During the Pandemic More Kids Have Missed Routine Vaccinations. Providing Care in the Community Could Offer a Solution.

A young patient receives an immunization shot from registered nurse Maribel Ali, during a Peds in the Park event held at the Neighborhood House in Morristown, New Jersey, (Photo by Erica Lee for Direct Relief)

During the pandemic, childhood vaccination rates have dipped, putting kids at risk for vaccine-preventable diseases like whooping cough, chickenpox, and even some types of cancer. But in the beginning of the pandemic, some providers were wary to administer these vaccines because of the possible risk of exposing children to Covid-19. 

“I actually pushed for them not to come in,” said Dr. Amy Kolter, a pediatrician at Zufall Health Center in New Jersey, who was torn between delaying immunizations and potentially exposing children to Covid. “I remember going into a room and it was a physical for an older child and I was shocked thinking, ‘Why are they here? Why is a healthy, older child being exposed?’”  

While she advocated for newborns to get their vaccines, she felt the potential risks of vaccinating preteens outweighed the benefits, until the pandemic wore on. “We all thought that the pandemic was going to be over after three to six months. Nobody thought it was going to last two years.”  

Community members check-in for a Peds in the Park event held at the Neighborhood House in Morristown, New Jersey, earlier this fall. The health center is expanding pediatric care to locations across the community to reach children and their families. (Photo by Erica Lee for Direct Relief)

Now, data from the CDC shows that while childhood vaccination rates have returned to pre-pandemic levels, the increase hasn’t been enough to make up for the dramatic dip. Between March and May of 2020, for example, administration of the Tdap vaccine, which protects against tetanus and whooping cough, decreased by 63% among 9 to 12-year-olds compared to the same period two years priors. And during the summer, when most stay-at-home orders had been lifted, these rates didn’t swing back up. From June through September 2020, Tdap vaccine rates for pre-teens remained 21% lower than the two previous years, according to the CDC analysis. 

The need to catch children up on their vaccines inspired Kotler to start Peds in the Park, a series of clinics where children can get vaccines and other health care services in places that are more accessible than a doctor’s office, like schools, parks, and community spaces. “The model is to be able to promote childhood health and improve health outcomes,” said Krishna Patel, the director of community-based clinical services at Zufall Health Center and a key organizer of the Peds in the Park program. 

Dr. Carolina Lopez checks a young patient’s teeth during a Peds in the Park event. (Photo by Erica Lee for Direct Relief)

At these clinics, the health center offers HPV, TDap, Hepatitis, flu, and Covid vaccines in addition to dental care, nutritional counseling, and chronic disease management. “A lot of [parents] aren’t able to get time off from work or it’s hard to make that trip out to get to the doctor for their kids, so if they can get a host of services, it really helps them.” Since holding their first clinic last December, providers like Kotler have seen over 500 patients. “We can be available and present all the time at a site, but sometimes they just need somebody to come out to them and say, you know, ‘We’re here to help you,’” said Patel.   

In addition to providing vaccines, these clinics have helped providers flag health issues that have gone unaddressed during the pandemic. “A lot of [patients] have had weight gain,” says Kotler. Many of her pediatric patients took classes online and had fewer opportunities to play outside, making it more difficult to exercise–an experience reflected in national trends. According to a CDC study, childhood obesity in the U.S. has accelerated, increasing from 19% before the pandemic to 22% during the pandemic. The study shows kids who were a healthy weight gained two more pounds a year on average and those who were severely overweight gained an average of 14.6 lbs per year compared to 8.8 lbs pre-pandemic. 

Yraida Lipski, the Children’s Oral Health Program regional coordinator, teaches a four-year-old how to brush his teeth properly during a Peds in the Park event held at the Neighborhood House. (Photo by Erica Lee for Direct Relief)

For Kotler, seeing patients regularly is key to preventing these kinds of health issues from snowballing into other conditions. If a patient has gained weight, she orders labs that can detect diseases like diabetes and metabolic syndrome. Other times, these regular check-ins are a chance to monitor chronic conditions that have gone unmanaged. Kotler says many patients haven’t followed up with their specialists. “I’ll ask them, ‘Why haven’t you gone?’ And they’ll say ‘Because of the pandemic.’”  

While Kotler says reversing health issues, like diabetes, can be difficult, the Peds in the Park program creates an opportunity to prevent new ones from emerging. “Infectious diseases, they can always come back. We want to make sure that our kids are fully protected, staying safe and healthy,” said Patel. 

Direct Relief, in collaboration with the Pfizer Foundation, provided Zufall Health Center a $250,000 grant to implement the Peds in the Park program and expand access to childhood immunizations throughout their community.