Vaccine Rates for All Ages Drop Dramatically During COVID-19

Marcia Frellick

June 08, 2020

Editor's note: Find the latest COVID-19 news and guidance in Medscape's Coronavirus Resource Center.

Noninfluenza vaccine rates are tumbling for adults as well as children, owing to the fact that concerns regarding COVID-19 have overshadowed routine care, an analysis from VaxCare indicates.

Wanda Filer, MD, head of medical affairs for VaxCare, a company dedicated to vaccine program management solutions in Orlando, Florida, and Yasaman Malone, PhD, chief data scientist for VaxCare, compiled the report, which compares noninfluenza vaccination rates from March 3 to May 11, 2019, to rates during the same period this year.

The article follows a report released May 8 by the Centers for Disease Control and Prevention that highlighted a drastic decline in pediatric immunizations through Vaccines for Children programs following the pandemic emergency declaration.

Improvement, but Deficits Remain Deep

Filer and Malone point out that the vaccination drop is severe across all age groups, and although numbers have been improving as medical offices begin to reopen for primary care visits, the deficits are deep.

The data represent more than 240,000 doses of noninfluenza vaccines administered across 1146 ambulatory care offices, including 231 health departments.

Overall, for the week of May 11, which was the most recent week of the analysis, there was decrease of 30.1% compared with that week in 2019. The largest percentage drop with respect to age group occurred among 19- to 49-year-olds and was twice that high, at 60.5%.

Table 1. Sampling of Year-Over-Year Changes (%) of Doses per Age Group

Week Start Date 0 – 24 Months 2 – 10 Years 11 – 18 Years 19 – 49 Years 50 – 64 Years 65+ Years All
3/2 -4.4 -5.7 0.1 -10.9 35 31.3 0.6
4/6 -31.0 -71.6 -76.3 -74.7 -70.2 -83.1 -55.9
5/11 1.6 -41.8 -46.4 -60.5 -56.0 -46.3 -30.1
Source: VaxCare


Jason McKnight, MD, assistant clinical professor in the Department of Primary Care and Population Health at Texas A&M University in College Station, told Medscape Medical News that the drop in those aged 65 years and older was particularly sharp.

In the week of April 6 this year (near the height of the COVID-19 pandemic in the United States) compared with that week in 2019, vaccination rates for adults aged 65 and older dropped 83.1%. That was a much steeper drop than the 55.9% drop for all ages combined seen for that week. By the week of May 11, the decline was still down by almost half from that week last year.

"This group is already high risk of complications from COVID and other healthcare issues," he said. "This could have long-reaching implications and possibly put them at further risk for bad outcomes later," he added.

The data also show large discrepancies in vaccination rates by state. New York and Pennsylvania, especially, continue to experience large deficits.

Table 2. Sampling of Year-Over-Year Changes (%) of Doses by State

Week Start Date Florida Georgia Texas Ohio Pennsylvania New York
3/2 1.6 -4.1 0.7 1.7 -20.8 7.6
4/6 -50.8 -51.2 -43.1 -61.6 -67.6 -88.3
5/11 -23.6 -22.5 -16.5 -11.5 -58.7 -63.2


The falling numbers are not surprising in light of directives to limit nonessential services during the pandemic. In addition, adults may be getting mixed messages.

About his own practice, McKnight said, "Last week was the first time [since the pandemic started] that we started scheduling annual exams, and we're still seeing very few of those."

The important thing to know is it's not too late to be vaccinated, McKnight said.

"For most things, especially things that develop long-term immunity, you can always catch up to those," he said.

McKnight agreed with the authors that the decline in vaccinations has broad implications for herd immunity and could potentially spur outbreaks of other diseases that, combined with COVID-19, could overwhelm the healthcare system.

James Cherry, MD, distinguished research professor in pediatrics at the University of California, Los Angeles, told Medscape Medical News that although the report does not specify which noninfluenza vaccinations were down, a few vaccines should be prioritized for timely delivery.

Tdap Essential for Pregnant Women

The tetanus, diphtheria, pertussis (Tdap) vaccine is essential for pregnant women, Cherry emphasized.

"Mortality in pertussis occurs in infants less than 2 months of age almost exclusively," he said. "Tdap in pregnant women between the 27th and 36th weeks prevents all deaths, basically."

Pneumococcal vaccines for older adults and measles-mumps-rubella inoculations should also be prioritized, he said, especially given the measles outbreaks in recent years.

Vaccines have received lower priority in adult medicine than in pediatrics, he said. "There are a lot of adults who are not caught up on measles."

Ada Stewart, MD, president-elect of the American Academy of Family Physicians (AAFP), told Medscape Medical News she is encouraged that the numbers are improving, which suggests the trend will not be long lasting.

But she emphasized the urgency for patients of all ages to visit their physicians so they can catch up on vaccines as well as other care, especially in light of the possibility of a second wave of the virus.

Healthcare offices will need to proactively reassure patients of steps the office has taken to maximize safety, she said. The AAFP has posted guidance on reopening practices on its website.

Normalizing vaccine administration is crucial in light of the possibility that a vaccine for COVID-19 will become available in the next year and that influenza season will return in late summer, she said. "We've got to get ready for this."

The authors also warn that the issue needs immediate attention.

"Primary prevention, primary care and public health must get the attention and resources long denied them if we are to avoid a tsunami of second round diseases and negative impacts," Filer and Malone write.

They add, "Immunizations can also be viewed as surrogates for primary care in general. Missed chronic disease visits, missed screenings for other conditions will take a rapid and expensive toll on America in both human and economic terms."

Filer and Malone are employed by VaxCare. McKnight, Cherry, and Stewart have disclosed no relevant financial relationships.

Marcia Frellick is a freelance journalist based in Chicago. She has previously written for the Chicago Tribune and and was an editor at the Chicago Sun-Times, the Cincinnati Enquirer, and the St. Cloud (Minnesota) Times. Follow her on Twitter at @mfrellick.

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