What an infectious disease doctor wants you to know about childhood vaccines

Note: This interview was originally published in Doing Well, a health news outlet from ASU Media Enterprise and ASU Learning Enterprise. Subscribe to Doing Well to get interviews with health experts delivered to your inbox weekly.

By Mel Moore

Every year, childhood vaccinations save an estimated 4 million lives worldwide. In the U.S., the federal government has long recommended several vaccines to protect kids against infectious diseases. These recommendations, developed by doctors, are backed by decades of scientific research showing vaccines are safe and effective in preventing disease.

Recently, though, federal vaccine policy has started to shift. To help you sort through the noise, we spoke with Dr. Rebecca Sunenshine — an infectious disease physician and the medical director of ASU’s Health Observatory — about childhood vaccines, changing vaccine policy and how you can best protect yourself against disease. The conversation has been edited for length and clarity.

Short on time? Here’s what to know:

• Childhood vaccines have been proven safe and effective at preventing illness throughout life.
• Childhood vaccine recommendations are based on data from clinical trials that determine when a child can safely receive the vaccine. If you’re interested in the most up-to-date recommendations based on medical evidence, the American Academy of Pediatrics is a great resource.
• Herd immunity functions like an umbrella in a rainstorm. When enough people in a community are vaccinated, their immunity forms an extra layer of protection, preventing unvaccinated people from ever getting exposed.
• Most vaccines are covered by insurance with no out-of-pocket costs. If you are uninsured, you can get vaccinated at no or low cost at a federally qualified health clinic.
• Nine in every 10 unvaccinated children who are exposed to measles will become infected. The best thing you can do to protect yourself and your community against measles is to get vaccinated.

Question: There are several doctor-recommended vaccines for children to protect against tetanus, polio, chickenpox, and hepatitis B, to name a few. Why are these recommended in childhood?

Answer: These vaccines have all been developed and rigorously tested for many years to prevent illnesses that are known to make kids very sick — or even kill them. These diseases were prevalent in many parts of the world, including the United States, at one time. When these vaccines are developed, they’re not only tested for safety, but to make sure that the benefits of the vaccine — the diseases that they prevent — outweigh any risks.

Q: Why are these vaccines important not just for individuals but for community health?

A: No vaccine is 100% effective on its own. So when you take that vaccine, you are doing the best thing you can to prevent yourself from getting sick if you’re exposed — but it’s not perfect. And there’s always going to be people in a community that can’t get the vaccine. Maybe the baby’s too young to get vaccinated, or maybe that person has an underlying cancer or something that depresses their immune system and they can’t get that vaccine — those people are relying on everyone around them to get vaccinated. That creates something called herd immunity or community immunity. 

I think about herd immunity as an umbrella. I think about the vaccine as a raincoat. With a raincoat, you’re standing there in the rain, and you’re mostly protected, but your face might still get wet and the water could drip onto your shoes. Community immunity is standing there in the rain, wearing a raincoat under an umbrella. That umbrella keeps the rain from ever getting to you, so it can’t leak in — that’s what community immunity is, it’s forming an extra layer of protection of people who are vaccinated so that it keeps people who are not vaccinated from ever getting exposed to the disease.

Q: How are childhood vaccine recommendations decided?

A: That’s based on clinical trials and on what we know about children and when their bodies develop the ability to produce antibodies. It’s also based on the properties of the vaccine. For instance, there are some vaccines that you’re given as a child, but they actually wear off over time, and so you need what’s called a booster.

Q: Some people may have heard about changes to federal recommendations for childhood vaccines. What are some of those changes? Will they affect the vaccines people have access to?

A: The changes started with COVID vaccines moving from being “recommended for everyone” to “shared clinical decision-making.” People who want to get the vaccine and their provider agrees that they should get the vaccine can still get it. But health insurance companies might not pay for a vaccine if it’s not universally recommended. The good news is ... the majority continue to cover the vaccine.

Federal recommendations are also moving in the direction of shared clinical decision-making for other vaccines that used to be recommended. That’s really concerning, because once you get below a certain threshold of the population getting immunized, you lose that herd immunity, and then all the people who can’t get vaccinated — young babies and those people with depressed immune systems — are much more susceptible not only to getting the disease, but to getting severe disease.

