Barriers to immunization for Children in the United States
Barriers to immunizations can come from the family. The parent may have cultural or religious objections to immunizations. If the family doctor doesn’t offer immunizations, then availability becomes a problem. Even if a child has health insurance, there is no guarantee that third party payers cover immunizations. Once a parent locates an affordable location for shots, days of availability may limit parents. Scheduling days off work, transportation, child care for other siblings may be a barrier to immunizations. If income is limited, a parent is going to provide the basic necessities before vaccines.
More and more children are shuffled between caretakers-mother, grandmother, foster-care, and joint custody. With multiple caretakers, coordinating vaccines may not be a priority. If parents work an hourly job, they are penalized financially for taking their children to a clinic during daytime hours, particularly if they do not have health insurance plans through their job.
People may not know how to access the local health department in Virginia for free vaccines. In some areas, parents may not have reliable transportation.
Education of the parents is important. Some parents do not understand that the risks of complications from vaccines are compared to the devastation of a childhood disease outbreak.. They may also be concerned by misinformation and believe immunizations will harm their children. They may believe that there is so little disease now, that immunizations are unnecessary. They may believe that children don’t need to be immunized until they enter school.
Physician characteristics can cause harrier to immunizations. If the primary care physician does not offer immunizations, then availability becomes a problem. If an the physicians requires a well child check-up before receiving vaccines, this may become a financial barrier to obtaining shots.
There are many missed opportunities when a child comes into the physician for a visit, but is not offered immunizations. Clinic hours may be impractical for parents. The emergency room becomes a substitute for a primary care doctor and more immunizations are missed. A clinic may not be located on a bus line, so it is difficult to reach.
Providers and parents may have trouble with the frequently changing immunization schedule and its complexity. Physician education does not stress the importance of immunizations. Physicians may perceive potential liability as a reason to not offer immunizations in the office setting, but not suggest alternatives through the public health department.
In many offices the medical record system is woefully inadequate. Immunizations are not written down or are inaccurate. There is no database to keep consistent record keeping as children change providers.
Physicians and community agencies do not encourage children to enroll in public programs such as Medicaid, which reminds parents about immunizations. They may not take advantage of he ‘Vaccines for Children” program which makes vaccines available free to doctors and health centers. Doctors may not know that the CDC provides free vaccines to states, or that states have immunization laws, which require children to be immunized by two years of age.
There are some solutions for overcoming barriers. Placing after hour clinics on city bus lines may help eliminate barriers. Providing statewide electronic links between providers will help as children move between providers. Immunization starts with education in the hospital at birth and continues through reminders in the mail.
Encourage community support for parents trying to raise children in a single parent home or with limited income. Parents and providers consistently need to be educated on the importance of immunizations. Restructuring medical education to train more primary care physicians or physician extenders may help overcome barriers in the future. Identifying and removing barriers must continue until all children have the equal opportunity to be immunized.
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