By Katie Kerwin McCrimmon
Colorado’s immunization rate for young children has faltered after climbing from dead last in the country in 2002 to 9th in 2008.
The latest figures show Colorado 15th nationally for immunizations of children ages 19 to 35 months, according to the National Immunization Survey conducted annually by the Centers for Disease Control and Prevention. Colorado failed to break through the national goal of immunizing 90 percent or more of its young children with any one of the recommended vaccines.
The cost of failing to vaccinate children for preventable diseases is exorbitant. Colorado researchers have found that in 2009 alone, hospitalization of children who suffered from vaccine-preventable diseases resulted in more than $56 million in hospital costs. Of those charges, taxpayers picked up the tab for $31 million, according to the Colorado Children’s Immunization Coalition.
At the same time, researchers for a separate study found a “disturbing drop” of nearly four percentage points from over 81 percent to over 77 percent nationally in 2009 for children who received vaccinations through private insurance companies. Meanwhile, immunization rates for poor children, who received vaccinations under Medicaid, have been inching up nationally.
The National Committee for Quality Assurance accredits health plans and examined quality data from over 1,000 plans that cover 118 million Americans.
Researchers attributed the 4 percent drop to parents who refused vaccinations for their children based on the unproven, but widespread notion promoted by celebrities like Jenny McCarthy, that vaccines cause autism.
“The drop in childhood vaccinations is disturbing because parents are rejecting valuable treatment based on misinformation,” said NCQA President Margaret E. O’Kane.
Economic hardships cutting vaccine rate
While fears may be driving some parents to skip or delay vaccinating their young children, economic hardships hitting both patients and doctors may also be a key cause for the declines.
“It’s the economy. People don’t have time. If you’ve got a single mom with two jobs, her choice is the kids eat or they have vaccinations,’’ said Dr. Sergio Murillo, a family physician at Comprehensive Family Care Center in Pueblo. “People are really struggling.”
For those who have lost health insurance, learning how to access public health programs can be difficult, causing some parents to miss key vaccinations for their children.
At the same time, doctors throughout Colorado face soaring costs and low reimbursement rates for giving vaccines, spurring some to send parents to public health clinics rather than offering vaccinations in their offices.
“Public health officials aren’t as worried about the kids who show up as the ones who don’t show up,’’ said Joni Reynolds, director of the immunization section for the Colorado Department of Public Health and Environment.
If parents have to make an extra trip to a public health clinic – rather than easily getting vaccines during regular visits with their doctor – vaccination rates may further decline. Some families may find it difficult to carve out the time for a second appointment and drive to a different location. Others may fear they’ll have to pay for the vaccines. That shouldn’t be the case for any children. A federal program called Vaccines for Children guarantees free immunizations to poor children, those without health insurance, American Indians and Alaska Natives, and children whose insurance plans don’t cover vaccines. While the vaccines are free, the program can be complicated for doctors to administer and barely reimburses health providers for their costs in giving the shots. Reimbursement rates for Colorado doctors who give vaccines to poor children are now as low as $6.36 per dose.
“There are doctors out there who are losing money giving vaccinations to their Medicaid population,’’ Reynolds said.
And Dr. Murillo in Pueblo says it’s difficult to keep a full stock of the VFC vaccines. Sometimes, his office simply runs out. He’ll have a privately-insured child in one exam room who can receive vaccines while the Medicaid-insured child in the room next door must be sent away without the full vaccinations.
“We have two sets of vaccines. Nobody talks about it, but I call it insurance discrimination,’’ Dr. Murillo said. “When we run out of the VFC vaccines, we’re done and we have to send them away to our (county) health department. You don’t feel good about that. I cannot document what happened or not.”
Experts say vaccines are safe
The stakes are high. When immunization rates drop, experts see a corresponding increase in expensive, potentially fatal diseases that could have been prevented.
“I’m concerned. We know that when vaccination rates go down, disease rates go up,’’ said Dr. James Todd, medical director for Epidemiology and Infection Control at The Children’s Hospital, who co-authors the Vaccine Preventable Disease Report each year for the Colorado Children’s Immunization Coalition and Children’s Hospital.
Todd and other experts say there is no proven link between vaccines and autism. With reports of pertussis – also known as whooping cough – on the rise in Colorado and causing a deadly outbreak in California, he said it’s critical for parents to get their children immunized.
“Vaccines are very safe in Colorado. They have saved 10s of 1000s of children per year. We have the best, most intricate vaccine safety program in the world. No other drug is submitted to so much safety testing,’’ he said.
Without vaccines, Todd estimates Colorado would see more than 70,000 children suffering from preventable diseases every year.
What’s tricky for new parents is that they must face vaccine decisions almost immediately after giving birth.
“Most of the really serious vaccine-preventable diseases occur in the very young. The first year of life is when vaccines are the most important,” Todd said. “There are a lot of theories out there. Most are generated by fear. The most important thing for parents in Colorado to do is talk to their own doctor.”
Parents face tough decisions
That’s exactly how Anne and Adam Hobson of Denver decided how to handle immunizations after their twins were born last October.
“We wanted to look into the whole autism thing,’’ Anne Hobson said, as her daughter, Lily, and son, Owen, practiced walking in their diapers during their one-year well baby visit at Cherry Creek Pediatrics in Denver.
“We questioned whether or not to actually do it,’’ Adam Hobson said of the recommended vaccination regimen.
