Increasing Immunization Coverage

Abstract

Despite many recent advances in vaccine delivery, the goal for universal immunization set in 1977 has not been reached. In 2001, only 77.2% of US toddlers 19 to 35 months of age had received their basic immunization series of 4 doses of diphtheria and tetanus toxoids and acellular pertussis (DTaP) vaccine, 3 doses of inactivated poliovirus vaccine, 1 dose of measles-mumps-rubella (MMR) vaccine, and 3 doses of Haemophilus influenzae type b (Hib) vaccine. Children who are members of a racial or ethnic minority, who are poor, or who live in inner-city or rural areas have lower immunization rates than do children in the general population. Additional challenges to vaccine delivery include the introduction of new childhood vaccines, ensuring a dependable supply of vaccines, bolstering public confidence in vaccine safety, and sufficient compensation for vaccine administration. Recent research has demonstrated specific and practical changes physicians can make to improve their practices' effectiveness in immunizing children, including the following: 1) sending parent reminders for upcoming visits and recall notices; 2) using prompts during all office visits to remind parents and staff about immunizations needed at that visit; 3) repeatedly measuring practice-wide immunization rates over time as part of a quality improvement effort; and 4) having in place standing orders for registered nurses, physician assistants, and medical assistants to identify opportunities to administer vaccines. Pediatricians should work individually and collectively at local and national levels to ensure that all children receive all childhood immunizations on time. Pediatricians also can proactively communicate with parents to ensure they understand the overall safety and efficacy of vaccines.

Why Parents Say No to Having Their Children Vaccinated against Measles: A Systematic Review of the Social Determinants of Parental Perceptions on MMR Vaccine Hesitancy

“…Undervaccinated children (vaccine schedule delays/longer time to vaccination) were from low-income households with multiple needs and competing priorities that resulted in unintentional delays rather than a deliberate choice [ 154 ]. Some studies in this review noted that parents with lower income and inadequate healthcare insurance coverage had greater concerns on vaccine safety and efficacy and were unfamiliar with recommended vaccine schedules; these families juggled family responsibilities against less flexible work schedules, particularly those who were hourly wage workers, had dual-working parents, or were single-parent households [ 72 , 87 , 111 , 115 , 122 , 141 ].…”

“…Other approaches mentioned in this review that could boost vaccine acceptance included the following: Creating innovative reminder tools such as using social media for appointments and vaccine reminders [ 72 , 80 , 87 , 141 ]; Administering educational interventions in clinical settings by handing out vaccine information to patients in the waiting room [ 104 , 106 , 139 , 140 ]; Connecting emotionally with parents by having physicians share positive personal vaccine stories, family experiences, and personal narratives that are understandable and memorable [ 106 , 109 , 140 ]; Utilizing visually enhanced education (VEE) techniques such as pictures, storyboards, or videos on vaccine-preventable diseases (VPDs) to educate parents on the serious health complications of VPDs [ 72 , 100 , 130 , 139 ]; Using simple, clear, and succinct language to convey scientific information by using fewer jargon and clinical explanations and more of simple descriptions or analogies [ 104 , 113 , 119 , 120 ]; Composing relatable and easily understood metaphors in discussing vaccine safety, benefits, and adverse effects [ 106 ]; Applying motivational interviewing techniques using the “Plan, Do, Study, Act” (PDSA) or the “corroboration, about me, science, explain” (CASE) methods to understand deeply held reasons for hesitancy or refusal [ 57 , 119 , 120 , 121 , 136 , 139 ]; Using a presumptive tone rather than a participatory tone (“We will do the shots” versus “What do you want to do about the shots?” conveys the provider’s confidence in vaccines and establishes vaccines as a routine part of a well-child visit) [ 109 , 112 , 121 , 135 …”

“…Creating innovative reminder tools such as using social media for appointments and vaccine reminders [ 72 , 80 , 87 , 141 ];…”

Related Factors of Age-Appropriate Immunization among Urban-Rural Children Aged 24-35 Months in a 2005 Population-Based Survey in Nonsan, Korea

“…Knowing when immunization is scheduled enhances the possibility of carrying out the behavior 29. Especially, if the caregiver thinks that it is important to be immunized timely, the caregiver is Universilikely to act in a timely way 2,9,28,30,40. These results imply that it is necessary to make a policy to reduce the barrier to time and distance.…”