Twin State health care providers took steps this spring, even as they had to cut back on in-person medical appointments during the first two months of the COVID-19 pandemic, to ensure that children didn’t fall behind on their vaccinations for preventable diseases such as measles, whooping cough and polio.
Though there have been signs of a slight dip in vaccinations delivered, providers say they have generally stayed on track.
“So many things in our lives have been put on hold during this pandemic,” said Alice Ely, executive director of the Public Health Council of the Upper Valley, in an email. “Childhood immunizations should not be one of these things. We certainly don’t want to protect ourselves from COVID-19 only to find that many of our youngest children begin getting sick from preventable childhood diseases.”
While that fear hasn’t been realized, at least not yet, doctors ordered fewer vaccines following the federal emergency declaration in mid-March. Nationally, there was a 2.5 million reduction in non-influenza vaccines ordered from the federal Vaccines for Children Program between January 6 and April 19 of this year compared with the number of doses ordered for the same weeks in 2019, according to a report published in the Centers for Disease Control and Prevention’s Morbidity and Mortality Weekly Report last month. There also was a decrease of 250,000 in the number of measles-containing doses delivered during the same time period, according to the report.
The Vaccines for Children Program was created following a measles outbreak in 1989-1991, which sickened tens of thousands of children in the U.S. and caused hundreds of deaths. The program provides roughly 82 million vaccine doses annually to approximately 40 million U.S. children aged 18 and younger whose families might not otherwise be able to afford them, according to the Department of Health and Human Services.
Health department spokesmen for Vermont and New Hampshire said on Wednesday that immunization rates in the Twin States did dip some, although it’s unclear how much, during the early days of the response when providers closed or limited their services due to COVID-19.
“Since then, however, many providers ... have been going out of their way to help make sure kids stay on track,” Ben Truman, spokesman for the Vermont Department of Health, said in an email.
By scheduling early morning clinic visits, as well as offering options such as giving shots to children in cars, on porches or in tents, Upper Valley pediatricians are hopeful that they’ve helped most children keep up with their vaccines in spite of the pandemic. They are, however, wary of the effect the pandemic has had on vaccination rates in areas harder hit by COVID-19.
“It’s always a worry that there will be an outbreak,” said Dr. Susanne Tanski, chief of general pediatrics at Dartmouth-Hitchcock Medical Center. Although most people aren’t traveling much these days, in general infectious diseases “can travel around the world quickly,” she said.
Before the new coronavirus arrived, the Twin States both had high rates of childhood immunization of above 90%, according to the CDC. Those high rates are something Tanski said she and other area pediatricians are proud of and sought to maintain.
Giving vaccines is “really the most important job we have in prevention,” she said. “Vaccines save lives.”
DHMC and the associated D-H clinics have seen a reduction of about 1% in the rate of children immunized during the pandemic, Tanski said. That dip was lower than they expected, she said.
Though DHMC largely moved to conducting outpatient visits via telemedicine during the early days of the pandemic, providers scheduled clinic hours before 8 a.m. for children who were due for vaccines. Doing so allowed well children to come into the building before sick ones, Tanski said.
D-H clinics in the southern part of New Hampshire, which has seen a larger share of the state’s cases of COVID-19, provided well-child visits in tents to keep children separate from sick patients during the early weeks of the pandemic, Tanski said.
Now, D-H clinics, and most other health providers, have reopened and are seeing patients for regular in-person well-child visits with various COVID-19 prevention procedures in place, including mask wearing, screening for COVID-19 symptoms and separating patients with respiratory symptoms from others.
Pediatricians at the D-H-affiliated Alice Peck Day Memorial Hospital in Lebanon also have continued to see children who were due for their vaccines throughout the pandemic, said Dr. Laura Greer, an APD pediatrician.
“We were very concerned that families would put off vaccinations for their children because they were worried” about COVID-19, Greer said.
Though APD initially saw fewer patients, Greer said she and other pediatricians now are “really up and running and vaccinating.”
Pediatricians at Gifford Medical Center in Randolph also adapted quickly to ensure that children continued to get their shots during the pandemic, said Dr. Joshua White, the chief medical officer. They provided vaccines on the practice’s porch or in family’s cars, White said.
In spite of the efforts of pediatricians in the Twin States, which haven’t seen the high rates of COVID-19 transmission as neighboring states such as New York and Massachusetts, White said he is concerned that outbreaks of vaccine-preventable diseases in children elsewhere could make their way to the Upper Valley.
“We have patients here who can’t be immunized,” White said. “Maybe they’re a cancer patient.”
Kathy Barth, school nurse at Crossroads Academy in Lyme and president of the New Hampshire School Nurse Association, said she and other school nurses will be reviewing students’ vaccination forms as usual.
“In May, I sent my usual ‘your child needs the following immunization before the first day of school 2021,’ and let parents know that this is the state expectation, even with COVID,” Barth said in an email. “Of course I will work with parents if there is a reasonable delay and if there is a future appointment on file.”
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