Ultimately, the Hobsons decided that concerns about autism were based on faulty science. They put their faith in their doctor, Steve Perry, a pediatrician who’s also an expert on immunizations and works with the CCIC. Perry has plenty of parents in his practice who worry about vaccines. He reassures them that vaccines are safe and recommends that they follow the tested schedule. Some parents choose to delay doses so they don’t have to give their babies multiple vaccines all at the same time. Perry respects the parents’ wishes, but warns them that they’ll have to make extra visits to his office, which can expose their children to even more illness.
“Concerns have plateaued over the last two to three years. It’s not so much that parents are refusing as that they are picking their own schedule,’’ Perry said. “Many have their minds made up. I tell them that studies show that antibodies work the best to prevent infection when you follow the schedule.”
For the Hobsons, Perry’s reassurance made their decision clear.
“Dr. Perry told us that there’s really nothing to worry about,’’ Adam Hobson said.
Anne Hobson also came to the conclusion that she had an ethical obligation to get her children immunized. There’s a concept among vaccine experts called “herd immunity.” Depending on how contagious a disease is, experts have found that if 90 to 95 percent of the population is immunized, the disease won’t be able to travel through the “herd.” “People get all high and mighty about vaccines. But, I don’t think it’s right for my kids to be vectors of disease,’’ Anne Hobson said.
Parents want assurances of safety, choices
Theresa Wrangham of Louisville is executive director of the National Vaccine Information Center. She urges parents to study vaccines carefully and make informed decisions before routinely having their babies vaccinated.
Boosting Immunization Rates
- Better tracking: The Colorado Immunization Information System tracks vaccinations for all babies born since 2001. Currently public providers use the registry along with 90% of pediatricians and 47% of family practitioners.
- Bulk buying power: Colorado is eyeing programs in other states. New Mexico and Wyoming both have programs for universal purchase of vaccines. Washington state buys vaccinations at a bulk discount for all children. Colorado considered a similar program, but the concept hasn’t reached the legislature here.
- Immunizing caretakers: With pertussis or whooping cough cases on the rise, Colorado health officials are working to immunize adults and create a circle of care around vulnerable infants. Called cocooning, the program aims to immunize parents, caretakers, health providers and hospital workers.
- Better coordination: Colorado is working with the CDC to help bill insurance companies as more insured families use safety net clinics.
- Better information: A new website will launch in Colorado in 2011 to give parents information and data about vaccines. The site will be at www.ImmunizeforGood.com.
Wrangham has two daughters, the oldest of whom is now 20 and has been diagnosed with an autism spectrum disorder. Wrangham calls Rachel a “full hit kid,” meaning that she was fully vaccinated until the age of 3 with vaccines containing thimerosal. Those, like Wrangham, with vaccine safety concerns believe mercury in thimerosal is dangerous, and as a precautionary measure, it has now been removed from most vaccines. Wrangham can only speculate about what caused Rachel’s declines in health. She believes vaccinations were a contributing factor. But, when Rachel was a baby, the family lived in Saudi Arabia. Dangerous air pollution from oil fires was spewing into the sky and Wrangham recalls workers spraying pesticides frequently at the compound where they lived.
All she knows for certain is that Rachel seemed to be doing fine, then started regressing and wasn’t speaking like a normal 2-year-old. After researching vaccines, Wrangham stopped giving them to Rachel when she was just over 3. Wrangham, herself, had experienced a severe reaction to a measles vaccine as a child. She wonders if pollutants and pesticides in Saudi Arabia combined with thimerosal exposure and a poor tolerance for vaccines put Rachel over the edge.
“It could have been a combination of all of the above,’’ Wrangham said. “Maybe she reached a toxic tipping point. I don’t know that we’ll ever know for Rachel.”
Wrangham wishes she had known then about the Vaccine Adverse Reporting System and the National Vaccine Injury Compensation Program, government programs established by in 1988 to require reporting of adverse vaccine reactions and compensate victims. Had she known about the programs when Rachel’s health declined, she would have obtained copies of her daughter’s medical records and could have filed a claim before the statute of limitations expired.
“Parents don’t know these systems exist. We’re not told what a vaccination injury looks like. It can be a fever, hives, convulsions,’’ Wrangham said. “If parents are in this boat and they think their child has experienced an injury or severe reaction, they don’t know where to turn.”
Back when Rachel was 6 and diagnosed with a developmental disorder on the autism spectrum, doctors gave Wrangham a grim prediction.
“They told us she would never have a job, or friends and would never live on her own,’’ Wrangham said.
She refused to accept that reality, and today, thanks to aggressive therapy and years of education, Rachel is doing well.
“She drives herself to college. She has held down a job. She’s made presentations to the (National Institutes of Health’s) autism coordinating committee,’’ Wrangham said.
Wrangham believes publicity about autism has “turned up the volume on concerns” over vaccines. When she counsels parents, she tells them to do their own research.
“What’s important to remember is that it’s a recommended schedule, not a required schedule,’’ she said. “Parents want to know that they’re safe and that they have a choice.”
Dr. Robert Brayden, a pediatrician at Children’s Hospital and a pediatrics professor at the University of Colorado Denver’s School of Medicine, is also president of the Immunization Coalition’s board.
He says most parents today don’t realize how dangerous diseases like whooping cough can be.
“They can be deadly. To not vaccinate a child is not to avoid a threat. Your child is going to be exposed or carries a possibility of getting a disease, that itself may be serious. The safe choice is to vaccinate,” Brayden said.
Ultimately, Brayden and other experts know family doctors and pediatricians will have a powerful influence over whether Colorado’s vaccination rate improves.
“I tell providers to be sure to spend the time with families and give them your opinions about how you feel,’’ Dr. Brayden said. “The local physician is very, very influential.”