Evelyn Twentyman, MD, MPH, senior advisor for vaccine strategy at the CDC's National Center for Immunization and Respiratory Diseases, spoke to Pharmacy Times® about the importance of on-schedule vaccination of children and overcoming vaccine hesitancy. Twentyman discussed the pivotal role of health care providers and pharmacists in building trust with parents and caregivers, as well as the importance of continuous, strong recommendations for vaccines. She also highlights equity in vaccine distribution, showcasing the CDC's Vaccines for Children program.
Pharmacy Times: What are some of the top questions you've seen caregivers ask surrounding childhood vaccines?
Evelyn Twentyman, MD, MPH, Senior Advisor for Vaccine Strategy, CDC: Thank you for that question. I also want to thank all the health care providers who are listening to this talk or this call, because your advice to those caregivers is so important. One of the main questions that we hear is about why it's important to follow the recommended schedules, especially when there's more than one vaccine in the schedule for a particular vaccine. So, let's start with that. Most parents do, by the way, follow the recommended vaccine schedule for their children, but others do have questions. “Is this safe? Do we need all this?” So, let's go through those. Are these vaccines safe? Very much so. CDC has been following these vaccines through the most intensive vaccine surveillance in US history. We have learned from the immunization with these routine vaccines of hundreds of millions of children. So now is a really good time to benefit from all that knowledge and get children the vaccines that they need.
And then now let's turn to the schedule, particularly when multiple doses of a vaccine are recommended to be protected against a given disease. These schedules are really carefully designed to make sure that children get the protection they need when they need it. In other words, it bears in mind both children's development and when we know that they're likely to be encountering exposures to these diseases, right? So what's great is, if parents can keep up with that schedule, they can make sure that their children are benefiting from the optimal protection from these lifesaving vaccines. If they're not able to keep up with the schedule, any delays there will reduce the amount of protection that they have from these vaccines, and that just makes the advice of health care providers like pharmacists and others listening on this call all the more important to really maintain that optimal protection for kids.
Key Takeaways
- Vaccines are safe, effective, and critical for protecting children from serious diseases. The CDC has extensive surveillance programs to monitor vaccine safety and efficacy.
- Healthcare providers, especially pharmacists, play a vital role in educating parents, addressing their concerns, and strongly recommending childhood vaccinations. Building trust and continuing the conversation is key.
- The CDC's Vaccines for Children program ensures equitable access to life-saving vaccines, regardless of a family's ability to pay. This program has had a significant impact, distributing over 1.3 billion doses since 1994.
Pharmacy Times: How can immunizers be prepared to answer these questions and provide clarity to those asking about childhood vaccination?
Twentyman: I'll say again that just their ability to be attentive to those questions and answer those questions is hugely beneficial. We actually know that health care providers are parents most trusted messenger about childhood vaccines, and so this makes their role extremely important. So, [there is] a few things that they can do. They can answer parents and caregivers’ questions and make a strong recommendation. They can increase their confidence by using those strategies. They can take the time to listen and build trust with those parents, with those caregivers over time, and additionally, they can not give up if the conversation doesn't work perfectly the first time. So, let's talk about how this conversation might go, for example. So first, health care providers want to introduce the topic of vaccination with the assumption that parents will plan to accept vaccines. A health care provider could state which vaccines a child needs in a given visit or in a given visit to the pharmacy, assuming that the parents will be willing to accept them at that time, and many will. Now, if parents are not ready to vaccinate, then health care providers can just share their strong recommendation. Since health care providers have this really unique, special position as parents and caregivers most trusted source of information, their strong recommendation is very critical for vaccine acceptance, and we see this time and time again. And then parents can really listen and respond to concerns. So even though research supports that most parents in the US do support vaccines and do accept vaccination for their children, health care providers will encounter patients with questions and concerns. So, if a parent seems hesitant about following the recommended schedule, that doesn't necessarily mean that they won't accept vaccines. Some parents just need answers to their questions. Some parents just want to be referred to additional information, like that on cdc.gov. And in any and all cases, please continue the conversation. What we've seen multiple times, we saw it pre-pandemic, we saw it during the pandemic, we've seen it after the pandemic, is that some parents need to be offered vaccination for their children multiple times, and some parents who have previously refused vaccination, accept on the second recommendation, the third recommendation. So thanks, many thanks, to all the health care providers on this call who are making these recommendations, and don't give up. Continue the conversation,
Pharmacy Times: What are some strategies to increase retention of second or third doses of immunizations?
