Among children born in 2020, vaccination coverage was 4 to 14 percentage points lower among those who were eligible for VFC versus non-eligible children.
Established in 1994, the Vaccines for Children (VFC) program has been helping ensure that all children in the United States are protected from life-threatening vaccine-preventable diseases at no cost to eligible children. Since its inception and among children born from 1994 to 2023, the VFC program "will have prevented approximately 508 million illnesses and 1,129,000 deaths, saving nearly $2.7 trillion in societal costs," according to a new Vital Signs edition of the Centers for Disease Control and Prevention's (CDC) Morbidity and Mortality Weekly Report (MMWR).1
The program was created after a measles epidemic that occurred from 1989 to 1991, which resulted in tens of thousands of cases and hundreds of death, according to the CDC. The federal agency stated that when the epidemic was investigated, cost of the vaccine was found to be a primary reason for children going unvaccinated, prompting a response by Congress to pass the Omnibus Budget Reconciliation Act and the creation of the VFC.2
In the MMWR report, the CDC analyzed data from the National Immunization Survey-Child (NIS-Child) from 2012 to 2022, evaluating vaccination coverage trends with ≥1 dose of measles, mumps, and rubella vaccine (MMR), 2–3 doses of rotavirus vaccine, and a combined 7-vaccine series, by VFC program eligibility status, and to examine differences in coverage among VFC-eligible children by sociodemographic characteristics.1
"NIS-Child is a nationally representative household survey that monitors coverage with Advisory Committee on Immunization Practices (ACIP)–recommended vaccines among children aged 19–35 months in the 50 states, the District of Columbia, and some U.S. territories using a random-digit–dial telephone sampling frame," explained the study authors. "With consent, parent-identified providers receive mailed immunization history questionnaires and are asked to provide information on vaccination types, doses, and dates administered and administrative data."1
For 2012 to 2022 NIC-Child surveys, the overall household response rates ranged from 21.1% to 42.5%. Overall, the sample size resulted in 152,915 children. Children were VFC-eligible if they met 1 of the following criteria1:
According to the study authors, percentage point differences in vaccination coverage among VFC-eligible and non-VFC-eligible children were calculated using Z-tests to evaluate the gap in coverage by program eligibility status. Estimates of vaccination coverage with the previously-mentioned vaccines were stratified by the child's race and ethnicity, health insurance status, urbanicity, and household income.1
Fifty-two percent of children aged 19 to 35 months who were born between 2011 and 2020 were VFC eligible. Of those born in 2020, 93.4% were Medicaid-insured, 7.4% were AI/AN, 43.7% lived in households with income below the federal poverty level, and 48.1% lived in a metropolitan statistical area (MSA) principal city. From 2011 to 2020, the proportion of VFC-eligible children who were uninsured decreased from 8.1% to 3.1%, respectively.1
From 2011 to 2020, among VFC-eligible children, coverage at 24 months was considered stable for ≥1 MMR dose, between 88.0% and 89.9%. Coverage for the combined 7-vaccine series was 61.4% to 65.3%. By 8 months of age, vaccination coverage was 64.8% to 71.1% and increased by an average of 0.7 percentage points annually.1
For children born in 2020, coverage was lower among each vaccination group among VFC-eligible children compared to non-VFC-eligible children. Coverage for ≥1 MMR dose was 3.8 percentage points lower, 2 to 3 doses of rotavirus vaccine was 11.5 percentage points lower, and the combined 7-series vaccination was 13.8 points lower among VFC-eligible than among non–VFC-eligible children, respectively.1
Of children born in 2020, all 3 vaccination coverage measures were lower among VFC-eligible children compared to non-VFC-eligible children who were1:
"Although the VFC program has played a vital role in increasing and maintaining high levels of childhood vaccination coverage for 30 years, gaps remain," stated the authors. "Enhanced efforts must ensure that parents and guardians of VFC-eligible children are aware of, have confidence in, and are able to obtain all recommended vaccines for their children.
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