During the summer delta surge, Dr. Mark Kline watched as the intensive care unit at Children’s Hospital New Orleans filled with patients, some under the age of one. Some who died.
As the hospital’s physician-in-chief, he has become a stark voice on Twitter excoriating the public to take seriously the pandemic’s pediatric body count and to get vaccinated.
But instead, Louisiana’s vaccine rates have stalled. And among kids ages 5 to 11, only 5% had at least one dose of a COVID-19 vaccine as of Dec. 1 — one of the lowest rates in the nation, and a figure Kline called “pathetic.”
At the same time, the effort to vaccinate children against COVID-19 has resulted in a political battle in Louisiana — particularly just before Gov. John Bel Edwards announced COVID-19 vaccines would be added to the list of required vaccinations for school-aged children. But pediatricians and state officials worry that on the horizon is a threat that reaches far beyond the ongoing pandemic.
“The threat to immunizations in general right now is off the charts,” Kline said.
Kline is afraid that the same misinformation fueling COVID-19 vaccine skepticism and politicization could spread and ultimately undermine confidence in all vaccines. If that happens, and fewer children get the regular schedule of vaccinations, he said a host of diseases could return.
“Are we going to go back to a time when we have children in this country dying of measles and paralyzed from polio?” Kline asked. “I'm not trying to be dramatic about it, but the ramifications potentially are huge. Epidemics of diphtheria again, paralytic polio in the infants.”
Vaccinations stall during pandemic
Louisiana law currently requires seven vaccines for a host of educational settings, ranging from daycare and K-12 to the university level.
The state tends to lag behind national averages for infant vaccines, but then exceeds national averages when children enter kindergarten and are required to show proof of their vaccination or an exemption, said Dr. Joseph Kanter, the state health officer.
Vaccine rates also vary widely parish-to-parish, and tend to be higher in public schools than private schools. For the 2019 to 2020 school year, private school vaccination rates for kindergarten ranged from 69 percent in St. Bernard Parish to 100 percent in Assumption. For most parishes, public school vaccination rates were in the high 90s.
These numbers are crucial because the required rates of vaccination for herd immunity are high, according to the American Academy of Pediatrics: for measles, it’s 95%; for polio, it’s 80%. Estimates for COVID-19 range from 70% to 85%.
But in July, the American Academy of Pediatrics issued a report warning of a dramatic drop in childhood immunizations early in the pandemic.
The report blamed missed doctors appointments thanks to lost health care coverage or financial hardship. It noted a drop of 11.7 million doses in non-influenza childhood vaccines across the country in 2020 compared to 2019.
Louisiana may have been hit harder than the national average, according to data from the health department.
It found that children who turned 2 years old in 2020 had a vaccination rate of 89.9% for at least one dose of the MMR vaccine, which protects against measles, mumps and rubella. That’s below the U.S. average of 92.8% in 2020, and it’s lower than Louisiana’s rate in 2019 of 94.6%.
More recent data shows flu vaccinations in Louisiana waning even in 2021. The state counted 762,552 flu shots in 2019, 772,001 in 2020 and only 573,343 in 2021, according to data provided by the health department.
Other factors could be playing a role in those numbers, said Dr. Rachel Chatters, a Lake Charles pediatrician and the head of the Louisiana Chapter of the American Academy of Pediatrics, especially the hurricanes that ravaged the southern part of the state in 2020. But the data show children in Louisiana are at risk of an outbreak.
Chatters said pediatricians across the state are working to get kids up-to-date in their vaccinations, but it’s a game of catch-up.
Anti-vaccine activists in Louisiana
Anti-vaccine misinformation gained a stark new foothold in state politics at a recent hearing of the House Health and Welfare Committee, when Attorney General Jeff Landry brought Robert F. Kennedy Jr., one the country’s most famous anti-vaccine activists who has been discredited for spreading misinformation about COVID-19 vaccines and other shots.
