youth receive age-appropriate annual preventive medical checkups that include administration of vaccines according to ACIP recommendations. Children ages 35 months and younger receive preventive medical checkups more often than once a year, according to the Texas Health Steps Periodicity Schedule.

Parents are exposed to misinformation about vaccines through dubious websites and social media. Rare adverse effects and scientifically unsubstantiated concerns make headlines and spread far and fast through the digital domain. Although parents may be motivated by safety concerns, those who choose NOT to vaccinate their child are putting that child AND children in their community at risk. Health-care providers are encouraged to become familiar with the reasons behind vaccine refusal and hesitancy and be prepared to counsel parents about the need for vaccines.

Lack of trust

While opposition to vaccination has always existed, the internet and social media amplify anti-vaccination misinformation, especially since the beginning of the COVID-19 pandemic. Theoretical safety concerns presented as scientific information abound online, and research suggests that just a few minutes of viewing a website with information critical of vaccines decreases intention to vaccinate. More than ever, medical professionals must attest to the safety of vaccines, the importance of vaccination and the potentially grave consequences of failure to vaccinate.

Supposed alternatives to vaccines

A 2011 study in the Maternal and Child Health Journal found that children in Washington State who received care from complementary health practitioners were substantially less likely to get recommended immunizations. Complementary and natural health-care practices have their place, but there are no effective alternatives to vaccines.

Safety concerns

Some parents delay or refuse vaccines for their children based on concerns that autism spectrum disorder (ASD) is caused by the MMR vaccine for measles, mumps and rubella, vaccines that contain the preservative thimerosal, or from receiving too many vaccines. Many studies have tested these claims and not one has shown that vaccines cause ASD. In addition, vaccine manufacturers voluntarily changed production methods to produce vaccines free of thimerosal or with only trace amounts, even though there is no scientific evidence that thimerosal is harmful.

Resources to help address vaccine hesitancy concerns

The nonprofit Immunize.org, formerly known as the Immunization Action Coalition, offers access to a wide variety of resources to address reasons for vaccine refusal or hesitancy, collected into one handy website. These include leading websites, handouts for families and staff materials, clinic tools such as how to develop a standing orders protocol, vaccine information statements for families, role-playing videos and talking points for addressing the concerns of parents using science-based materials from respected health organizations such as the AAP, CDC and more.

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Immunization Trends and Vaccine Hesitancy

Did you know?

Threats to public health

What’s behind vaccine refusal and hesitancy?

Resources to help address vaccine hesitancy concerns