Washington has lost about $2.5 million through federal cuts that will hit childhood vaccination programs and immunization data-tracking efforts, both of which state officials say grew during the pandemic but are now at risk of crumbling.
The Centers for Disease Control and Prevention reductions were confirmed earlier this month by Kaiser Family Foundation Health News, which obtained an email from agency officials linking cuts to the recent debt ceiling deal. The losses could result in incomplete reporting on vaccinations, which will likely mean less-informed and less-equitable public health strategies, state officials said.
“There will be no easy solution for this,” CDC officials wrote in the email.
Further details about the reductions are limited, and it’s too soon to know exactly how they’ll affect Washington’s vaccination efforts, but the state confirmed last week that initial cuts are significant.
About 20% of the Department of Health’s core 2023-24 budget for statewide immunization work, which includes childhood vaccines and immunization data, has been eliminated, according to Michele Roberts, the state’s assistant secretary for prevention and community health. Earlier this year, the federal government allocated about $11.9 million for these programs, but the budget has now shrunk to about $9.4 million, which state officials say likely will not be enough to continue to support them for long.
“Historically, chronic underfunding has created serious gaps in our public health infrastructure,” Roberts said in a statement. “This has left our nation and state less prepared to respond to health emergencies and prevent disease. DOH hopes solutions can be found to address this situation and secure the necessary resources to support this critical public health infrastructure.”
Shots for kids
The cuts represent a potential disruption to state programs that make sure vaccines are ordered and distributed to providers equitably.
The funding was dedicated to supporting the state’s Immunization Information System, a lifetime immunization registry where health care providers can see what vaccines a patient has had previously. During the pandemic, providers tracked the progression of coronavirus shots through the immunization system, or IIS.
“We can’t prevent infectious disease without data,” Roberts said. “Due to debt ceiling negotiations, it is likely there will be other impacts to public health over time.”
The online system also serves as the state’s tool for distributing vaccines to children under the federally funded Childhood Vaccine Program, which provides shots at no cost for people under 19 without insurance or with limited coverage.
Given the federal cuts, state officials are concerned that providers won’t be able to order and distribute as many shots to uninsured and underinsured kids who need that program to get vaccines. About 2.6% of Washington children were uninsured as of 2021, according to the state’s Office of Financial Management.
Most insurance plans cover childhood vaccines, so those with insurance will continue to be billed for immunizations through the same system, even with these budget cuts.
“Vaccinating children is a public health priority,” Dr. Eric Chow, King County’s chief of communicable diseases, said last week. “For younger children, particularly when they’re first born, immune systems are still developing. We know they’re at greater risk for infection, as well as becoming seriously ill if infected.”
He continued, “The greater our vaccination rates are within our communities, the greater our protection and prevention of spread of infections when they do occur.”
In the past year, almost 800,000 Washington kids and teens — or 47% of the state’s 18-and-under population — received a publicly funded vaccine, including COVID-19 shots, through the federal program.
In Washington, all K-12 students are required to get vaccinated against a group of infectious diseases, including chickenpox, measles, polio and whooping cough — unless they have a religious or medical exemption. Neither flu nor COVID shots are required, though both are recommended by health officials and are funded by different federal and state programs.
The state’s student vaccination rates dropped slightly in the past couple years, from 91.7% during the 2021-22 school year to about 90.9% this past year. Decreases among kindergartners were particularly noticeable, Chow said — 87.6% this past school year, compared with 89% in 2021-22.
King County’s K-12 vaccination rates also fell about a percent, settling at 91.4% this year, though numbers ranged widely depending on the school district. For example, the Lake Washington School District on the Eastside reported about 94.4% of students were up to date, while Highline Public Schools in South King County is about 86.6% vaccinated.
Seattle Public Schools reported about 92.3% students were vaccinated in the 2022-23 school year.
Rates in Snohomish County haven’t changed much since 2020 and hover around 91%, said Kari Bray, county public health spokesperson. While county health leaders are pleased they didn’t drop, they would “much rather see an increase,” Bray said.
There are many explanations for the drop-off among childhood vaccinations during the pandemic, according to local health experts. People might have had more anxiety around going to the doctor’s office. Classes were at home, so perceptions of risk could have changed. Clinic times fluctuated.
“Now we’re kind of playing catch-up in trying to get people up to date with their recommended vaccinations, but we’re still facing barriers,” Chow said. “And one of the big barriers people are constantly concerned about is immunization costs.”
Health officials also continue to worry about the spread of vaccine misinformation, which is still a “significant problem” for primary care providers hoping to immunize patients. In Snohomish County, providers have been spending more time working through vaccine hesitancy and education with patients, Bray said.
The CDC announcement has added new urgency to local efforts to get kids and teens vaccinated before the school year begins and schedules fill up.
“Summer is a really critical time to get kids their required vaccines so they can start school successfully in the fall,” said Dr. Mersine Bryan, an attending physician at Seattle Children’s. “We did see a decline in childhood vaccines during the COVID pandemic, and we still need to make efforts to get kids caught back up.”
King County’s public health teams are working with Seattle Children’s Odessa Brown Children’s Clinic (with locations in the Central District and Othello), HealthPoint, Go-Vax Kids, Stepping Stone Pediatrics and others to host free vaccination clinics over the next several months.
But once August arrives, appointments often book up, according to public health officials.
The next two clinics — with the Highline School District and Federal Way High School — will welcome those between 4 and 18 next week.
“Vaccinations are a really important part of keeping children and communities healthy,” Bryan said. “They provide protection for individuals, but also herd immunity when the majority of a population gets vaccinated and protects those who are unable to.”
Meanwhile, the CDC has not provided DOH with further information about its funding decision or other potential cuts.
The state plans to use existing, one-time pandemic funds to keep the immunization records system up and running for now, but Roberts said she’s worried about the long-term sustainability of the online tool, which has found a rhythm in tracking COVID vaccine data.
“We are working toward replicating that success with all routine vaccines, but this funding cut is a tremendous setback,” Roberts said. “We have a long way to go to achieve the vision of public-facing dashboards for all vaccines, not just COVID. … We will not get there without investment in IIS.”