By Savannah Tryens-Fernandes & Ramsey Archibald
Vaccination rates for Alabama’s youngest residents have fallen dramatically since the COVID-19 pandemic. And that’s especially true when it comes to the vaccine for polio.
The state’s infants and toddlers are falling short of thresholds needed to fight off all-but-eradicated diseases, such as measles, according to data from the Centers for Disease Control and Prevention and the Alabama Department of Public Health.
“Anytime vaccine rates are coming down, it creates the opportunity for these diseases to re-emerge in the population,” said Wes Stubblefield, a pediatrician and medical officer at ADPH.
Statewide, the vaccination rate for children between 19 and 47 months plunged from around 71% in October 2021 to just 65% last November, the last date for which monthly data was available from ADPH. That’s about 13,700 more unvaccinated toddlers in the state than just two years ago.
Vaccination rates for Alabama toddlers fell
Vaccination rates for Alabama kids between 19 and 47 months fell more than five percentage points in less than two years.
Source: Alabama Department of Public Health • Chart: Ramsey Archibald
Federal data looks at different ages, but paints a similar picture of a growing rejection of immunizations in Alabama. Just 65.5% of 35-month-old kids born in 2021 received all their recommended vaccines. That’s down from 82.5% for kids born in 2017.
Routine, recommended vaccines include immunizations against hepatitis, polio, measles, chickenpox, diphtheria, tetanus and pertussis, pneumococcal disease and Haemophilus influenzae.
No vaccination saw its uptake fall faster or in more places than the IPV vaccine, which prevents polio. That vaccine series fell more than any other in just over half of Alabama counties, and saw the biggest overall decline in the state.
Kids are meant to complete their primary series of vaccines by 47 months, though there are additional booster shots that are scheduled for 4-6 year olds.
“I’m probably one of the last physicians still practicing in Alabama that has actually ever seen a true case of measles,” said Karen Landers, a pediatrician and the chief medical officer at ADPH. “These children suffered terribly from these illnesses. Some of them died, and we just don’t see that anymore.”
She said she wants to see the state reach a total vaccination rate of 95%.
But Alabama is not alone in heading the other direction, as many states are recording declines. Alabama now ranks 10th lowest in the nation for full vaccination rate for children born in 2021.
And vaccine rates vary widely in the state. Some counties within Alabama saw more than 20-point drops in vaccination rates for specific types of shots in the last few years.
In two Alabama counties, Barbour and Blount, fewer than half of toddlers were considered fully up-to-date on their immunizations.
“We feel far removed from these diseases because we’ve eradicated them,” Landers added. “But they can come back, and they can come back with a vengeance if we don’t use the tools we have, such as vaccines,” she said.
Last year, doctors warned against the decline in the rate of vaccination against measles, mumps and rubella in the state, saying rates were too low to prevent outbreaks. For example, the threshold for achieving herd immunity against measles is 95%. But the rate of vaccination in Alabama for kids under 4 was only 77%.
“We are nervous, very nervous, that we may have a measles outbreak across the country,” said David Kimberlin, co-director of UAB and Children’s Division of Pediatric Infectious Diseases, during a press conference last February. “We have been fearful for quite some time that we will start to see a resurgence of vaccine-preventable diseases.”
“We feel far removed from these diseases because we’ve eradicated them,” Landers added. “But they can come back, and they can come back with a vengeance if we don’t use the tools we have, such as vaccines,” she said.
Last year, doctors warned against the decline in the rate of vaccination against measles, mumps and rubella in the state, saying rates were too low to prevent outbreaks. For example, the threshold for achieving herd immunity against measles is 95%. But the rate of vaccination in Alabama for kids under 4 was only 77%.
“We are nervous, very nervous, that we may have a measles outbreak across the country,” said David Kimberlin, co-director of UAB and Children’s Division of Pediatric Infectious Diseases, during a press conference last February. “We have been fearful for quite some time that we will start to see a resurgence of vaccine-preventable diseases.”
President Donald Trump’s nominee for Human and Health Services Secretary, Robert F. Kennedy Jr., is known for his vaccine skepticism, though on Tuesday he told lawmakers he wouldn’t take away any vaccines.
According to Politico, Kennedy has convinced some Republican senators that he’s reconsidered his previous beliefs that the measles vaccine can cause autism and the polio vaccine can be more fatal than the disease, and is now “pro-vaccine safety.”
Alabama Republican Sen. Tommy Tuberville, who in December indicated support for Kennedy’s skepticism, calling his stance “a breath of fresh air,” told reporters this week “I don’t keep up with all that” when asked again if he had any concerns about Kennedy’s past criticisms of vaccines.
Doctors have said they are concerned about the impact Kennedy could have on already declining immunization rates if confirmed to lead the agency.
“As pediatricians,” the American Academy of Pediatrics said in a statement after Trump nominated Kennedy, “we firmly believe the most effective way for HHS to ensure the future health of our nation is to protect and support the health of our children: by ensuring that science continues to underpin all decision-making, policies and programs.”
In a little more than half of the counties in Alabama, every type of vaccine declined. The polio vaccine was the fastest-shrinking in more than half.
The first two doses of DTap and Hib vaccines are administered at the same time as the immunization for polio – at two months, then again at four months. Those each went down 5 percentage points in the last few years in Alabama, but polio dropped by 8 points.
“We’ve got to stick to what we know and believe in science that has been established, which shows the safety of vaccines and that vaccinating our children is the best way to keep our children healthy, our communities, our state, our country healthy as a whole,” said Brittney Anderson, a family medicine physician in Demopolis, a city west of Montgomery in the Black Belt.
‘Vaccinations are safe’
One bright spot was the Black Belt region. That area, which spans the length of the state in a crescent from just south of Tuscaloosa to the south of Auburn, was home to some of the lowest vaccination rates in the state in 2021.
Change in vaccination rate for children 19-47 months
Change from January 2021 to November 2024.
Three Black Belt counties were below 50% in 2021 — Dallas, Perry and Russell. But as the state overall saw a drop, all three of those counties climbed significantly, seeing double-digit percentage point increases in vaccination rates for toddlers. Perry and Dallas counties led the state in increased vaccination rates, with 17.1 and 16.6 percentage point jumps, respectively.
Anderson, the family medicine physician in the Black Belt, said doctors in the region have established strong relationships with their patients.
“There’s a level of trust there that probably lends more to patients and parents of those patients believing their physicians when they tell them that vaccinations are safe,” Anderson said.
She said she routinely has conversations with parents about vaccines, adding that part of her job as a doctor is educating patients about their health. According to Anderson, the best thing you can do when faced with hesitancy is answer every question a parent has.
“One of the things that I ask of our parents is that they trust our training and trust our experience — if you don’t trust me when I say that your child needs to have these vaccinations, then do you trust me if I tell you your child has an ear infection or stomach virus?”
