The NCSL Blog


By Erik Skinner and Khanh Nguyen

The COVID-19 pandemic has shifted the way Americans seek health care in numerous ways, including keeping kids at home and out of doctors’ offices. Many health care providers adjusted practices to minimize in-person visits for nonemergency issues, and parents canceled preventive care appointments to avoid the risk of COVID-19 exposure. While these actions can help slow the spread of the new virus, they also resulted in a drop in well-child visits and childhood immunization rates, leaving children susceptible to other deadly diseases such as tetanus and whooping cough.

There were notable decreases in the ordering and administering of recommended childhood vaccines during the first four months of 2020 compared with the same period in 2019, according to a May 8 report from the Centers for Disease Control and Prevention (CDC). For example, there was a steep drop in measles-containing vaccines administered to children in the week of March 16, following the national emergency declaration, indicating the change is likely due to COVID-19 (see figure below). Although vaccination rates for children 24 months and younger started to rebound, they remain lower than in earlier weeks, and the rates for older children are a small fraction of what they were in February.

As local and state public health measures like stay-at-home orders are lifted, it’s critical that parents and health care providers work together to make sure their children continue to be protected from deadly vaccine-preventable diseases, according to Dr. Nancy Messonnier, CDC director of the National Center for Immunization and Respiratory Diseases.

covid immunization chart

As childhood immunization rates began dropping in March, the American Academy of Pediatrics and CDC issued guidance for health care providers to continue necessary care for children while minimizing exposure to COVID-19. These guidelines include strategies to separate preventive care visits from sick visits and prioritize immunizations for children under 24 months.

Some state health agencies have updated their immunization guidance to reflect challenges presented by the pandemic. The New Jersey Department of Health recently highlighted the importance of continuing to immunize infants during the CDC’s National Infant Immunization Week. The message encouraged providers to talk to patients about the importance of immunizing newborns and encouraged parents to take their children to the doctor for recommended immunizations.

The Washington State Department of Health and Wyoming Department of Health posted guidance for health care providers to continue vaccinating patients and included tips on how to do so safely. The Pennsylvania Department of Health offered information and guidance for certain providers on vaccine storage and handling requirements and maintaining childhood immunizations during the pandemic.

While NCSL continues to monitor official statements and actions related to state policy and guidance on maintaining childhood immunization rates during the pandemic, immunization managers, public health professionals and policymakers are gathering their own data, analyzing the results and determining a path forward for their states and localities.

Additional Resources

Erik Skinner is a policy associate in NCSL’s Health Program. Khanh Nguyen is a senior policy specialist in NCSL’s Health Program.

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Posted in: Health, COVID-19
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About the NCSL Blog

This blog offers updates on the National Conference of State Legislatures' research and training, the latest on federalism and the state legislative institution, and posts about state legislators and legislative staff. The blog is edited by NCSL staff and written primarily by NCSL's experts on public policy and the state legislative institution.