The week of April 24-30, 2020, was World Immunization Week,1 an ironic note during this SARS-CoV-2 pandemic when the worldwide childhood immunization rate has been way down. The combination of parents staying socially isolated at home with their children and the closure or limited accessibility of some physicians’ offices and outpatient clinics during the pandemic have resulted in missed pediatric vaccinations.

On March 26, 2020, the World Health Organization (WHO) recommended the suspension of mass vaccination efforts around the world in an effort to avoid spreading COVID-19 among the populations and healthcare workers.2 Polio vaccination campaigns had already been paused as of 2 days earlier, and 23 countries had already paused measles vaccination campaigns.2 At the same time, the WHO recommended that individual children continue to be immunized at local clinics,2 but the availability of vaccines was gravely compromised by travel restrictions (and as a result, delivery).3

In the United States, a survey of pediatricians revealed that they administered half as many measles, mumps, and rubella (MMR) vaccines in early April 2020 compared with 2 months earlier.4 The Centers for Disease Control and Prevention (CDC) reported a marked decrease in noninfluenza vaccine orders submitted to the federally funded Vaccines for Children Program between January and April 2020 compared with the same period in 2019, with most of the decline occurring after a national emergency was declared in the United States on March 13, 2020.5 After March 13, 2020, the number of measles-containing vaccine doses administered declined drastically compared with earlier in the year.5 Review of the Michigan Care Improvement Registry revealed that in May, 2020, vaccination rates were lower for all pediatric age groups except at birth (hepatitis B vaccine is administered in the hospital at birth) compared with each May of the previous 4 years.6 In Massachusetts, 68% fewer pediatric vaccines were ordered in the first half of April 2020 compared with the same period a year before.7 In Nebraska, vaccination rates in children between 2 and 7 years of age declined more than 30% from January to April 2020 compared with those months in the previous year.8 In Florida, 40% fewer vaccinations were given in April 2020 than in April 2019.9 In New York City in mid-May, child vaccinations were down 63% from a year before; the decline was 91% for children older than age 2.10

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This staggering decline in vaccination rates during the SARS-CoV-2 pandemic could lead to outbreaks of communicable infectious diseases in the United States and around the world. For measles, an extremely contagious respiratory virus, immunization rates falling below 95% could lead to a loss of herd immunity.6 Social isolation and use of face coverings during the COVID-19 pandemic could protect against the spread of all respiratory pathogens, including measles virus, but when these measures are no longer common, a vulnerable, nonimmunized pediatric population becomes exposed.

Some creative solutions such as house calls and parking lot automobile lineups have been employed to administer vaccinations on schedule,10 but many children will need to “catch-up” with their vaccinations. The CDC has published catch-up guidance for pediatric immunizations.11,12 This guidance specifies applicable minimum and maximum ages for relevant vaccines, the minimum intervals allowed between doses for multidose vaccines, as well as recommendations for special clinical situations.11


  1. World Health Organization. World immunization week 2020. Accessed June 17, 2020.
  2. Roberts L. Pandemic brings mass vaccinations to a halt. Science. 2020;368(6487);116-117.
  3. Lovelace B. WHO warns that ‘children will die’ as coronavirus pandemic postpones vaccinations against other diseases. April 27, 2020. Accessed June 17, 2020.|email&par=sharebar
  4. Hoffman J. Vaccine rates drop dangerously as parents avoid doctor’s visits. The New York Times. April 23, 2020. Accessed June 17, 2020.
  5. Santoli JM, Lindley MC, DeSilva MB, et al. Effects of the COVID-19 pandemic on routine pediatric vaccine ordering and administration- United States, 2020. MMWR Morbid Mortal Wkly Rep. 2020;69(19):591-593.
  6. Bramer CA, Kimmins LM, Swanson R, et al. Decline in child vaccination coverage during the COVID-19 pandemic- Michigan Care Improvement Registry, May 2016-May 2020. MMWR Morbid Mortal Wkly Rep. 2020;69(20): 630-631.
  7. Freyer FJ. Parents worried about coronavirus are missing vaccination appointments- opening the door to outbreaks of a different kind. Boston Globe. April 30, 2020. Accessed June 17, 2020.
  8. Ulcinaite R. Child vaccination rates down in Nebraska due to COVID-19 fears. KMTV News Now Omaha. May 20, 2020. Accessed June 17, 2020.
  9. Sexton C. Child immunizations in Florida drop amid COVID-19 pandemic. Orlando Weekly. May 27, 2020. Accessed June 17, 2020.
  10. Higgins-Dunn N. New York Mayor de Blasio says number of kids getting vaccinated is down more than 60%. CNBC. May 20, 2020.  Accessed June 17, 2020.|email&par=sharebar
  11. Centers for Disease Control and Prevention. Table 2. Catch-up immunization schedule for persons aged 4 months–18 years who start late or who are more than 1 month behind, United States, 2020. Reviewed February 3, 2020.  Accessed June 17, 2020.
  12. Centers for Disease Control and Prevention. Recommended child and adolescent immunization schedule for ages 18 years or younger: United States, 2020. January 29, 2020.  Accessed June 17, 2020.