Adolescent and Childhood Vaccination Recovery

Defining the Problem: According to BCBS transactional data, an estimated 9 million doses of certain childhood vaccines may have been missed in 2020.[1] The CDC’s public sector vaccine ordering data showed a 14% drop from 2020 to 2021 compared to 2019.[2]

Interventions to Help Increase Vaccinations

Try these strategies to help get recommended childhood and adolescent vaccinations back on track.

Reinforce the importance of recommended vaccinations

The reduction in face-to-face office visits limits the opportunities for providers to discuss and deliver recommended vaccines.[3][4][5] Providers can reinforce the importance of well visits and recommended vaccinations and communicate the extra steps being taken to see children safely in office.[6][7] Additionally, providers can conduct a vaccination assessment and counseling during a telemedicine visit and schedule the patient for a brief, vaccination-only encounter at an appropriate time and location.

Implement safety strategies

Parents may fear COVID-19 exposure during preventive care visits.[8] Providers can implement safety strategies and clearly communicate plans for office visits. 57

Inform patients about free or low-cost vaccination programs

For parents and patients who are unsure about access to and coverage for vaccines, providers can inform patients about free or low-cost vaccination programs (such as Vaccines for Children), local health centers or state health departments that may offer vaccines with fees charged on a sliding scale, and mobile or community clinics that offer free or reduced-cost vaccines.[9]

Educate patients about vaccines

Parents and patients may be unsure or misinformed about the safety and efficacy of recommended vaccines.9-11 Providers can educate patients about vaccines using the CDC’s Vaccinate With Confidence framework to help strengthen vaccine confidence.9[10][11][12]

Identify and notify appropriate patients in need of a routinely recommended or catch-up vaccination

Providers can use reminder/recall or other vaccination assessment tools to identify and notify appropriate patients who are due or overdue for a vaccination.3 Additionally, providers can remind parents about programs, such as Vaccines for Children, that may cover the cost of vaccination for qualified families who are uninsured or underinsured.9[13]

Provide a strong recommendation for vaccination

Use a presumptive approach (one that assumes parents will choose to vaccinate) versus a participatory approach (one that presents parents with a decision to make).[14] For example, a participatory approach might sound like, “Have you thought about the vaccines your child needs today?” Instead, consider trying this presumptive approach: “Your child is due for a recommended vaccination today.”

Maximize opportunities for vaccinations

Providers may want to consider alternative sites and appointments to get appropriate patients caught up on vaccinations.5 For example, providers could schedule patients for a vaccination-only appointment following a telemedicine visit.3 Alternative vaccination sites, including drive-through vaccination services at fixed sites or curbside clinics, could also be considered.5 Additionally, healthcare systems and providers could prompt clinicians for when children who are in office are due or overdue for their recommended vaccines.[15] Lastly, providers can use standing orders to simplify the process of vaccination.3

[1] Blue Cross Blue Shield. Missing vaccinations during COVID-19 puts our children and communities at risk. Accessed January 4, 2022. download-infographic/health-of-america-insight/Vaccinations_ infographic_2020_0.pdf

[2] Centers for Disease Control and Prevention. Childhood vaccination toolkit for clinicians. Last reviewed July 26, 2021. Accessed January 4, 2022. childhood-vaccination-toolkit.html

[3] Immunization Action Coalition. Ask the experts. COVID-19 and routine vaccination. Updated October 22, 2020. Accessed January 4, 2022. experts_covid19.asp

[4] Data available on request from Merck & Co., Inc., Professional Services-DAP, WP1-27, PO Box 4, West Point, PA 19486-0004. Please specify information package US-NON-07434.

[5] Centers for Disease Control and Prevention. Interim guidance for routine and influenza immunization services during the COVID-19 pandemic. Last reviewed April 15, 2021. Accessed January 4, 2022.

[6] Centers for Disease Control and Prevention. Catch up on wellchild visits and recommended vaccinations. Last reviewed September 22, 2021. Accessed January 4, 2022. https://www.cdc. gov/vaccines/parents/why-vaccinate/well-child-visits.html

[7] American Academy of Pediatrics. Guidance on providing pediatric well-care during COVID-19. Last updated January 6, 2021. January 9, 2022. during-covid-19

[8] Czeisler MÉ, Marynak K, Clarke KE, et al. Delay or avoidance of medical care because of covid-19–related concerns — United States, June 2020. MMWR Morb-Mortal Wkly Rep. 2020;69:1250–1257.

[9] National Foundation for Infectious Diseases. Issue brief: the impact of COVID-19 on US vaccination rates. Accessed January 4, 2022. https://www.

[10] Centers for Disease Control and Prevention. Recommended child and adolescent immunization schedule for ages 18 years or younger, United States, 2021. Accessed January 4, 2022. https://

[11] Centers for Disease Control and Prevention. Recommended adult immunization schedule for ages 19 years or older, United States, 2021. Accessed January 4, 2022. schedules/downloads/adult/adult-combined-schedule.pdf

[12] Centers for Disease Control and Prevention. Vaccinate with confidence. Last reviewed October 30, 2019. Accessed January 4, 2022. https://www.cdc. gov/vaccines/partners/vaccinate-withconfidence.html

[13] Centers for Disease Control and Prevention. VFC detailed questions and answers for parents. Last reviewed December 17, 2014. Accessed January 4, 2022. programs/vfc/parents/qa-detailed.html

[14] Centers for Disease Control and Prevention. Immunization strategies for healthcare practices and providers. Last reviewed August 18, 2021. Accessed January 4, 2022. https://www.cdc. gov/vaccines/pubs/pinkbook/strat.html

[15] Centers for Disease Control and Prevention. Help kids’ safe return to school – get caught up on recommended vaccines. Accessed January 4, 2022.

Merck does not guarantee that your use of this information will help you achieve your vaccination goals.

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