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Despite overall success of the CDC Vaccines for Children (VFC) initiative, vaccine coverage still lagged in multiple areas for VFC-eligible children, according to CDC data.

Although almost 90% of VFC-eligible children born during 2011-2020 received the measles, mumps, and rubella (MMR) vaccine, just 61% to 65% received a combined series of seven pediatric vaccines, "highlighting room for improvement," reported Madeleine Valier, MPH, of the CDC National Center for Immunization and Respiratory Diseases, and colleagues.

And, rotavirus vaccination coverage remained suboptimal, although it increased over time from 65% to 71% among children born in 2011-2020 -- by approximately 0.7 percentage points each year, they wrote in a of the Morbidity and Mortality Weekly Report.

Among VFC-eligible children born in 2020, coverage was highest at around 90% for first doses for the MMR and varicella vaccine and for the series administered earlier in life, such as the poliovirus vaccine and the hepatitis B vaccine. Coverage, however, dropped to about 74% to 77% for vaccines that required multiple doses and for doses recommended after age 12 months, such as for the diphtheria, tetanus, and acellular pertussis vaccine (DTaP), the pneumococcal conjugate vaccine (PCV), and the Haemophilus influenzae (Hib) vaccines.

"This suggests children face challenges to receiving vaccines that require multiple doses, as well as doses in the second year of life," co-authors Georgina Peacock, MD, MPH, director of the CDC Immunization Services Division, told reporters during a press call.

Importantly, when researchers compared vaccine coverage rates among VFC-eligible versus VFC-non-eligible children born in 2020, they found that coverage among VFC-eligible children was 3.8 percentage points lower for one or more MMR doses, 11.5 percentage points lower for two to three doses of rotavirus vaccine, and 13.8 percentage points lower for the combined seven-vaccine series.

The report "highlights the need to reduce the gaps in vaccination coverage for children living below the poverty level and those without health insurance," Debra Houry, MD, MPH, CDC chief medical officer, told reporters. "We need to do more."

The VFC program, established in 1994, provides vaccines at no cost to children who are Medicaid-eligible, uninsured, underinsured, or American Indian or Alaska Native. In 2023, approximately 54% of children in the U.S. were eligible to receive vaccines through the VFC program, which distributed approximately 74 million vaccine doses to 37,000 participating locations.

A recent CDC report found that routine childhood vaccinations over the past 30 years have prevented approximately 508 million cases of illness, 32 million hospitalizations, and 1,129,000 deaths, resulting in societal savings of nearly $2.7 trillion, including a direct savings of $540 billion.

Researchers also found that among VFC-eligible children born in 2020, vaccination coverage was about 19 to 35 percentage points lower among uninsured children than among Medicaid-insured children. However, the proportion of uninsured children decreased from approximately 8% in 2011 to just 3% in 2020. And VFC-eligible children living below the federal poverty level also had lower coverage for rotavirus vaccine and the combined seven-vaccine series when compared with VFC-eligible children living at or above the poverty level.

"Despite successes, the need to increase coverage with all routine vaccines and to reach children living in lower-income households and who lack insurance continues," Valier and colleagues wrote.

The study authors encouraged healthcare providers to make strong vaccine recommendations for their patients, strengthen family-provider relationships, and provide parental education about the vaccines. They suggested reducing missed opportunities for vaccination by offering simultaneous administration of childhood vaccines and administering catch-up vaccinations to all inadequately vaccinated children.

The report relied on data from the 2012-2022 National Immunization Survey-Child (NIS-Child) to assess trends in vaccination coverage with one or more doses of the MMR vaccine, two to three doses of the rotavirus vaccine, and recommended doses of a combined seven-vaccine series, by VFC program eligibility status. The combined seven-vaccine series included the DTaP vaccine, poliovirus vaccine, measles-containing vaccine, Hib, hepatitis B vaccine, varicella vaccine, and PCV.

The authors acknowledged several limitations to their report. Overall response to the household survey was relatively low (21.1%-42.5%), which may have resulted in selection bias. The data may have underestimated actual coverage for some vaccines. Also, misclassification of VFC eligibility status may have occurred for a variety of reasons.

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