Congress created the Vaccines for Children (VFC) program in 1994 to provide routine vaccines at no cost to eligible children. CDC estimates that vaccinating children born during 1994–2023 will have prevented about 508 million illnesses and 1,129,000 deaths, saving nearly $2.7 trillion in societal costs. In 2023 the program distributed about 74 million pediatric doses to participating providers.
Children up to 18 qualify if they are Medicaid-eligible, uninsured, underinsured, or American Indian or Alaska Native (AI/AN). The Centers for Medicare & Medicaid Services allocates the funds to CDC, which funds 61 state, local and territorial immunization programs to run it.
For the program's 30th year, CDC looked at how coverage among eligible children changed and how it compared with other children.
How the study worked
The National Immunization Survey-Child (NIS-Child) phones households with children aged 19–35 months, interviews parents and, with consent, collects vaccination records from the children's providers. Surveys from 2012 to 2022 gave 152,915 children with adequate records, born 2011–2020.
For the survey, a child counted as VFC-eligible if they were AI/AN; enrolled in Medicaid or the Indian Health Service (IHS), or uninsured; or had ever been vaccinated at an IHS, Tribal or urban Indian health facility. Researchers tracked three measures:
- at least 1 dose of MMR (measles, mumps and rubella) by 24 months;
- a full rotavirus series (2–3 doses) by 8 months;
- the combined 7-vaccine series by 24 months — DTaP, polio, measles-containing, Hib, hepatitis B, varicella and pneumococcal conjugate vaccines.
Who is eligible
Among children born 2011–2020, 52.2% were VFC-eligible (52.6% of those born in 2020). Among eligible children born in 2020, 93.4% had Medicaid, 7.4% were AI/AN, 43.7% lived below the federal poverty level, and 48.1% lived in the principal city of a metropolitan area. The uninsured share of eligible children fell from 8.1% (born 2011) to 3.1% (born 2020).
Coverage among eligible children
| Measure | Range, born 2011–2020 | Born 2020 |
|---|---|---|
| ≥1 MMR dose | 88.0%–89.9%, stable | 89.6% |
| Rotavirus | 64.8%–71.1%, up 0.7 points a year on average | 71.0% |
| 7-vaccine series | 61.4%–65.3%, stable | 61.4% |
Within the series, coverage for first doses and early series (varicella, MMR, polio and hepatitis B) was about 90% for children born in 2020, but 73.6%–76.7% for series needing doses after 12 months (DTaP, pneumococcal conjugate and Hib) — suggesting barriers to finishing multidose series and to vaccination in the second year of life.
Coverage among VFC-eligible children and the gap with non-eligible children, by birth year. CDC figure.
Gaps within the eligible group (born 2020)
- Uninsured children's coverage was 18.9–34.7 percentage points lower than Medicaid-insured children's.
- Children below the poverty level had 9.3–9.9 points lower coverage for rotavirus and the 7-vaccine series.
- AI/AN and Hispanic or Latino children had 6.9–8.9 points higher rotavirus coverage than White children.
- MMR coverage did not differ by race and ethnicity, poverty or urban-rural residence.
Eligible vs not eligible
Coverage was lower for eligible children throughout 2011–2020, and the gap widened for MMR and the 7-vaccine series. For children born in 2020, eligible children trailed by:
- 3.8 points for ≥1 MMR dose;
- 11.5 points for rotavirus;
- 13.8 points for the 7-vaccine series.
Gaps appeared among White children, children at or above poverty, and children in metropolitan principal and nonprincipal cities. The authors called the lower MMR coverage concerning, because small pockets of low coverage have caused measles outbreaks.
Children born 2018–2020 may have had care disrupted by COVID-19, but earlier analyses found no difference in coverage by 24 months between children due for vaccines before versus during the pandemic.
Why uninsured and poorer children lag
Uninsured children are more likely to live in poverty, to have had no provider visit in the past year, and to leave multidose series unfinished. Even with free vaccine, office visit fees or charges for other services can deter low-income families, and having a regular place for routine care is linked to being up to date.
Limitations
Household response rates were low (21.1%–42.5%), and only 49.4%–63.9% of interviewed children had provider records, though data were weighted. NIS-Child may underestimate coverage for some vaccines. The eligibility definition counted Medicaid-enrolled rather than Medicaid-eligible children, excluded some underinsured children, and used insurance status at interview. The study was cross-sectional, so causes could not be determined.
What the authors recommend
Parents of VFC-eligible children need to be aware of, confident in and able to get all recommended vaccines. Proven steps for providers include strong recommendations, reminder-recall systems, giving several vaccines at one visit, cutting missed opportunities, parent education and catch-up vaccination. Reducing the number of uninsured children, including through Medicaid access, can connect families to care. CDC urges providers serving eligible children to join the program and to assess every child's vaccination needs at every visit.
Sources
- Valier MR, Yankey D, Elam-Evans LD, et al. "Vital Signs: Trends and Disparities in Childhood Vaccination Coverage by Vaccines for Children Program Eligibility — National Immunization Survey-Child, United States, 2012–2022." Morbidity and Mortality Weekly Report 73(33), Centers for Disease Control and Prevention.
Licence: CC0 1.0 (public domain) · Adapted from www.cdc.gov
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