The Centers for Disease Control and Prevention’s Vaccines for Children Program is celebrating a big landmark this year: For 30 years, the program has safeguarded the health of low-income, uninsured or otherwise vulnerable children through immunization. The program offers free vaccines to health providers who serve vulnerable children, distributing over 71.5 million doses of vaccines in 2022 alone. A 2020 study found that 86% of U.S. pediatricians participate in the life-saving program.

The Nation’s Health spoke to Georgina Peacock, MD, MPH, director of the Immunization Services Division in CDC's National Center for Immunization and Respiratory Diseases, on the past, present and future of the program.

Why was the Vaccines for Children Program started?
It was in response to a measles outbreak that occurred between 1989 and 1991. Children were going in to see their primary care providers and they didn't have access to be able to get the vaccine. Some of those children were getting measles, and so this program was established so children would have access to no-cost vaccines.

How would you define the mission of the program?
The current mission of the Vaccines for Children program is to make sure that all children that are eligible have access to no-cost vaccine. Those include…enrolled children that are uninsured or underinsured, and children that are American Indian and Alaska Natives.

What communities are the furthest from vaccine equity?
A core mission of the Vaccines for Children program is to try to address disparities that exists among vaccine coverage. There are challenges with race and ethnicity and those that live in rural areas. That is an area where it's really important for us to have an increased focus is making sure that there is continued access, or greater access to vaccine providers in the program, particularly in rural areas.

What role has the Vaccines for Children Program played during the COVID-19 pandemic?
The COVID vaccination program used the framework of the Vaccines for Children program for distribution of vaccines. We have a process by which we work with a central distributor, and that central distributor sends vaccines out to all of the providers when the emergency use authorization for COVID-19 was approved for children and adults.

What are some of the big successes over the program’s three decades?
Essentially it's the decrease in those disparities across different groups. We estimate that routine childhood vaccinations have prevented 508 million illnesses, 32 million hospitalizations and about 1.1 million deaths.

So really, there's been a dramatic impact of the Vaccines for Children program, and we estimate we've kept up to date about 40 million children on their routine childhood vaccinations.

The rate of children eligible for the Vaccines for Children Program surged during the pandemic. How has the program worked with providers to reach families?
During the pandemic many more children became eligible for Medicaid. One of the things that we did is issue a call to action for health care providers, health care systems, parents, state and local governments, to promote catch-up of vaccinations for children.

Where there were challenges was children weren't regularly going to school. There are often checks of vaccination records and things like that with children in school. It was really important for us to send out those reminders, or that call to action to make sure that children were staying up to date, or getting back up to date on their routine childhood immunizations.

Even with growing need, the number of Vaccines for Children Program provider locations has fallen, with about 37,000 today. What’s driving the drop?
We’re not clear on exactly what is driving this decline in providers, but it is something we are very interested in addressing.

One of the things that we're doing as a big push this fall is looking at increasing the number of birthing hospitals that are Vaccine for Children providers. With the new availability of immunizations against RSV for infants, if we can enroll birthing hospitals in VFC, we can ensure greater access for infants.

Also we are looking at different VFC policies that might make it more challenging to be a VFC provider, and seeing what we can do where we still maintain the integrity of the VFC program.

Too many vulnerable U.S. children are still not up to date on their recommended vaccines. Why is that?
I think the pandemic highlighted, or even exacerbated, the issue of access to health care. Children not getting well-child visits is highly correlated with children not getting vaccines.
There may be some places where adolescents could get some of their vaccines in a pharmacy, or there may be school-based clinics where children can get vaccinated. I think it's really important to continue to think about other ways to reach children in addition to their medical home.

How has the Vaccines for Children Program addressed lagging vaccination rates for vulnerable kids?
One the things that we did in 2023 was launch the Let's Rise Initiative — (as in) let's rise standard immunizations on schedule for everyone.
Our Let's Rise team works with states on particular areas where they may be having a challenge. We worked with a state that saw very low MMR vaccinations in their kindergarten entry. We worked with the state health department to look at the data, figure out which communities had these low rates, and then worked with them to come up with a back-to-school campaign that would help encourage MMR vaccination for kindergarteners.

What should parents know ahead of this back-to-school season?
The first thing is making sure your child is up to date on vaccinations. We know over the last couple of years that vaccine coverage for kindergarteners has dropped. Each year, about 250,000 children are estimated to enter kindergarten not up to date on their vaccinations.
In light of the fact that we are seeing measles outbreaks in different parts of the country, it's very important that we have children that are healthy and ready to learn. One of the ways for that to happen is that they have their vaccinations.

The interview was edited for clarity, space and style.

Photo by FatCamera, iStockphoto