Too many Philly kids are missing routine vaccines, putting us all at risk. Here’s how to keep our city safe. | Expert Opinion

Philadelphia has a problem with routine childhood vaccines: Nearly one in five public school students is not fully vaccinated, with immunization rates falling for two straight years.

While Philadelphia’s kindergarten vaccination rates remain slightly above the national average and above cities such as Washington, D.C., and Houston, the city should not be complacent. If we can’t turn around this trend and boost childhood vaccination rates, the city risks those rates slipping even further, which can open the door for deadly outbreaks. Young children are already facing high rates of transmissible illnesses such as respiratory syncytial virus (RSV) and the flu as many return to socializing after being relatively sheltered during the pandemic; adding another virus to the mix could be disastrous.

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What’s more, Philadelphia has an opportunity to make itself a national exemplar in this area. Wouldn’t it be great to be known for having the nation’s most effective, citywide public vaccination effort that protects our children and reflects well on our health systems, School District, and city government?

But we’re not there.

Last year, only 82.2% of kindergarteners in Philly public schools had all five mandatory childhood vaccinations: polio, measles-mumps-rubella (MMR), diphtheria-tetanus-pertussis (DTaP), hepatitis B, and chicken pox. This is down significantly from 89.9% during the 2019-20 school year. Over this period, the kindergarten MMR rate dropped below measles’ herd immunity threshold (95%), increasing the possibility of measles outbreaks in schools. What’s more, one in five babies born in Philadelphia likely has no immunity against measles because their mothers lack protective antibodies that can be passed in the womb, leaving them vulnerable until getting their first vaccine dose at 12 months.

Even more worrisome are the enormous neighborhood disparities in vaccinations. For instance, citywide, 90% of children under 5 have received all required doses of the polio vaccine, but in some neighborhoods of South Philadelphia, the number is less than 60%. This is well below polio’s herd immunity threshold (80%).

The city’s drop in routine immunizations is neither inevitable nor irreversible.

Parents are not citing religion or personal preference for not getting their children vaccinated; only 1.3% of students received these types of exemptions last year. Instead, Philadelphia struggles to enforce its policies and ensure easy access to vaccinations. This, too, has been exacerbated by the strain COVID-19 placed on schools and public health operations.

When Philadelphia kindergarteners are unable to obtain all their required vaccinations before the school year starts, they are given a ”provisional” enrollment status.

In 2017, Pennsylvania reduced the time allowed for students to comply with school-entry vaccination requirements from eight months to five days. The result: Provisional enrollment dropped dramatically across the state, from 11.1% in 2016-17 to 2.5% in 2017-18. But not in Philadelphia, where officials didn’t enforce the new policy. As a result, provisional enrollment has remained above 10% over that same time period.

This does not need to be the status quo.

This does not need to be the status quo.

Here are four steps city officials can take to fix this issue in time for the 2023-24 academic year.

Supporting school nurses — who track compliance with school vaccination requirements and reach out to families of those behind schedule — means addressing the ongoing school nurse shortage. Last year, more than a dozen Philadelphia public schools lacked a full-time nurse. The city should ensure each public school has a nurse available on a full-time basis, as well as additional staffing in place to support various COVID-related duties, freeing up school nurses to focus on helping kids comply with other routine vaccinations.

School nurses must also be given the proper authority to enforce vaccination policies. In 2019, the Philadelphia School District started to prohibit school nurses from sending unvaccinated kids home, likely given the large numbers of such students. While exclusion from school is not an ideal outcome, school nurses should have this recourse if repeated outreach fails, particularly when their school community includes immunocompromised students or pregnant teachers.

There is significant variation in the supply of primary care providers across the city, and there exist primary care “shortage” zones, such as some neighborhoods of Northeast and Southwest Philadelphia. Most of the city’s public school kids are on Medicaid, and wait times for primary care appointments in Philadelphia are much longer for people with Medicaid vs. those with private insurance (16 days vs. nine days).

To ease access to primary care in the short term, Philadelphia can catalyze partnerships between community faith-based organizations and the city’s largest health systems — Penn, Jefferson, Temple, and Virtua — to establish pop-up vaccine clinics. COVID-19 vaccine distribution provided a blueprint for what these partnership models might look like and their effectiveness in combating vaccine disparities. In this case, pop-up vaccine clinics should be targeted to neighborhoods with the lowest per capita pediatric primary care access or routine immunization rates.

The city should agree to pay for any childhood immunizations not fully covered by insurance. This will help ensure that the possibility of cost is not a dissuading factor for any parent hoping to immunize their child.

Many community-led groups, such as the Black Doctors COVID-19 Consortium, played a central role in COVID vaccine distribution and have since expanded to other aspects of primary care. These groups are well-positioned to assist with routine vaccinations and might build on COVID outreach efforts by exploring new collaborations with the city’s youth-focused organizations and after-school programs.

The city’s Public Health Department does not have a director-level position focused primarily on routine immunizations, a reflection that more can be done to politically prioritize this issue. This person — an expert in local partnership building and education to combat vaccine misinformation — should be based in the Mayor’s Office, and coordinate efforts among the Department of Public Health, the Philadelphia School District, large health systems, and community groups.

On the heels of the COVID pandemic and in the lead-up to the election of a new mayor and city government, the city has a rare opportunity to strengthen its school- and community-based public health infrastructure and routine immunization rates for years to come.

Ezekiel J. Emanuel is the vice provost for global initiatives and a professor of medical ethics and health policy at the University of Pennsylvania. zemanuel@upenn.edu Matthew Guido is a project manager within Penn’s Healthcare Transformation Institute. matt.guido@pennmedicine.upenn.edu