One Earlier this month, a pediatrician’s nightmare became a reality: Polio, once thought to be eradicated in the U.S., paralyzed an unvaccinated adult, and was found in wastewater in New York City and outlying counties. virus.
This polio case is particularly concerning for three reasons. First, the person had not traveled recently, suggesting that he contracted the virus in the United States, not overseas. Second, the strain of polio (type 2) that infected him caused about 1 in 2,000 infections to be paralyzed, suggesting that hundreds, if not thousands, of people in New York have recently been infected with the virus. Third, genetic analysis showed that the polio strains evolved from the oral polio vaccine (using a live attenuated virus) and were the same strains causing community transmission in London and Israel, suggesting that multiple The country’s problems were previously considered polio-free.
There are an estimated 1.7 million children in New York City where we work, all of whom have the opportunity to get vaccinated at the pediatrician’s office because there are safety net hospitals where every child can seek care and get vaccinated, regardless of insurance or immigration status. 7 A decade ago, parents lined up to get their children vaccinated for a disease that disabled or prevented thousands of people from breathing every year. Today, with pictures of children using iron lung machines a thing of the past, in some New York City neighborhoods, as many as 40 percent of 5-year-olds are not fully vaccinated against polio, putting thousands at risk of paralysis and death.
How could our nation’s commitment to such safe and life-saving health interventions slip so far, leaving children vulnerable?
Pediatricians’ offices are the infrastructure America relies on to vaccinate children. This strategy has been largely successful, with only 0.5-1.5% of children never vaccinated, a rate lower than in most parts of the world. Families trust their pediatrician to provide health information.
While the pediatrician’s office is a key venue for translating vaccines into vaccines, the law is a key check on whether the system is working as intended. The best predictor of high childhood vaccination rates in the United States was strict enforcement of vaccination requirements for children in school and day care. However, vaccine hesitancy and refusal, due to misinformation or religious and medical exemptions, have undermined high rates of routine vaccination. This foundation crumbled further when the Covid-19 pandemic disrupted children’s visits to pediatrician’s offices both domestically and globally.
Despite relying on the pediatrician workforce to administer vaccines in children, pediatricians have limited training or resources to provide vaccine information and evidence-based approaches to effective vaccine administration. They are largely unprepared to deal with the increasing volume and decreasing accuracy of vaccine-related information parents hear or see.
We believe that there is an urgent need to strengthen vaccination policy and practice through pediatricians. Here are three ways to get there.
First, the Centers for Disease Control and Prevention and states must fund staffing and partnerships between local health departments and pediatrician offices to identify children who are not up-to-date with vaccines. With the right resources, health departments can look up immunization registry data and electronic medical records and notify parents of children who need vaccinations. Childhood vaccination support supported by local governments is even more necessary during this time of medical staff shortage.
Second, pediatricians should follow the model created for influenza vaccines during seasonal rollout, increasing the high use of routine vaccines during quality improvement in their practice. Regulatory boards such as the American Academy of Pediatrics and hospital rankings such as U.S. News & World Report should include standard indicators of childhood vaccination rates; doing so will facilitate quality improvement efforts to increase vaccination rates within independent pediatric offices and large healthcare systems. Pediatricians and their staff should make extensive use of training resources with certified coaches in their practice and training to address vaccine hesitancy.
Third, state Medicaid programs should provide substantial incentives to pediatricians who achieve high vaccination rates and should encourage private payers to do the same. Preventing even one case of polio paralysis that disabling a child for life would almost certainly make these interventions cost-effective from a government and health system perspective.
Poliovirus is circulating due to low vaccination rates, and outbreaks of measles and other vaccine-preventable infections are not far behind. Fighting polio recirculation is a war America knows how to win, but only if it equips the front lines — pediatricians — with the tools they need to deal with vaccine misinformation, hesitation and complacency.
Sallie Permar is a pediatrician at New York-Presbyterian Comansky Children’s Hospital and chair of the department of pediatrics at Weill Cornell Medical College. She reported consulting for Merck, Moderna, Dynavax, Hoopika and Pfizer on their cytomegalovirus vaccine programs. Jay K. Varma is a physician and infectious disease epidemiologist, professor of population health sciences at Weill Cornell Medical College, and director of the Center for Pandemic Prevention and Response.