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Issue Brief: The Impact of COVID-19 on US Vaccination Rates

The COVID-19 pandemic has impacted our health and well-being beyond the damage caused by the virus, with profound implications across the US healthcare system. In nearly every community, elective surgeries have been postponed and routine healthcare has been delayed, including vaccinations. While routines have changed and we all adjust to a new normal, some things have not changed: Individuals of all ages—from newborn babies to older adults—need to stay up-to-date on all recommended vaccinations. Vaccine-preventable diseases have not gone away, but they can be prevented with safe and effective vaccines.

However, amid overwhelmed US healthcare systems and fears of contracting COVID-19, routine vaccination rates  declined significantly across all populations in the US, with demand plummeting as much as 95 percent for certain vaccines. These declines are dangerous to public health—the US can no longer delay life-saving vaccines and must address the concerning decline in vaccination rates.

Declining Vaccination Rates Among All Ages

The US is currently experiencing an alarming decline in vaccination rates across the lifespan, putting individuals of all ages at risk of contracting vaccine-preventable diseases:

  • A study from the Centers for Disease Control and Prevention (CDC) found that in Michigan, fewer than half of infants age 5 months and younger are up-to-date on recommended vaccinations. Infant immunizations protect newborns from many dangerous diseases, including hepatitis B, Hib, rotavirus, and measles.
  • In New York City, vaccine doses given to children dropped by 91 percent for childer older than 2 years of age from March 23 to May 9, 2020
  • Similar declines were recorded in Miami-Dade County, with an approximate 60 percent decline in children’s vaccines administered in April 2020 when compared to 2019, according to data from statewide immunization registry Florida SHOT
  • An analysis from VaxCare found that non-influenza vaccine rates among individuals of all ages dropped dramatically during COVID-19: Vaccination rates for adults age 65 years and older dropped an alarming 83 percent compared to last year, and in individuals age 19- to 49 years, there were declines of more than 60 percent
  • To better understand the impact of the COVID-19 pandemic on adolescent and adult vaccination in the US, Avalere conducted an analysis of 2019 and 2020 claims submissions, illustrating that across commercial, Medicaid managed care, Medicare Advantage, and Medicare fee-for-service, vaccination services for adolescent and adults substantially decreased at the beginning of the pandemic and have not rebounded since
  • CDC issued a letter, Help Kids’ Safe Return to School—Get Caught Up on Recommended Vaccines, to call out the importance of making sure that children get caught up on vaccines that were missed over the last year

Declines in vaccination rates are an international challenge amid a global pandemic. In July 2020, the World Health Organization (WHO) and UNICEF warned of declining vaccination rates across the world, which threaten years of progress. Data show a drop in the number of children completing three doses of the diphtheria-tetanus-pertussis (DTP3) vaccine for the first time in 28 years.

Immunization Disparities Continuing During Pandemic

Disparities in access to, and utilization of, vaccines have been a long-standing challenge in some communities. For example, non-Hispanic White adults are twice as likely as non-Hispanic Black and Hispanic adults to receive a shingles vaccine. Disparities are also evident across income and education, as research has shown that adults with a lower level of education and household income are less likely to get vaccinated against influenza (flu).

While the health of all communities are at risk due to declining vaccination rates, some are at greater risk, including communities of color, immigrant populations, those who live in crowded inner cities, and families without access to a car. Determinants of health such as transportation and access to care are especially challenging for these populations. Individuals who work in grocery stores and other essential workers may also put themselves and their families at greater risk for exposure to viral respiratory diseases including COVID-19.

The Positive Impact of Vaccines on Public Health

Since the first vaccine was invented in 1796 to protect individuals against smallpox, immunizations have had a tremendous impact on public health and overall quality of life. Unfortunately, too many people still do not receive all recommended vaccines and each year in the US, more than 50,000 adult deaths are attributable to vaccine-preventable diseases. Amid COVID-19, outbreaks of other infectious diseases will put the capacity of health systems and hospitals at risk.

Vaccination has resulted in the eradication of smallpox globally and the elimination of polio and measles in many parts of the world. Implementation of vaccination programs has resulted in significant decreases in once common diseases. According to CDC, among children born between 1994-2018, vaccination will prevent an estimated 419 million illnesses, 26.8 million hospitalizations, and 936,000 deaths.

Vaccines are one of the most important and effective public health tools available to prevent a variety of diseases across the lifespan. For example, two doses of the measles-mumps-rubella (MMR) vaccine provide 97 percent protection and flu vaccinations can reduce the risk of flu and related complications by up to 60 percent.

High vaccination rates are also good for the US economy, as diseases have a significant economic cost. Flu alone is estimated to cost the US more than $11 billion each year, and the average flu illness can last up to 15 days, typically with up to a week of missed workdays.

Despite the overwhelming evidence that supports the effectiveness of vaccines, some individuals in the US still face barriers to receiving recommended immunizations. Below are some common barriers and possible solutions/examples of how healthcare professionals and the public health community are taking steps to address and reduce those challenges.

Challenge Recommended Steps
No Missed Opportunities   Maintaining vaccination rates is everyone’s responsibility and all healthcare professionals play a role in encouraging patients to stay up-to-date with recommended vaccines. Every time a patient encounters the healthcare system represents an opportunity to discuss/encourage vaccinations.
Dispelling Myths and Promoting Credible Information   Most individuals in the US are confident in the safety and effectiveness of vaccines but misinformation about vaccines continues to put communities at risk and can lead to outbreaks of vaccine-preventable diseases. A recent study found that up to 20% of respondents were at least somewhat misinformed about vaccines.
Educating About Financial Assistance for Vaccines Many people in the US are unaware of free or low-cost immunization programs. Most vaccines are fully covered by public or private insurers, but even for those without health insurance, programs may be available. Vaccines For Children (VFC) is a federally-funded program that fully covers the cost of all recommended vaccines for children under 19 years old. Local health centers and state health departments may also offer vaccines with fees charged on a sliding scale. Additionally, mobile or community clinics may offer free or reduced-cost vaccines.
Leveraging Telemedicine The current pandemic has led to a significant increase in the use of telemedicine for primary care and specialist visits. Conversations with patients about vaccination, addressing their concerns, answering questions, and confirming their medical records can help remind patients to stay up-to-date with routine immunizations. A strong healthcare professional recommendation is critical to encouraging individuals to remain current with all recommended vaccines.


The significant decline in vaccination rates is very concerning, but fortunately, there are steps we can all take to help reverse the decline:

Patients and Families Healthcare Professionals Advocacy Organizations
Check with your healthcare professional about vaccines recommended for you and your family. Immunizations protect entire communities—when communities are not up-to-date with recommended vaccines, vulnerable populations may be at risk of exposure to serious and deadly infectious diseases. Encourage vaccinations at every patient interaction—from annual physicals to elective surgeries. Educate patients about the safety of vaccines and assure them that steps are being taken to make vaccinations safe and comfortable. By leveraging all opportunities, keeping up the rates can and must be every healthcare professional’s responsibility. Amplify messages to stakeholders and use available  platforms to encourage healthcare professionals and consumers to receive all recommended vaccinations. With declines across all ages and populations, all individuals need to be reminded about the value of vaccination from trusted sources of information.

Looking Forward

Vaccines are critical to the health of the US and we must collectively address declining vaccination rates. COVID-19 vaccines may not be available until 2021, but there are many vaccines recommended for individuals of all ages today. The National Foundation for Infectious Diseases (NFID) encourages you to share this information and take action to stay up-to-date on all recommended vaccinations for you and your family.


Published August 2020