During the first few months of the COVID-19 pandemic, many families not only socially distanced from each other, but also from their pediatrician. As a primary care pediatrician, I heard from patient families who would rather wait until after the pandemic to see me for preventative care. That sounded like a good idea when we thought COVID-19 was a fleeting issue, but now, I am yearning for my patients to return.
So upon learning that the Pennsylvania Department of Health is temporarily suspending the regulations requiring immunizations for school attendance, I worried even more if my patients would delay routine child care. Typically, school requirements for immunizations, guided by state regulations, prompt many families to seek care in the months leading up to the first day of school. The state Department of Health worries that COVID-19 has limited the ability of pediatric offices and school nurses to provide the required immunizations safely before school starts, and therefore is allowing a two month grace period rather than the usual five days.
While I support any administrative changes that ease the burden on families who are already stressed during the pandemic, I fear that this change may have unintended consequences.
One of the most notable concerns is that immunization delays that started due to COVID-19 are now compounded by the Department of Health immunization suspension, leaving more children vulnerable to vaccine-preventable diseases. Based on Pennsylvania regulations, schoolchildren are immunized against diphtheria, poliomyelitis, measles, hepatitis B, varicella, tetanus, and meningococcus, at minimum, before entering school, and at appropriate grades thereafter.
An outbreak of any of these diseases could be devastating during a global pandemic. Furthermore, in a time period where we rate services and people as “essential” or “nonessential,” I worry that state-sanctioned immunization delays denote a nonessential status to immunizations. The small, but vocal, anti-vaccine community may use this to propagate mistrust in the scientific community at a time when we need evidence-based public health and scientific support most.
Pausing requirements for immunizations further delays other preventative care, which is one of the most important aspects of my primary care pediatric practice. In addition to immunizations, visits include assessments of growth and development, hearing and vision screenings, screening for anemia, lead, cholesterol, and HIV, screening for depression, and much more. If my patients think that they can postpone immunizations, they may also delay these valuable appointments.
Without the trained, watchful eye of pediatricians, who will identify the faltering growth curve of the child with celiac disease, the unusual “rash” on the child with leukemia, the burns scarring the child victim of abuse, or the failed screening questionnaire from the teen contemplating suicide? These are the children who make my heart ache during this pandemic, as well-intentioned parents and legislators unintentionally socially distance them from the pediatricians who want to provide the care they need.
I understand the objective behind suspending vaccine requirements. We do not want to overwhelm families, schools, or pediatric offices with immunization demands. However, during this pandemic, we have already seen a 50% to 70% drop in immunizations for Philadelphia children, suggesting we have a lot of catch-up to accomplish. Some of this delay is the fault of the health system; earlier in this pandemic, we encouraged families to stay home as we braced for an influx of COVID-19 patients. We now better understand the capacity of our pediatric health system, and how to safely provide care despite COVID-19. When my patients ask when it is safe to return to routine care, I say now!
Some of the precautions offices are taking include previsit screenings for COVID-19 symptoms and exposures, universal mask use, hand hygiene, social distancing, and enhanced cleaning protocols. Accessing a pediatrician right now is, in many cases, easier than ever before.
Even as COVID-19 continues, we at least have lifesaving vaccines waiting in our offices to protect children from so many other infections. So I encourage families to consider the Pennsylvania school immunization requirement suspension a generous, but unnecessary, courtesy, and opt to immunize today. Timely and safe preventative care is available and essential for keeping Philadelphia children well even in the midst of a global pandemic.