Childhood Immunizations in United States

United States

Early childhood immunizations are a safe and cost-effective way of protecting children from potentially life-threatening preventable diseases early in life when they are most vulnerable. The success of vaccines in controlling many infectious diseases led the Centers for Disease Control and Prevention (CDC) to name vaccines one of the Ten Great Public Health Achievements of the 20th century.

In 1994, the Vaccines for Children Program expanded access to life-saving vaccines against childhood illnesses. A 2024 review of the program found that children born between 1994 and 2023 will, throughout their lifetimes, be spared 508 million cases of disease, 32 million hospitalizations and more than 1.1 million premature deaths due to vaccine-preventable diseases. These estimates translate to net savings of $540 billion in direct costs and $2.7 trillion in total societal costs.

According to the National Immunization Survey, the vaccination coverage among young children for the combined seven-vaccine series was lower among:

• Children living below the poverty level compared with those living at or above the poverty level. 
• American Indian/Alaska Native, Black and Hispanic children compared with Asian and white children.
• Uninsured children and children on Medicaid compared with privately insured children. 

The CDC supports immunization operations at the local, state and national levels through funding and initiatives such as the Vaccines for Children Program, which provides free vaccines to children whose health insurance does not cover them. The 2010 Affordable Care Act requires health insurance plans to cover preventive services, including immunizations, without charging deductibles, copayments or coinsurance. This legislation allows the Vaccines for Children Program to provide eligible children with access to vaccines at no cost through certain doctors. 

The Community Preventive Services Task Force's recommendations to increase vaccination rates include:

• Expanding home visiting services.
• Establishing vaccination programs and requirements in schools and child care centers.
• Increasing community demand for vaccinations through active outreach, tracking, education, incentives and case management as well as reminder and recall systems. 

The spread of misinformation about vaccine safety accelerated during the COVID-19 pandemic, causing a spike in opposition to state and school vaccine requirements. The Public Health Communications Collaborative has recommendations for providers, public health agencies and anyone else crafting messaging to promote routine childhood vaccinations in their community. These include:

• Emphasizing the individual health benefits of vaccinations.
• Keeping COVID-19 vaccination messaging separate from messaging about routine childhood vaccinations.
• Working with trusted community leaders and organizations to deliver accurate information regarding vaccinations.

Healthy People 2030 has several vaccination objectives focused on children, including reducing the proportion of children who get no recommended vaccinations by age 2.

Centers for Disease Control and Prevention. “Ten Great Public Health Achievements -- United States, 1900-1999.” MMWR. Morbidity and Mortality Weekly Report 48, no. 12 (April 2, 1999): 241–43. https://www.cdc.gov/mmwr/preview/mmwrhtml/00056796.htm.

Hill, Holly A., David Yankey, Laurie D. Elam-Evans, Michael Chen, and James A. Singleton. “Vaccination Coverage by Age 24 Months Among Children Born in 2019 and 2020 — National Immunization Survey-Child, United States, 2020–2022.” MMWR. Morbidity and Mortality Weekly Report 72, no. 44 (November 3, 2023): 1190–96. https://doi.org/10.15585/mmwr.mm7244a3.

Zhou, Fangjun, Tara C. Jatlaoui, Andrew J. Leidner, Rosalind J. Carter, Xiaoyu Dong, Jeanne M. Santoli, Shannon Stokley, Demetre C. Daskalakis, and Georgina Peacock. “Health and Economic Benefits of Routine Childhood Immunizations in the Era of the Vaccines for Children Program — United States, 1994–2023.” MMWR. Morbidity and Mortality Weekly Report 73, no. 31 (August 8, 2024): 682–85. https://doi.org/10.15585/mmwr.mm7331a2.