Boosting childhood vaccination rates amid a resurging pandemic

Routine pediatric immunizations are down worldwide. The World Health Organization and UNICEF reported that about 23 million children missed out on basic childhood vaccines last year—one more devastating side effect of the COVID-19 pandemic.

Here in the United States, where August is National Immunization Awareness Month, the Centers for Disease Control and Prevention (CDC) is sounding the alarm, too. In a recent report, the agency noted a substantial decrease in the number of routine childhood and adolescent vaccinations in 10 U.S. jurisdictions from March to May 2020 compared to the same period in 2018 and 2019.

Learn how to improve childhood vaccination rates with multi-channel engagement through Eliza, now part of Cotiviti's Consumer Engagement solution suite.

Read the fact sheet

The table below demonstrates the median percent change in the average weekly number of doses of the DTaP vaccine administered in some of the regions seeing the largest decreases.


Age <24 months

Age 2–6 years

New York City









Table 1. Median weekly percent change in DTaP doses for March–May 2020 compared to average during same period in 2018 and 2019. (Source: Centers for Disease Control and Prevention)

“This lag in catch-up vaccination might pose a serious public health threat that would result in vaccine-preventable disease outbreaks, especially in schools that have reopened for in-person learning.” — CDC Morbidity and Mortality Weekly Report, June 11, 2021

According to an infographic published by the Blue Cross Blue Shield Association’s The Health of AmericaSM initiative, the decrease in DTaP, MMR, and polio vaccines administered between January and September 2020 could total 26%, or an estimated 9 million doses missed for all of 2020.

This is no major surprise given that the country spent most of the year at home and many patients delayed preventive care. Vaccination rates improved when stay-at-home orders were lifted from June to September 2020, but not enough to catch up those children who missed appointments. This could pose a threat to public health, especially with schools resuming in-person learning this fall and cases of the highly contagious COVID-19 Delta variant surging.

How payers are taking action to improve immunization rates

For commercial and Medicaid payers, this problem could lead to not only decreased member wellness, but lower quality scores on measures such as Childhood Immunization Status (CIS) for annual HEDIS® reporting. Between Measurement Years 2019 and 2020, Cotiviti’s Quality Intelligence Medicaid clients experienced a 2% average decrease in CIS administrative rates, with some experiencing up to a 10% decrease. There is a strong likelihood this trend will continue in MY 2021 as the pandemic continues.

Here are four examples of healthcare payers taking steps to improve childhood immunization rates during the pandemic: 

  • Independence Blue Cross has been continually mining its claims data to identify members with missing immunizations and send reminders via text, email, or phone call
  • HealthPartners has added children-only appointment hours on Saturdays and communicated about its numerous safety measures to reassure parents that it’s safe to visit the clinic for a vaccine
  • In Kentucky, Anthem Blue Cross and Blue Shield partnered with other organizations to fund the “Raise Your Guard, KY” campaign, urging residents to get their scheduled immunizations as well as annual flu shots
  • Blue Cross and Blue Shield of Massachusetts partnered with the Massachusetts Association of Health Plans and other organizations to launch an awareness campaign to remind families to get pediatric vaccinations and flu shots

Beyond awareness campaigns and identifying at-risk members through claims data, however, health plans need access to robust member engagement tools versus a one-size-fits-all approach. The challenge is particularly acute for Medicaid plans, who serve populations that experience significant barriers to care outside of the pandemic, including transience, socioeconomic challenges, language and cultural differences, and untreated comorbidities. Reaching these members in the right place at the right time with the right message is critical.

The Eliza Consumer Health Management solution, now part of Cotiviti, offers healthcare organizations the ability to notify parents and guardians quickly and efficiently about vaccination gaps, provide important educational information, and even assess barriers to care.

With Eliza, Cotiviti clients have performed over 8 million immunization reminders in the last four years, realizing a relative 5.5% improvement in immunizations for engaged members compared to those not engaged. Prior to the pandemic, one large regional client reported a 30% improvement in childhood immunization rates with Eliza’s help. Download our Childhood Immunization Solution fact sheet to learn more.

Read the fact sheet

HEDIS® is a registered trademark of the National Committee for Quality Assurance (NCQA).


Jennifer Forster
Jennifer Forster joined the Cotiviti organization in 2014 as the director of Medicaid strategy and is responsible for developing and implementing Eliza’s Medicaid offerings and sales strategy. She previously worked for Tufts Health Plan where she served as the product director and operational contact for Tufts’ government-sponsored business. As the director of public partnerships, she led a team that supported contract management activities including compliance, reporting, communications, and negotiations.

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