The Evolving Childhood Vaccine Schedule: Addressing Immunization Inequities Through Education

This roundtable series discusses the ongoing recommendation changes being made to the pediatric vaccine schedule, and how this is impacting US public health.

During the COVID-19 pandemic, numerous studies pointed to vaccine disparities and increasing disease incidence rates in certain socioeconomic groups. Marginalized populations saw the greatest burden including those with little to no access to medical care, and limited education and financial means.

Fast forward to today, and we could be again facing more disease, more mortality and more healthcare costs, likely being distributed disproportionately across these aforementioned socioeconomic groups due to low vaccine uptake.

Jacinda Abdul-Mutakabbir, PharmD, MPH, associate professor of clinical pharmacy and antimicrobial resistance researcher at the University of California San Diego, has studied vaccine disparities, and works with marginalized groups in a community clinic setting. She sees lower levels of medical education literacy in these groups.

“Folks that reside in areas of higher social vulnerability are less likely to have access to vaccines, access to education,” Abdul-Mutakabbir said. “And my vaccine program that I run, it is astounding to me, how many folks have not even heard of these vaccines before, and I mean, I have to think about the fact that I am talking to a majority of racially and ethnically minoritized folks that live in areas of high vulnerability. They may not have access to a primary care provider. If they don't have that access, they don't have anyone referring them or talking to them about the new RSV vaccine that they should get.”

She mentions a recent small RSV vaccine study she participated in that had about 100 participants. She said an overwhelming number of people (73%) did not know about the vaccine.

“I think about just that lack of access to education awareness, and how that is just going to be so compounded now that we have so much disinformation, misinformation,” she said.

Despite these issues, pilot programs that offer prenatal education can help increase immunization uptake. Abdul-Mutakabbir notes a study that was written up recently in a vaccine journal. It detailed the experiences of providers working with expecting mothers and hepatitis B vaccine uptake in the Washington DC area.

“They saw education be an independent mediator in terms of vaccine uptake. So the lower education that the mother had, the more likely she was to refuse that vaccine.”

However, the study’s investigators noted they were able to reduce vaccine refusal of the hepatitis B vaccine to 0% at safety net hospitals. One of the hospitals noted in the study was Howard University Hospital. Abdul-Mutakabbir did her residency there and was trained to discuss the hepatitis B vaccine with expecting mothers. This was a comprehensive effort across different specialties.

“The success that I saw in that study was that they had a workflow, but every single discipline involved in that—from the physician to the pharmacist to the nurse—everyone had a role in ensuring that the mother was educated and that vaccine got to the baby,” she said.

Mary Koslap-Petraco, DNP, PNP-BC, CPNP, clinical assistant professor at Stony Brook University School of Nursing, had a similar experience working in Suffolk County in New York with prenatal education having a direct effect on immunization uptake.

“As soon as they had the baby, not one mother refused the hepatitis B vaccine,” Koslap-Petraco said. “There were private provider babies whose [families] refused the vaccine, and 3 of those babies seroconverted to hepatitis B.”