The hearing was centered around the Louisiana Department of Health’s plan to include COVID-19 vaccines fully approved by the U.S. Food and Drug Administration in the regular schedule of childhood vaccinations required for schools, though state law allows broad exemptions on religious, medical or philosophical grounds.
In a largely symbolic gesture, a majority of committee members voted against the rule, and a week later, Edwards announced it would take effect.
For now, that means only children 16 years and older will be required to be vaccinated against COVID-19 or provide an exemption letter for the 2022 school year. Kline said he supported the rule, as did Dr. Joseph Bocchini — a pediatric infectious disease specialist in Louisiana since 1977.
“There's no question that school mandates have been a critical component of the success of our immunization program in the United States,” Bocchini, also the vice-president of the Louisiana Chapter of the American Academy of Pediatrics, said.
But the meeting went beyond a discussion of the requirement. It included a lengthy presentation from Kennedy, complete with posters, alleging a slew of false claims about the COVID-19 vaccine. Kline was watching.
“The falsehoods were coming so quickly that even though I was making notes, I could barely keep up. It was like one a minute,” Kline said. “I just really thought it was embarrassing and shameful for our state.”
The presentation encapsulated how anti-vaccine activists raise objections and concerns whether there’s any basis for them or not, he said.
Kanter — who was called upon to testify nearly two hours into the meeting — said it was particularly concerning that Kennedy was given “center stage.” He said Kennedy’s presentation “cherry picked” data to give the appearance it was factual.
“If you look at this individual, and his track record, he has done the exact same thing for countless vaccines. He has been at the center of pieces of myths and misinformation on other vaccines that have really caused families harm,” Kanter said.
Kennedy is the founder of Children’s Health Defense, a group that promotes disinformation about vaccines and their ties to autism, among other things — claims vigorously rejected by the Centers for Disease Control and Prevention and the Autism Society of America, which states bluntly that “there has never been any credible scientific or medical evidence linking vaccinations with autism.”
During the committee hearing, the slides from Kennedy’s presentation were tweeted out by Health Freedom Louisiana. The private organization is the leading state-level organization fighting COVID-19 vaccine mandates and public health measures, including masks requirements.
Since the pandemic’s outbreak, the group has worked on a series of bills to restrict vaccine mandates and advanced unproven claims about vaccine safety in previous committee hearings. A review of its Facebook page shows its influence has been growing. It had 5,112 followers in August of 2020, and now has over 13,000. Health Freedom Louisiana did not respond to multiple requests for comment.
On Twitter, the group is pushing the hashtag #fireKanter, in reference to the state health officer.
The group has also re-tweeted Dr. Robert Malone, a scientist who helped create mRNA technology and has recently repeated misinformation about COVID vaccines, including that they could make infections worse.
Malone was also a guest of Landry’s at the committee hearing, and he wrote that he, Kennedy and Landry — the state’s most powerful Republican — have been strategizing over how to fight COVID-19 vaccine mandates.
“COVID has catalyzed the anti-vaccine, anti-science movement,” Kline said, who added that the movement has “become a central element of the anti-government movement.”
Kline said that creates a threat far beyond the immediate pandemic.
“This has got to be maybe the lowest point in modern history for American medicine and public health. I can't think of a lower point in our history,” he said.
Chatters said she tries to avoid the politicization of the vaccines.
“I want to have science-based conversations about the immunizations, and I want to answer really legitimate questions about the vaccines themselves,” she said.
She worries that including COVID-19 vaccines in the immunization schedule could decrease uptake for all childhood vaccination.
Kanter said it was too soon to tell whether or how much immunizations in general are being impacted by COVID skepticism, anti-vaccine activists and misinformation, particularly on social media.
But Chatters said she’s already seen evidence of waning uptake in other vaccines.
“I worry about that a great deal,” she said. “I can tell by the number of flu vaccines that I've given this year that that number is much less. And I'm attributing some of that to the conversations that people may be having around vaccines in general.”
