Most US pediatricians participate in the Vaccines for Children Program (VFC), perceiving that its benefits far outweigh its burdens, but this does not necessarily translate into adherence to timely universal childhood vaccinations, two new reports suggest. "Maintaining high participation in the VFC program by pediatricians is crucial to maintain or increase vaccination rates in the US," Dr. Sean T. O'Leary of the University of Colorado and Children's Hospital Colorado, in Aurora, told Reuters Health by email. The VFC program, created in 1993 to ensure that children would not suffer from vaccine-preventable diseases because of inability to pay for vaccines, supplies more than half of vaccines for children in the US. Most VFC vaccines are administered by primary-care pediatricians, who must meet participation requirements related to ensuring proper storage and handling, administration and documentation of vaccines. In one of two reports in Pediatrics, Dr. O'Leary and colleagues describe the responses of 372 pediatricians, a response rate of 79%, regarding VFC participation, perceived burden vs benefit of participation, and knowledge and perception of a time-limited increased payment for VFC-vaccine administration under the Patient Protection and Affordable Care Act. Overall, 86% of survey respondents currently participate in the VFC. Among those not participating, the most commonly cited reasons included nonparticipation in the Medicaid program, not having enough low-income patients, the burden of separating stocks of VFC and private vaccines, the difficulty of VFC record-keeping requirements, and the administrative burden of VFC participation. Almost all pediatricians strongly agreed that participation in the VFC is valuable because it allows practices to administer vaccines to children regardless of ability to pay, that the VFC improves access to childhood vaccines, and that the VFC is valuable because it allows children to be vaccinated in the medical home. Nevertheless, substantial proportions of pediatricians also endorsed statements about specific aspects of VFC participation that were burdensome or challenging. Still, most pediatricians felt that the benefits of participating in the VFC outweighed its burdens. Only 40% of pediatricians who accepted Medicaid were aware of the increased payment for VFC administration fees authorized for the years 2013 and 2014; 10% of these pediatricians reported that their practice increased the proportion of Medicaid and/or VFC-eligible patients on the basis of that specific change. "I think the recognition by pediatricians of the importance of the program in maintaining high vaccination coverage is a key finding," Dr. O'Leary said. "I think physicians could also engage the administrators of their state's VFC program to work towards solutions to some of the reported burdens." "Solutions to these burdens are not necessarily straightforward but could include increased payment for vaccine administration, uniform rules allowing borrowing between VFC vaccine and private stocks, and incentivizing the purchase of proper storage and monitoring equipment," the authors suggest. In the second report, Dr. Robert A. Bednarczyk of Rollins School of Public Health, Emory University, in Atlanta, and colleagues estimate the proportion of children not adhering to Advisory Committee on Immunization Practices (ACIP)-recommended early-childhood-immunization schedules and explore associations between schedule adherence, sociodemographic characteristics and up-to-date immunization status by 19 to 35 months of age. Based on National Immunization Survey data for 2014, the latest year available, 63% of children had vaccination patterns consistent with the ACIP-recommended schedule, 23% followed an alternate pattern, and about 15% fell into the unknown or unclassifiable category. About 58% of children were up-to-date for recommended vaccinations at the time they were surveyed. Children following an alternate vaccination pattern were 4.2 times as likely not to be up-to-date and children following unknown or unclassifiable patterns were about 2.4-fold more likely not to be up-to-date, compared with children vaccinated according to the recommended schedule. Sociodemographic factors did not significantly predict the association between schedule adherence and up-to-date status. "Seeing that approximately two-thirds of children had vaccination patterns that followed the recommended schedule was promising, but we were very interested in the fact that about one-third did not follow the recommended schedule, and many of these children had received no doses of at least one vaccine," Dr. Bednarczyk told Reuters Health by email. "This type of selective refusal of vaccines, along with the other vaccine delays or alternate scheduling, leaves children vulnerable to infectious diseases at earlier ages when these diseases may be more severe," he said. "This highlights the need for better analysis of vaccine schedule adherence to help develop and implement more directed interventions to address specific concerns that may drive these delays or atypical vaccination patterns." "I would hope that physicians will see that there are many children who are not protected from vaccine-preventable diseases as early as possible," Dr. Bednarczyk said. "I also would like to see physicians and all healthcare providers work with parents to highlight the extensive expert review by the Advisory Committee on Immunization Practices that goes into the development of the recommended schedule, which is designed to maximize protection at the earliest possible ages." —Will Boggs MD Source