Twentyman: One thing that they can do is talk about the win for the parents or caregivers children if they do keep up with a recommended schedule. They get that optimal protection from the disease for which the vaccine is designed to prevent. And this is really powerful. For example, if a parent follows the CDC-recommended vaccine schedule for their children after they're first born, by the time that they're 2 years old, by the time they get to their second birthday, that child will be protected from 14 potentially serious diseases. So, following this immunization schedule can be really powerful for their child. And I think all parents really care quite a bit about their children, so I think mentioning the impact of really following the schedule could be helpful. And you know, like I said before, the schedule really is designed to offer the children the right protection at the right time. So both according to the child's development and according to when they're going to interface, when they're going to be exposed to that disease for which the vaccine is designed to protect that child. Some diseases do need multiple doses of a given vaccine. Some just need the one. And in all these cases, I think emphasizing the power here, emphasizing the benefit for the child. And if you have to, going into the loss for the child, the sub-optimal protection if a vaccine schedule is not followed, could be beneficial. And again, over time, building that relationship, building that trust, keeping that conversation going.
Pharmacy Times: What work has the CDC done to increase childhood vaccination rates?
Twentyman: This is something that we all have to work together to keep up together. Public health is really a team sport, so thank you, Pharmacy Times, for being a team member with us. One of the things that CDC has recently recognized is that our childhood vaccination program has been so successful, that many of the diseases that used to really threaten children in the US and elsewhere are not even part of our common vocabulary. Diseases like diphtheria, mumps, rubella, that used to be serious threats to our children are now practically unheard of, and we at CDC really want to keep it that way. And so because of this, CDC has launched a new effort called “Keeps it That Way,” which really encourages parents to learn more about vaccine preventable diseases and how vaccinations provide protection to keep their children healthy, to keep their children protected against these.
So, CDC overall recommends protection against several different diseases, including pertussis, which is whooping cough, including polio, including measles, including Hib, including meningococcal disease; all of these diseases can make a child very sick and even threaten their life. So, we really encourage parents to visit CDC’s website to see which vaccines are recommended. Talk to their child's health care provider about vaccination. Talk to their child's pharmacist about vaccination, and keep up with the recommended schedule, keep their kids healthy, keep their kids in school.
Pharmacy Times: On this front, what are some of the key initiatives of the CDC’s Vaccines for Children program?
Twentyman: Oh, thank you for asking. Okay, so, as you probably already know, health equity is near and dear to CDC’s heart. It's really important to CDC that all people have the equal opportunity to achieve their optimal health outcomes. And so providing these critical, lifesaving vaccines is important, not just for children whose parents can afford these vaccines, but for all children. And so, the Vaccines for Children (VFC) program was set up exactly to this end. The VFC program has been helping families protect their children since 1994, so we recently celebrated our 30th anniversary or 30th birthday, if you want to make it a little more fun. VFC covers the cost of vaccines for kids whose parents or guardians might not be able to afford them, and in so doing, it brings pediatric immunizations to kids across the US.
We really prioritize underserved communities to improve vaccine equity, to uphold health equity, to improve health equity. And we do this on a pretty giant scale. In 2022 alone, for example, VFC distributed over 71.5 million doses of pediatric vaccines to participating provider locations. And from 1994 through 2021, VFC provided more than 1.3 billion non-influenza vaccinations to eligible kids across the country. So, it's an exciting effort to be a part of, and we really thank the providers listening to this call for their help in getting the recommendations out and for connecting kids who need vaccines under the vaccines for children's program to this program.
Pharmacy Times: Is there anything else that you would like to add?
Twentyman: Sure, I would love the audience to know that vaccines have saved lives for over 100 years and are essential to protecting all of us from deadly diseases. A recent CDC study found that routine vaccinations for children born from 1994 to 2003 will have prevented about 508 million illnesses, averted more than 32 million hospitalizations, and saved over 1.1 million lives. All of this together results in more than $2.7 trillion saved in societal cost. So I think the reason I'm bringing this up is that it's not just that vaccines are lifesaving. It's not just that they help us reach our optimal health. It's also that they're incredibly economically wise. For every dollar spent on childhood immunizations, we save $11 based on the math that I just walked through there with you. And so, to help our communities, to protect our children, to protect our families, we really need to continue this teamwork effort, especially through the leadership of health care providers like the listeners here, who are out there in the field recommending routine immunizations, having these critical conversations, continuing the conversations if the recommendations don't go well the first time. All of this works together to save money, to prevent illness, prevent hospitalization, and save lives. So, thank you so much everyone on this call, listening to this recording for your help.
