Despite Success of Vaccines for Children Program, Disparities Persist

Although the Vaccines for Children (VFC) program has made significant progress in improving the health of children through vaccination, continued initiatives are needed to address gaps in coverage between eligible children and their non-eligible peers, according to a report by the CDC.¹

The VFC program is 1 of the nation’s primary health platforms created to promote health equity through vaccination. Since its inception in 1994, it is estimated to have prevented 508 million illnesses, 1,129,000 deaths, and saved nearly $2.7 trillion in societal costs among children born between 1994 and 2023.¹ But despite its success, disparities exist in coverage among VFC-eligible children compared with non-VFC-eligible children.

To address these inequities, the CDC analyzed vaccination trends among the 2 groups and identified opportunities to boost protection. The agency’s research utilized data from 152,915 children born between 2011 and 2020 from the NIS-Child, a nationally representative survey of children aged 19 to 35 months.² This survey tracks vaccination coverage based on Advisory Committee on Immunization practices recommendations across the United States, the District of Columbia, and some US territories.

A child was considered eligible for the VFC program if they met at least 1 of the following criteria: they were American Indian or Alaska Native; they were enrolled in Medicaid, covered by the Indian Health Service (HIS), or uninsured; or they had previously received a vaccination at an HIS-operated center, Tribal health center, or urban Indian health care facility.

Birth cohorts from 2011 to 2020 were constructed for 1 or more dose of the measles, mumps, and rubella (MMR) vaccine, 2 to 3 doses of the rotavirus vaccine, the combined 7-vaccine series, and other routinely recommended vaccines. Estimates of vaccination across each immunization were stratified by the child’s race and ethnicity, health insurance status, urbanicity, and household income.

READ MORE: CDC, ACIP Announce Vaccine Recommendations and Updates

Overall, VFC-eligible children born between 2011 and 2020 had lower vaccination rates compared to their non-eligible peers for MMR, rotavirus vaccine, and the combined 7-vaccine series. The gap in vaccination coverage between the 2 groups grew larger over time for both MMR and the combined 7-vaccine series.

Specifically, among children born in 2020, VFC-eligible children were 3.8 percentage points less likely to receive at least 1 dose of MMR, 11.5 percentage points less likely to complete the rotavirus vaccine series, and 13.8 percentage points less likely to complete the combined 7-vaccine series compared to their non-eligible-peers. Researchers expressed special concern about lower coverage for MMR vaccination among VFC-eligible children compared with non-VFC-eligible children because even small decreases in coverage have resulted in measles outbreaks.³

When stratified by sociodemographic characteristics, VFC-eligible children had lower vaccination rates for all 3 vaccination measures compared to non-VFC-eligible children, regardless of whether they were White (−17.9 to −6.2 percentage points); lived above the poverty line (−11.2 to −4.6 percentage points); lived in Metropolitan statistical area (MSA) principal cities (−12.8 to −3.3 percentage points); or lived in MSA nonprincipal cities (−15.4 to −4.1 percentage points). While the gap in MMR vaccination coverage based on sociodemographic characteristics was narrower, disparities were more pronounced for rotavirus (−17.9 to −7.7 percentage points) and the combined 7-vaccine series (−17.1 to −9.7 percentage points).

Based on their findings, researchers offered several opportunities to improve vaccination coverage.

One key area of concern was the completion of vaccine series. Although initial vaccine doses given earlier in childhood had higher coverage rates among VFC-eligible children, completion rates for multi-dose vaccines given after 12 months were lower. This suggests potential difficulties in completing vaccine series and vaccinating eligible children during their second year of life. However, “provider reminder-recall systems and simultaneous administration of childhood vaccines at well-child visits have been established as effective strategies that can reduce missed vaccination opportunities and increase coverage,” noted investigators.

Further, although the proportion of coverage among uninsured children to insured children has narrowed overtime, uninsured children still have lower rates of protection. Medicaid enrollment, among other measures, can improve health care access for children and boost vaccination rates.

VFC-eligible children from low-income families also demonstrated lower vaccination rates for rotavirus and the combined 7-vaccine series compared to their higher-income peers. Although the VFC program provides free vaccines, other costs such as office visits and non-vaccine services can be barriers for these families. Additionally, factors related to health care providers, parents, and the health care system contribute to the disparity. Establishment of a consistent place of care has been associated with increased likelihood of VFC-eligible children in low-income households being up to date with recommended vaccines.

In conclusion, investigators called for “increased efforts” to “ensure that parents of VFC-eligible children are aware of, have confidence in, and are able to obtain all recommended vaccines for their children,” as well as benefit from the full potential of the VFC program.

READ MORE: Immunization Resource Center

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References

1. Valier MR, Yankey D, Elam-Evand LD, et al. Vital Signs: Trends and disparities in childhood vaccination coverage by Vaccines for Children program eligibility—National Immunization Survey-Child, United States, 2012–2022. MMWR Morb Mortal Wkly Rep. Published August 13, 2024. doi.org/10.15585/mmwr.mm7333e1

2. National Immunization Surveys. Fact Sheet. CDC. Accessed August 15, 2024. https://www.cdc.gov/nchs/hus/sources-definitions/nis.htm#:~:text=NIS%20is%20a%20group%20of,years%20(NIS%E2%80%93Teen).

3. Measles, mumps, and rubella (MMR) vaccination: What everyone should know. Fact sheet. CDC. Accessed August 15, 2024. https://www.cdc.gov/vaccines/vpd/mmr/public/index.html#:~:text=During%20outbreaks%20of%20measles%20or,for%20added%20protection%20against%20disease.