Experts discuss the pandemic's impact on routine immunizations


Watch the AMA's daily COVID-19 update, with insights from AMA leaders and experts about the pandemic.



AMA Chief Experience Officer Todd Unger speaks with physician and adjunct associate professor at Emory School of Medicine Sandra Fryhofer, MD, chief strategy officer of the Immunization Action Coalition L.J. Tan, PhD, MS, and infectious diseases specialist at the University of Maryland Medical Center James Campbell, MD, MS, on updates regarding COVID-19 including, the impact on routine immunizations, in part one of a two-part series.

Learn more at the AMA COVID-19 resource center.

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Unger: Hello, this is the American Medical Association's COVID-19 Update. This is part one of a two part series on the impact of COVID-19 on routine immunizations. I'm joined today by Dr. Sandra Fryhofer, an internal medicine physician, adjunct associate professor of medicine at Emory University School of Medicine and an AMA Trustee in Atlanta. Dr. Fryhofer is the AMA liaison to the CDC's Advisory Committee on Immunization Practices. Dr. L.J. Tan, chief strategy officer of the Immunization Action Coalition in Chicago. He also co-founded and co-chairs the National Adult and Influenza Immunization Summit. And Dr. Jim Campbell, professor of pediatrics and an infectious disease specialist with the University of Maryland Medical Center in Baltimore, Maryland. I'm Todd Unger, AMA's chief experience officer in Chicago.

Recently the World Health Organization reported that as many as 80 million babies worldwide are missing out on routine childhood vaccinations because of COVID-19. Dr. Fryhofer, why the disturbing drop in vaccination rates?

Dr. Fryhofer: Well, Todd, as many as 68 countries are having problems with their immunization programs, and there are many reasons. People are scared. Many are reluctant to go to a clinic for fear of getting COVID. They're concerned for themselves, for their babies and for health care workers. And in some cases, health care workers that traditionally administer vaccines have been reassigned to respond to the COVID pandemic.

Many clinics don't have enough protective equipment and have had to limit the number of patients they see, which means there are fewer appointments. Travel restrictions also play a role. Some people may not physically be able to get to a clinic. Travel restrictions, including cutbacks in air travel, can also affect vaccine delivery to the clinics. And you can't vaccinate if there's no vaccine available. In some areas, health care facilities have had to even cancel appointments.

Unger: Dr. Tan.

Dr. Tan: Yeah. Thank you for that, Dr. Fryhofer. I think that's a really important comment that you made about what's going on internationally. And if you take a look at what's happening in the United States, I think it's interesting to note that obviously the way our surveillance system works for coverage rates in our children, there's a lag between when we actually have the data and when we can actually report, when we report it. So the best way to look at how we're doing in the United States is actually to look at a program called the Vaccines for Children's Program and seeing how many vaccines are actually being ordered by providers.

There's a publication that just came out recently that showed that there is a dramatic drop in the ordering rate of vaccines in the Vaccines for Children's Program. And that data is also further supported by state level data, such as in the state of Michigan, where they have shown some of the coverage rates in children under the age of two dropping below 50%.

And obviously those are things we do not want to see because when coverage rates drop below what we call the range for herd immunity, we're going to see some dramatic impact in terms of disease in the United States. So I think that's a great point that you brought up internationally, and unfortunately, we're also seeing it in the United States.

Unger: Dr. Campbell, what are you seeing?

Dr. Campbell: Yeah, the same thing. And I would just echo what was said by our other two guests that we're seeing that here in the state of Maryland. And one of the ways that the states can, individually are looking at what those rates are, are through these immunization registries. So many states now have ways that they can look across the state at people who have been vaccinated.

And in the state of Maryland, for example, where I work, there's been a reduction in last month, the month of April, if you compare rates of measles vaccination in children in April 2020 to April 2019, down 71%. So the most contagious of any virus that we know of, 71% lower, and that equates to over 16,000 children in March and April, just in the state of Maryland, who did not receive MMR this year. And did, that same cohort did last year. So it's just a huge reduction in certain vaccines.

