This case of polio was of particular concern for three reasons. First, the person had not traveled recently, indicating that he contracted the virus in the US, not abroad. Second, the strain of polio that infected him (type 2) causes paralysis in about 1 in 2,000 infections, suggesting that hundreds and possibly thousands of people in New York have recently been infected with the virus. Third, genetic analysis showed that the polio strain is a strain that came from an oral polio vaccine – which uses an attenuated live virus – and is identical to the strain that has caused community transmission in London and Israel, indicating that this is a problem in many countries previously considered polio-free. New York City, where we work, has approximately 1.7 million children, all of whom have the opportunity to be vaccinated in a pediatrician’s office, given the presence of safety net hospitals where any child can seek care and vaccination, regardless of status insurance or immigration. Seventy years ago, parents lined up to vaccinate their children against a disease that left thousands disabled or unable to breathe each year. Today, with images of children on iron-lung machines consigned to history, up to 40% of 5-year-olds are not fully vaccinated against polio in some New York neighborhoods, leaving thousands now at risk of paralysis and death. advertising How did our country’s commitment to such an eminently safe and life-saving health intervention slip so far to leave children vulnerable? Pediatricians’ offices are the infrastructure the US relies on to vaccinate children. This strategy has been largely successful, with only 0.5-1.5% of children never being vaccinated, a rate lower than most regions of the world. Families trust their pediatricians for health information. advertising While pediatricians’ offices are the critical site for converting vaccines into immunizations, laws serve as a critical check that this system is working as intended. The best predictor of high childhood vaccination rates in the US is strong enforcement of vaccine requirements for school enrollment and child care. However, reluctance and refusal to vaccinate, due to misinformation or religious and medical exemptions, have reduced high rates of routine vaccination. This foundation crumbled even further when the Covid-19 pandemic interrupted the visits of good children to pediatricians’ offices both domestically and globally. Despite the reliance on the pediatric workforce to administer childhood vaccines, pediatricians receive limited required training or resources for evidence-based approaches to providing vaccine information and effective vaccine administration. They are largely unprepared to handle the increasing volume and decreasing accuracy of vaccine-related information that parents hear or see. We believe there is an urgent need for policies and practices to strengthen the provision of vaccines through pediatricians. Here are three ways to get there. First, the Centers for Disease Control and Prevention and states must fund staffing and partnerships between local health departments and pediatricians’ offices to identify children who are not up to date on their vaccines. With the right resources, health departments can search immunization registry data and electronic medical records and notify parents of children who need to be vaccinated. Supporting childhood vaccination with the support of local government is even more necessary in this period of health care staff shortages. Second, pediatricians should add achieving high routine vaccination rates to their practice quality improvement processes, following models established for seasonal influenza vaccines. Regulatory boards, such as the American Board of Pediatrics, and hospital rankings, such as US News & World Report’s, should include standard measures of childhood vaccination rates. Doing so will spur quality improvement efforts to increase vaccination rates in independent pediatric practices and large health care systems. Educational resources with certified trainers should be widely available for pediatricians and their staff, both in practice and in education, to address vaccination hesitancy. Third, state Medicaid programs should offer substantial incentive payments to pediatricians who achieve high vaccination rates and should encourage private payers to do the same. Preventing even one case of polio paralysis that leaves a child disabled for life, these interventions are almost certain to be cost-effective in terms of government and health systems. Where the polio virus circulates due to low vaccination rates, outbreaks of measles and other vaccine-preventable infections are not far behind. Fighting the resurgence of polio is a war the US knows how to win, but only if it can equip the front lines—pediatricians—with the tools they need to combat vaccine misinformation, hesitancy, and complacency. Sallie Permar is chief pediatrician at NewYork-Presbyterian Komansky Children’s Hospital and chair of the Department of Pediatrics at Weill Cornell Medicine. He reports consulting with Merck, Moderna, Dynavax, Hoopika, and Pfizer on cytomegalovirus vaccine programs. Jay K. Varma is an internal medicine physician and infectious disease epidemiologist, professor of population health sciences at Weill Cornell Medicine, and director of the Center for Pandemic Prevention and Response.
