Geographic Variation in Routine Childhood Vaccination Using Real-World Evidence: Pre- and Post- COVID-19 Pandemic

OBJECTIVES: Vaccine surveillance has been a longstanding priority and is highlighted as a goal in Healthy People 2030, since vaccines promote wellbeing during development and disease prevention. In the United States, there is a growing number of vaccine hesitant parents. The primary objective of this abstract is to investigate the geographic variation in routine vaccination during the first two years of life among children born during the COVID-19 pandemic compared to children born in the two years prior.

METHODS: Cross-sectional study design was employed using the Inovalon closed claims database for medical, pharmacy, and enrollment data from January 1, 2018 to December 31, 2023. Children with commercial and managed Medicaid covered lives were included in this analysis. Avalere spatially aggregated data to the ZIP-3 level for the Inovalon closed claims prior to calculating area-specific period prevalence. Geographic heatmapping was performed to visualize the prevalence of children that had completed the 7-vaccine series by 24 months. Two separate sets of geographic heatmapping were generated for children born recently (2020-2021) compared to children born prior to the COVID-19 pandemic (2018-2019). In addition, for children born in 2020-2021, we visualized the prevalence of children that had received at least two COVID-19 vaccines.

RESULTS: Completion of the routine 7-vaccine series was relatively similar geographically in children at 24 months when comparing children born during and prior to the COVID-19 pandemic. There was some regional variation in COVID-19 vaccination at 24 months in rural compared to urban regions.

CONCLUSIONS: Common themes of misinformation that were in frequent circulation during the pandemic included medical misinformation, conspiracies, and distrust in vaccine development. Vaccine rates held constant pre and post pandemic although continued vaccine surveillance is crucial given the increasing concern and circulation of misinformation.