Unger: Those are pretty disturbing figures. Dr. Tan, what are the potential long-term implications of these missed immunizations?

Dr. Tan: So, with our wonderful guests, I think we all have been involved in the arena of immunizations for a long time. And we know that one of the reasons why we emphasize getting immunization coverage rates up is not only because it protects the health of the child or the person in general, we have this thing called community immunity or herd immunity, where when we have enough people protected, the disease can't take hold, it can't anchor. And if it can't anchor, then it doesn't have a chance to make people sick.

So when we have our coverage rates drop like this, what we see is we see an erosion of that so-called herd immunity, and this kind of disruption to the immunization programs will then actually result in a resurgence of all these vaccine preventable diseases that we've actually gotten rid of in the United States. All of you remember right? Measles surged recently, we had the 2014 outbreak in California. We had a recent surge just last year, which almost made us lose the United States certification as a measles-free country. And I worry with the data that was just referred to by Dr. Campbell. I worry that we might lose that measles eradication certification because of this decline in our immunization coverage rates. We cannot trade COVID-19 for another deadly outbreak in measles. That's just not acceptable. We have to do both.

Unger: Dr. Fryhofer, Dr. Campbell.

Dr. Fryhofer: Well, I agree with both of the other speakers. Of all infectious diseases, measles is one of the most contagious, and if you're exposed and you're not immune, 90% of the time you're to get it too.

You know, scientists and researchers are in a race to find a COVID vaccine, but we already have a measles vaccine. It's safe. And it works. Two doses of MMR, the measles, mumps, rubella vaccine are about 97% effective in preventing measles.

And the other thing I worry about is we've all been sheltering in place. And the concern is as the social distancing rules become more relaxed, that children that have not been vaccinated become more vulnerable to diseases like measles. And remember, before the measles vaccine, nearly three to four million children were infected in the U. S. each year. Four to five hundred of them died. And pockets of unvaccinated children led to those measles outbreaks that Dr. Tan mentioned back in 2019. And that's, by the way, is the greatest number of cases reported across the US in more than 20 years.

Dr. Tan: Absolutely.

Unger: As states develop plans for reopening, what can physicians do to encourage families to insure their children are up to date with vaccinations, Dr. Fryhofer?

Dr. Fryhofer: Well, the CDC says it's important to prioritize vaccination of newborns and infants and children under the age of two, even during this pandemic. But this drop in immunization rates is occurring at a time in which we need strong immunization networks and programs in place. So when a COVID vaccine is available, we have a mechanism in place to get people vaccinated and protected quickly and efficiently.

Unger: Dr. Campbell, why don't you talk a little bit about the campaign that's been launched by the American Academy of Pediatrics to help physicians urge parents to get their immunizations?

Dr. Campbell: Yeah, thanks. So we can start with, there's been messaging on websites and through private practices, states, the Centers for Disease Control, the American Academy of Pediatrics, but sometimes those just sit on the website and people are not necessarily getting to them and hearing the message. But just recently, the American Academy of Pediatrics has put out a whole campaign called #CallYourPediatrician, which is a way to try to get the word out, both to the public, to be talking to their health care providers for their children, and for pediatricians to be getting the message more out to the families that they care for. And it includes things like humor and empathy and other social media tips that I think are very helpful. So if people haven't gone to that website to see it, or haven't seen it on social media, I think it's a really good way to get the word out.

Unger: That concludes part one of our update on immunizations and COVID-19. Thank you to Dr. Fryhofer, Dr. Campbell and Dr. Tan for being here today and sharing your perspectives. We'll be back tomorrow to continue this important discussion with part two of our series. In the meantime, for updated resources on COVID-19 visit Thanks for being with us here today and take care.

Disclaimer: The viewpoints expressed in this video are those of the participants and/or do not necessarily reflect the views and policies of the AMA.