A recent health survey reveals that only two-thirds of parents say they’ll vaccinate their children against the flu this year, raising concerns among pediatricians as the flu season begins, some schools re-open for in-person learning and COVID-19 cases spike.

Two Rutgers New Jersey Medical School pediatricians, Joseph Schwab, an associate professor of pediatrics, and Hanan A. Tanuos, director of primary care and an associate professor of pediatrics, discuss the importance of keeping children and adults up to date with immunizations during the coronavirus crisis.

A person receives the seasonal influenza vaccine (flu shot).

How has COVID-19 affected flu vaccination and immunization rates in children?

Although it’s difficult to get real-time, localized numbers, pediatricians participating in the Vaccines for Children performed fewer immunizations during the first months of the pandemic when many practices canceled or postponed in-person visits. More children are receiving routine immunizations now that schools are opening again, but we have not recovered fully.

We are particularly concerned about flu this year and worry about the effect of the COVID-19 pandemic on flu immunization rates. A recent study found the influence of COVID-19 on parents’ decision to have their child receive flu vaccine varied widely. About one-third of parents said the pandemic made them less likely to get the flu vaccine this year, while another third said it made them more likely to get the flu vaccine. The most significant factor was whether they got a flu vaccine last year. Flu vaccine rates have been historically low in our area, so we need effective ways to increase confidence in getting vaccinated.

How important are flu vaccinations and immunizations for children during a pandemic as we head into the flu season?

As the cornerstone of public health practice, routine immunizations protect children against important vaccine-preventable diseases. Anything that lowers immunization rates in a community doesn’t just leave individual patients at risk, but also set the stage for transmission and a local outbreak or wider epidemic. This is particularly true for influenza, which causes many cases of severe illness, hospitalizations and deaths every year, even with routine immunization available.

This could add to the burden of an already overtaxed health care system trying to provide care during a pandemic. This is why we’re advocating for maintaining high immunization rates, especially among children, even during the COVID-19 pandemic. New Jersey has the same immunization requirements for school attendance, whether a child is attending school in person or online.

If enough children are not vaccinated, how would that affect a potential second wave of COVID-19 in the coming months?

The biggest fear is increase in disease. Without immunization, events like the recent measles outbreaks in some communities could become more common. The decline in immunizations against pertussis, or whooping cough, could lead to more cases of this potentially devastating illness among our youngest patients.

Additionally, even with typical immunization coverage every year, the flu results in vast numbers of patients of all ages needing emergency and inpatient care, including ICU care. Adding this burden to hospitals during a potential second wave of COVID-19 could result in scenarios worse than what we saw during the first wave.

What can parents do to ensure children are vaccinated during this pandemic?

Parents should be aware of the recommended immunization schedule and their child’s immunization status. They should contact their primary care providers to schedule routine immunization visits at recommended and safe times. They should particularly ask about the flu vaccine, and they should vaccinate their entire families as early as possible before influenza takes hold in our area.

Children under nine who have never had a flu vaccine will need two doses 30 days apart. Families with infants under six months can protect their baby by immunizing the entire family, a term we call cocooning. People over 65 can get a high dose vaccine this year, which gives them better protection, given their decreased ability to respond to the vaccine.

Parents who have concerns about side effects or vaccines’ effectiveness should talk to their health care providers. A trusted provider is the best source of reliable information for all their healthcare needs, including immunizations.

How are doctors helping to rectify this problem?

The American Academy of Pediatrics is encouraging routine immunization for all children during this pandemic. Although many providers and even some local health departments had to close their offices earlier on during the COVID-19 pandemic, most are now open and available to immunize children.

Parents have also been fearful of bringing their children to the doctor’s office at this time. We hope they will now take advantage of the lower COVID-19 infection rates in New Jersey to get to their provider’s office for immunizations. The added burden of insurance restrictions allows only a patient’s listed primary care provider to get reimbursed for providing an immunization.

Work needs to be done to make immunizations available and easily accessible now and provide education to families, encouraging them to seek vaccines for their children and assuring them that measures will be taken to ensure patient safety.

The COVID-19 crisis is a rapidly evolving situation, and there needs to be ongoing communication between health providers, public health officials, insurers and families.

We need to be open to new strategies to streamline the delivery of vaccines. We should prioritize patients whose vaccines are delayed and utilize strategies such as vaccine-only visits to allow more patients to be protected as quickly as possible. This is especially true for influenza immunization, particularly in this time of COVID-19.