Edward Jenner was an 18th century English physician and scientist who was instrumental in the development of the world’s first vaccine, which was for smallpox. There is a long and involved story involving English nobility, a trip to Constantinople (now Turkey), milkmaids, cowpox, and of course, cows, hence vaccination (from the Latin root vaca).
The Emperor of France, Napoleon Bonaparte, had all of his troops vaccinated against smallpox after learning about the success of the smallpox vaccine, though France and England were at war at the time. A few years later, George Washington’s army lost the battle of Quebec because of a smallpox epidemic that sickened many formerly healthy troops. The rest of this story involves sketchy ethical boundaries, such as testing the vaccine on prisoners and one’s own child, crude medical procedures and technology and a life expectancy that was quite poor at the time, for children and adults.
So, how does this 300-year-old history relate to our current situation?
As a nurse and pediatric nurse practitioner for many decades, caring for children who are well or ill has given my professional life purpose, and drives my passion in the area of enhancing wellness and preventing disease. It’s that simple. More recently, the IHI, which is the Institute for Healthcare Improvement, has developed a framework to optimize health system performance. It is quite modest: We strive to improve the patient experience of care, improve population health and reduce costs of health care.
Providing immunizations to children at low or no cost accomplishes these goals. The Vaccines for Children program provides all recommended vaccines at no cost for children under age 19 who qualify for Medicaid, don’t have insurance or can’t afford out-of-pocket insurance costs for vaccines, or are Native American or Alaskan Native.
Many immunizations were delayed earlier this year due to the pandemic, especially in the early months of March and April when clinics and offices were only open for emergency care. Now, many offices are back to a semblance of “business as usual,” but delayed immunizations remain delayed, as a few are two to three injection series that are spaced out by weeks or months.
It is essential that children receive immunizations and receive them on time.
Tina Tan, an infectious disease specialist at Lurie Children’s Hospital, was alarmed to see immunization rates fall dramatically as outpatient clinics limited their hours and parents stayed home rather than bringing their child to the pediatric office. It would be unconscionable if a child died of measles or another vaccine-preventable disease because of the COVID-19 crisis.
So, where are we now with immunizations for children?
Estimates show 2.5 to 4 percent of the population will refuse all vaccinations for themselves and their children, though all childhood vaccines have been supported by solid medical evidence for decades as effective against vaccine preventable diseases (VPDs). Most parents who refuse vaccines were themselves recipients of vaccines as children. VPDs in children make the patient experience of care decline, worsen population health and increase costs of health care for all of us.
A COVID-19 vaccine is in progress but it is fraught with complications — both political and medical. At this point no one can predict when this vaccine will be widely available, who will get it and who will refuse it for themselves or their children, and whether it will be effective long-term. While a COVID-19 vaccine sounds good at first blush, it is not a panacea.
What can we do to improve child health care this fall, right now, today, in the absence of a COVID 19 vaccine?
We can advocate that all children receive a flu shot. The American Academy of Pediatrics recommends routine influenza immunization of all children without medical contraindications, starting at 6 months of age. The AAP is not for profit, and pediatricians are the lowest paid medical specialty. They are not getting rich from immunizations or flu shots.
The Influenza vaccination is an important intervention to protect vulnerable populations and reduce the burden of respiratory illnesses during this pandemic. Further, for the 2020–2021 influenza season, we need to look at COVID-19 and flu season simultaneously to determine risk of illness to children. There is some evidence that the flu vaccine may reduce the risk of severe COVID-19, especially among high-risk groups, however more evidence is needed to support this idea. It is very important that children at high risk receive the flu vaccine, this includes children less than 5 years old, those with chronic pulmonary diseases like asthma and cystic fibrosis, kidney or liver disease, sickle cell disease or metabolic disorders like Type I diabetes, epilepsy, stroke, developmental delay or other conditions that make a child high-risk.
On the positive side, masking, distancing and sanitization precautions many of us are continuing to perform to avoid COVID-19 may reduce the incidence of other winter infections, such as flu, colds and gastroenteritis.
This is not the year to skip the flu vaccine for yourself or your child.
Ruth K. Rosenblum is an associate professor of nursing at San José State University, a practicing Pediatric Nurse Practitioner, and a Public Voices Fellow with The OpEd Project.