THINGS HAVE CERTAINLY CHANGED since the 1950s and 1960s. Baby boomers probably recall standing in line in the elementary school auditorium for an oral polio vaccine.
Today, some parents are up in arms about the battery of immunizations facing their school-age children—from influenza and hepatitis B to pneumococcal conjugate and human papillomavirus (HPV), not to mention measles-mumps-rubella (MMR), varicella (chicken pox) and tetanus-diphtheria-acellular pertussis (DTaP). Some refuse inoculation based on religious or medical reasons, such as the questionable relationship between vaccines and autism.
Brenda Gleason, president, M2 Health Care Consulting LLC, based in Washington, D.C., says there are other barriers to childhood and adult vaccinations, including timeliness and specificity of the vaccine.
New Jersey has become the first state to require flu shots for young schoolchildren who are attending licensed daycare and preschool programs. The Advisory Committee on Immunization Practices (ACIP), part of the Centers for Disease Control and Prevention (CDC), recently recommended that children six months to 18 years should get a flu vaccination—adding about 30 million children to the number of people for whom the CDC recommends an influenza vaccine.
"If states don't take responsibility, parents may refuse," says Melanie Corch, quality improvement nurse manager for Geisinger Health Plan headquartered in Danville, Pa. "If the vaccines are mandatory, there will be higher rates."
On the other hand, she is not convinced that making vaccines mandatory is the way to go.
"Parents have a right to refuse but should be aware of the ramifications," she adds.
As an integrated healthcare system, Geisinger is in the driver's seat when it comes to delivery of care, Corch says. The plan relies on personal phone calls and written materials to update physicians about current CDC guidelines and to remind members about getting recommended immunizations.
"It is understandable that states would mandate vaccines because the risk of mortality and morbidity is significant, but it has to be a decision between the member and physician," says Sam Cramer, MD, vice president, clinical programs, Comprehensive Health Solutions for WellPoint. "As a plan, we can't mandate, but we can ensure that members and providers are well-informed about risks and benefits."
Despite some controversy over the safety of vaccines expressed by concerned parents, more than 77% of U.S. children have received all vaccines in the recommended series, with less than 1% not receiving any vaccines from ages 19 to 35 months, according to a CDC estimate.
While many efforts to vaccinate are backed by public health departments, private insurers also are trying to remove existing barriers to immunizations. Their primary tool is education.
Kaiser Permanente and Health Net are emphasizing the influenza vaccination for children.
To reduce barriers, Kaiser Permanente has handed over the responsibility of administering vaccines to nurses, who do not need a physician order. In addition, the vaccines are free to members.
Through a poster, brochure and mail/phone reminder campaign for all populations targeted by ACIP, more than 63,600 people were vaccinated in just one day at Kaiser Permanente Northern California, says Roger Baxter, MD, infectious disease specialist and co-director of the Vaccine Research Center at Kaiser Permanente.
"It's reasonable to have concerns as a parent, but vaccines are so natural," he says. "They stimulate the natural immunities in the body. We need to get everyone to buy into preventive care."
Elaine Robinson-Frank, director of quality improvement for Health Net of California, based in Woodland Hills, Calif., agrees that immunizing individual children can help protect the health of a community.
"They are more infectious and shed the virus longer," she says.