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Dear Tennessee, Pausing Vaccine Outreach to Kids Was Ill-Advised

Two weeks ago, news reports stated that the Tennessee Department of Health (TDH) was halting all vaccination outreach to kids — and not just for COVID-19. From measles to HPV, vaccine outreach to adolescents was to stop. Thankfully, the state changed course rather quickly after significant backlash, announcing it would resume outreach. But the pause on outreach and confusing messaging from the TDH undermines vaccination — both novel and routine — in a state with one of the lowest COVID-19 vaccination rates in the country and at a time when public health has never been more in the public eye.

As pediatricians in Tennessee, we are alarmed by the rise of vaccine hesitancy, misinformation and, at times, disinformation. Summer is a critical time for return to school vaccinations under normal circumstances, and even more so this year as routine childhood immunization rates dipped throughout the pandemic. Through messaging, outreach, and public health efforts, we can get back to our pre-pandemic immunization levels. But for the health of Tennessee’s children, the deliberate undermining of vaccine safety must stop.

The Importance of Vaccines

For pediatricians, vaccinations are a part of our daily job. We know they save lives and prevent serious disease. Besides clean drinking water, they are, in our opinion, the greatest lifesaving advancement in public health. Per the CDC, between 1994 and 2018, childhood vaccines have netted $1.9 trillion in total societal cost savings, prevented 419 million illnesses, 28.6 million hospitalizations, and 936,000 deaths. For U.S. children born in 2009 alone, childhood immunizations will prevent 20 million cases of disease and 42,000 premature deaths. Families deserve evidenced-based information about vaccinations to better understand the importance for child health.

Our current vaccination success has led some to forget the disease burden that once existed. The World Health Organization has included vaccine hesitancy on its list of top 10 global threats. What was previously a trickle of vaccine disinformation on social media has become a daily deluge that families cannot escape. Trusted sources for reliable vaccine information have become harder to discern from ones with an anti-vax agenda. In a recent Vanderbilt Center for Child Health Policy poll, Tennessee parents were asked who they trusted to provide COVID-19 vaccine information, and the only choice to garner more than 40% of responses was their child’s healthcare provider. Our herd immunity for vaccine preventable diseases is at risk as we see the vaccination levels in some Tennessee counties slipping dangerously close to the minimum percentage required for protection. As healthcare providers, we are privileged to care for our patients and hold their trust. We owe it to our families to welcome their questions and direct them to accurate immunization information as they navigate decisions about vaccinations.

The Role of Vaccine Messaging

When emails from the TDH messaged a pause in vaccination outreach, it generated sincere concern among countless pediatricians. We know how tenuous vaccine trust and access can be, and these actions can have consequences on immunization rates that are hard to mitigate. Some families do not know which vaccinations are required for school entry or seventh grade, much less how to easily obtain them. TDH is the trusted partner in those cases, not only providing that information for families but often providing a location for the vaccinations if the child does not have a pediatrician of their own. Even if the pause was a well-intentioned moment to regroup, it was still a pause in the middle of the worst pandemic we have known in our lifetime. It sends an unfortunate signal to our families that vaccines are not a priority.

Where do we go from here? We need to get back to the basics of public health. We need to provide answers to questions from, and reassurances for, the vaccine hesitant. We need respectful dialogue that is anchored in science and apolitical. We need robust vaccination outreach with coordination from all community stakeholders in conjunction with a clear pro-vaccine message from the entity whose mission is preventive health: the TDH. We need to encourage our adolescents to be active participants in their own healthcare so they can grow into healthy and healthcare-knowledgeable adults.

We support our public health officials, and we know they want our children and adolescents to be protected from vaccine preventable disease. We are grateful that TDH is returning to vaccine outreach to adolescents — and it’s critical they maintain this outreach and advance consistent messaging. Let us all work together to get vaccinations back on track.

Anna Morad, MD, is president of the Tennessee Chapter of the American Academy of Pediatrics (TNAAP) and an academic general pediatrician practicing in Nashville. Jason Yaun, MD, is vice president of TNAAP and an academic general pediatrician practicing in Memphis.

The opinions expressed in this article are the authors’ own and not the opinions of their employers.

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