Q: It sounds like a lot of these recommendations are shifting from “This is universally recommended” to “This is up to you and your provider,” and that is changing how many people get vaccines and insurance coverage.

A: It could change insurance coverage. There is disagreement on whether the insurance companies have to cover vaccines with shared clinical decision-making. Whereas if it’s recommended by federal guidelines, they have to cover it with no out-of-pocket cost.

It’s also changing the way doctors can talk about vaccines. Before they could say the federal Advisory Committee on Immunization Practices recommends that every child has this vaccine, and now it’s more difficult for them to say that. 

However, it’s very important for people to understand that none of the science has changed to support these new recommendations. There’s been no new evidence, no new science, just different people on the committee. Because of that, many states have said, “We’re going to rely on the organizations that we know will continue to make recommendations based on science.” The primary one for childhood vaccines is the American Academy of Pediatrics (AAP). The AAP has not changed its recommendations for any of those vaccines. 

Q: What testing does a vaccine traditionally have to go through before it’s approved for use in the U.S?

A: It has to go through typically years of clinical trials. First, it’s developed in a laboratory, and it’s often tested on animals first. Then it goes through safety trials where they’re making sure that it’s safe in both animals and humans. And then it goes through Phase 3 clinical trials where they actually determine how effective it is. And then they have to prove to the Food and Drug Administration that it is both safe and effective, and that the benefits outweigh the risks.

Q: What resources would you suggest someone consult to make an informed decision about vaccines?

A: If you just want to know the vaccine recommendations or where to get vaccines, go to the Arizona Partnership for Immunization (TAPI). If you want to understand the medical recommendations and the reasoning, go to AAP. And if you want to understand that deep scientific evidence, I would go to the Vaccine Integrity Project. They are continuing to review the literature as it comes out. We don’t always know everything about a vaccine. If we learn something new and a new study comes out, you need a group of unbiased experts to review that scientific evidence and change the recommendations if needed.

Q: If someone has insurance, what vaccines should be covered? And if they don’t have insurance, are there clinics they can access where there are low-cost vaccines?

A: If somebody has insurance, no one should ever have to pay a copay, for instance, or a deductible for getting a vaccine. At this point, most insurance companies are covering most vaccines. However, things may change, and it’s really important that people check with their insurance company.

People who don’t have insurance, there’s a couple things they can do. They can go to a federally qualified health center. There are also free and reduced-cost clinics. My favorite place to find free and reduced-cost health care in general is a website called Find Help; not only can you find health care, but you can find lots of other free and reduced-cost services.

Q: The Health Observatory has been tracking measles outbreaks in Arizona and other states. What worries you most about what’s happening with measles?

A: What worries me the most is knowing that measles is the most contagious disease known to humans, and that about 9 in 10 people who are not immune to measles who are exposed will get the disease. When we see pockets in the community where lots of people are unvaccinated, that’s where we see rampant spread of measles. All the outbreaks that we’re seeing are occurring in communities where large proportions of people are unvaccinated. Measles is so infectious that you need a very high rate of vaccination to create that extra layer of protection. For measles, you need to have 95% of people vaccinated in order to have herd immunity.

Q: What is one thing everyone can do to protect themselves or their kids from measles?

A: Get vaccinated. You want to get vaccinated before you’re exposed to the disease. The times when we’re exposed to the disease is if there’s an outbreak going on in your community and if you travel. We used to say traveling anywhere outside of the United States was a risk, and that is still true. But now even traveling to places in the United States increases your risk. So it’s really important to get vaccinated.

Q: Not everyone has their childhood vaccine records. If someone wants to make sure they’re up to date on vaccines that are typically recommended during childhood, is there anything they can do?

A: If you’ve been in Arizona the entire time, the Arizona Department of Health Services has this service called MyIR and they actually have documentation of every vaccine that you’ve gotten. You register through this site and they will give you documentation of all your vaccines.

If you were born out of state, your best bet is to call your parents or to try to find those vaccine records.