AAP Voices Blog

Putting Vaccine Accessibility in Motion

Earlier this year, a single mother who escaped domestic violence relocated with her two small children to a women’s shelter in Phoenix, where I practice. It was aboard our 40 -foot mobile medical clinic that I met this struggling family. Because of barriers to health care, this was the first opportunity for a well child check they’ve had in years. This clinic-on-wheels provided comprehensive care for her children, including vision and hearing screenings, routine lab testing and blood work, connection to social workers and resources, full physical examination, and of equal importance, administration of life-saving vaccines made available through the federally funded Vaccines for Children program. Truly a one-stop-shop. Families with similar stories are more common than some may think. I see them every day in my clinics. As rents rise and affordable housing becomes scarcer, thousands of children are losing regular access to medical care including vaccines.  

For many families experiencing homelessness or fleeing desperate social situations, the ability to get their children vaccinated doesn’t come as easy as it does for many of us. Most of my patients do not have transportation, and many do not have any health insurance. Without transportation, families who lack stable housing are at the mercy of navigating a confusing and slow public transportation system, with their young children in tow, just to get to a clinic. For those without any health insurance, the options for medical care are few and far between. I’m finding not only are they experiencing these tangible obstacles, but they are also vulnerable to the vaccine misinformation that has rapidly spread. And sadly, mistrust in the health care system can be high based on the few medical encounters they have had in the past. 

In these circumstances, it should be our responsibility as providers to work toward breaking down these barriers and improving health equity through innovation and creating pathways for more accessible vaccines for these populations. While having a mobile medical clinic is not feasible for every organization, there are several approaches that we use that can be used in many settings to help bridge the vaccination gaps.

“Some parents cannot get past their daily hurdles to make it to clinics for scheduled appointments, but are able to get their children quickly caught-up on vaccinations when we meet them at places they already frequent.”

A strategy that our clinic adopted is organizing vaccine “pop-up clinics.” They are well-advertised to the identified community, and with extra staff recruited to help, patients can pop in for a vaccination. I’m always impressed with how efficiently we can vaccinate a patient population. We have held these at our established clinic sites, but they are more successful when we can bring these pop-up clinics to schools and child care centers. Some parents cannot get past their daily hurdles to make it to clinics for scheduled appointments, but are able to get their children quickly caught-up on vaccinations when we meet them at places they already frequent.

Across various populations, families have lost touch with their pediatrician, especially due to the pandemic. Whether the vaccine pop-up clinic is on- or off-site, it is a great way to open the door of getting them back into health care. Although our ideal is to pair vaccinations in the context of a full well visit, this is a chance to establish a relationship of trust, and ultimately have them return for ongoing care. Our clinics also offer vaccines for older siblings or young parents through the Vaccines for Adults program (ages 19 and older). We find frequently that this age group has also missed many recommended vaccinations such as HPV, Meningitis B, and COVID-19. More practices should consider being part of these federally funded vaccination programs that cover vaccinations for those without insurance or Medicaid.

The families that we serve are often transient, living from shelter to shelter, on the streets, or couch-surfing. This was the impetus for us to take every opportunity with a child as a chance to check their vaccination history. A child may have missed their annual visits but will often come in for health concerns such as a rash or allergies. Implementing this means that we systematically check immunization registry records with every type of visit and take a few moments to review and educate parents. They may come in for a snotty nose but leave with protection against serious diseases. It does add time to each visit, but the return on this investment is great. Those few extra minutes to the routine are worth it if it means reaching our common goal of protecting children from vaccine-preventable illnesses and decreasing vaccine disparities.  

Pediatricians will be called on increasingly to think out of box to help kids get vaccinated. The efforts are effective for patient wellness and public health. It is also extremely rewarding from a personal standpoint. Sometimes it takes the humbled mindset of placing yourself in the shoes of the families you care for to achieve the best possible health for all children.