by Capt. Thomas Weiser, MD, MPH, Medical Epidemiologist, Portland Area Indian Health Service and Northwest Portland Area Indian Health Board
One of the many impacts of the COVID-19 pandemic has been the disruption of
routine clinical care. This has occurred in health systems across the
country, including the Indian Health Service.
Over 50% of primary care physicians who see children reported that parents’ concerns about COVID-19 presented a major or moderate barrier
to bringing their children to a doctor’s office or clinic. One critical
area that the pandemic has impacted has been the provision of routine
immunizations to children and adolescents. The primary series of vaccines
that all children under the age of two should receive protects them against
14 serious illnesses. Without these vaccines, children under the age of two
remain susceptible to diseases like measles, diphtheria and meningitis. The
percent of children two years old who were fully immunized with the primary
series of immunizations tracked by IHS fell from 63.6% at the end of FY
2020 to 56.9% in the 2nd quarter of FY 2021. This is the lowest
recorded pediatric immunization coverage since IHS began tracking this
measure over a decade ago.
To address this important public health issue, IHS has embarked on an
effort to improve pediatric immunization coverage. Members of the IHS
COVID-19 Vaccine Task Force have joined forces with the National
Immunization Program, the Office of Quality and other subject matter
experts from across IHS to lead a quality improvement collaborative to
increase pediatric immunization coverage back to pre-pandemic levels and
beyond. A kickoff webinar was held on
May 13th and had over 200 attendees. Our ultimate goal is for
immunization coverage to reach the National Healthy People 2030 goal for
this measure of 80%.
Adolescent immunization coverage also needs our attention. Each year during
summer, thousands of adolescents receive routine immunizations before
returning to school in the fall. This year, adolescents 12–17 are also
eligible to receive the Pfizer COVID-19 vaccine. Recently, CDC updated
their guidance allowing adolescents and adults to receive routine
immunizations, like TDaP or flu, at the same time as they receive a
COVID-19 vaccine. While co-administration of vaccines with COVID-19 vaccine
will make it easier, the extra effort to administer COVID-19 vaccines will
mean we have to work a little harder to ensure that all adolescents receive
all recommended routine immunizations for a safe return to in-person
learning in the fall.
IHS, tribal and urban facilities that wish to engage in this quality
improvement collaborative will use the Accelerated Innovations and Model
for Improvement, or AIMI, platform that IHS has been using for quality
improvement projects across Indian Country. Through this platform, sites
will be able to track their own improvement data and learn from others. We
will also be hosting a webinar series to share best practices for improving
immunization coverage, how to overcome barriers, and how to use Information
Technology tools to help us work smarter and more efficiently.
A toolkit with recorded webinars and other links will be developed and
hosted on the IHS National Immunization Program webpage.
We are excited to begin this improvement journey to help protect all
American Indian and Alaska Native children from vaccine preventable
diseases. Please join us – Together, We CAN Do This!
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