Three years after the onset of the COVID-19 pandemic, routine childhood vaccination rates in the United States remain lower than pre-2020 levels, according to a study published in Pediatrics on March 26. The research highlights a persistent decline in coverage for key vaccines, raising concerns about potential gaps in immunization and the risk of preventable diseases.

The study, led by Dr. Malini B. DeSilva from HealthPartners Institute in Bloomington, Minnesota, analyzed vaccination data from 395,143 infants born between January 1, 2018, and May 31, 2023. Researchers focused on coverage for the rotavirus vaccine, diphtheria, tetanus, and acellular pertussis (DTaP) vaccine, and pneumococcal conjugate vaccine (PCV)—all critical immunizations for infants.

Findings showed that by five months of age, coverage for two doses of these vaccines had dropped from 87.8% in February 2020 to 80.8% in October 2023. Similarly, by 12 months of age, vaccine series completion rates fell from 92.3% in January 2020 to 89.6% in October 2023. The decline underscores the lingering impact of the pandemic on routine childhood immunization programs.

The study identified several factors associated with lower vaccine uptake, including having a caregiver whose primary language was neither English nor Spanish, being of non-Hispanic Black race, and being enrolled in Medicaid, which often serves lower-income families. These disparities highlight structural and social barriers to immunization, which may include limited access to healthcare, vaccine hesitancy, and logistical challenges such as transportation or appointment availability.

The authors emphasized the need for targeted interventions to improve vaccine coverage among vulnerable populations. They also called for further research into how sociodemographic and cultural factors, healthcare accessibility, and vaccine confidence contribute to disparities in immunization rates.

While the study provides crucial insights, it also notes potential conflicts of interest, as several authors disclosed financial ties to the pharmaceutical industry. Despite this, the findings reinforce the urgency of strengthening vaccination programs to ensure that routine childhood immunization rates return to—or exceed—prepandemic levels.