Improving Childhood Immunizations in Schools - A Case Study
Working with schools to improve immunization numbers and build community connections
Childhood immunizations are a key component of keeping our students healthy and in school! During the COVID-19 pandemic, rates for routine childhood immunizations dropped significantly. In the fall of 2023, the CDC released data showing that the kindergarten national vaccine coverage rate fell from 95% to 93% (with some states as low as 81% - yikes)! This information should worry every school administrator since we need AT LEAST 95% to achieve herd immunity! Many of these vaccine-preventable diseases require multi-week quarantine periods away from school for those unvaccinated individuals who become exposed. That’s a huge consequence for academics and school operations!
We all know that the flu and COVID-19 are no walk in the park - but throw measles, polio (or any other disease that is almost unheard of in the U.S. today), and you’ve got a recipe for outbreaks, A LOT of missed school, and most concerningly, very sick kids. I spent the better part of last year diving in with public charter schools in DC, where we turned the challenge of low vaccination rates into a success story. Was it a lot of work? Absolutely yes! Did they see amazing results? You bet!
How did they do it? Well, immunization rates are a complex problem that requires effective family engagement, data management, a team of folks on campus doing the work, and a clear point of contact in schools to set the priorities and lead the work (more on this later). One step, one student at a time – meeting families where they’re at. It’s not always a fast process, but one step and one immunization at a time, these fantastic education superheroes got the work done! Let’s walk through a few of the key lessons we picked up along the way.
Step 1: Start Early – Like, Really Early
Get a jumpstart months before the school year begins. Identify which students need vaccinations and reach out to their families early. Think of it as getting a head start on your homework so you're not cramming the night before. This gives parents plenty of time to finish those shots without feeling the last-minute panic. As a side note, remember, once you set a deadline for families, don’t change it! Keeping things consistent and visible from day one, brokers trust and empowers families to take action and support the process. BUT, keep in mind that many families are super busy and work on short turnaround times and quick deadlines, so even while it’s important to start communicating early, it’s also important to keep communication clear, direct, and ongoing for those families who will get the shots taken care of right before the deadline.
Step 2: Communicate Directly, Clearly and Ongoing
Go all out with communication. Don’t just send one letter and hope for the best. Send letters, emails, texts, and even the school’s social media channels. Schools that excelled at this tell me they followed each email home to a family with a phone call or face-to-face conversation. Schools also held immunization education sessions where healthcare pros could answer questions and bust myths about vaccinations.
Step 3: Make it Personal
Understanding that every family is unique, school nurses and administrators took a personalized approach. They had one-on-one meetings with parents to discuss their specific needs. This wasn't a one-size-fits-all deal—it was custom-made care and attention. Just like educators know that differentiated instruction works for students, families also have unique barriers to getting their kids’ shots up to date, and connecting with these families to help them navigate their barriers is essential. Yes, this takes staff time to do, but so does calling families to tell them their kids need to stay home for three weeks because of a measles outbreak. So, put in the work now, and let your school avoid a vaccine-preventable outbreak later on!
Step 4: Convenience is Key
To make getting vaccinated easy, the schools set up on-site vaccination clinics on campus. These clinics were like pop-up shops for health, open at different times, during and after school. And DC also offered weekday and weekend clinics in the community for families to access. Ideally, everyone has a medical home – a pediatrician – who is providing all vaccines, but we know that it's sometimes easier for families to access community clinics and get all their kids up to date with one visit!
The Mantra: One Step, One Student at a Time
The secret sauce? Their commitment to this mantra – one step at a time, one student at a time, one deadline at a time. This approach was all about steady progress and individual attention. By focusing on the next key milestone and focusing attention on each student and their family, the schools could offer the right support and make a real impact.
And finally, 7 Key Steps to Immunization Compliance
The steps above are absolutely essential to effectively engaging your families towards improving your school’s childhood immunization rates, but wait, there’s more! Behind the curtain, so much work happens to achieve success, and here are seven key steps to success:
Effectively use all available resources
Work as a team within the school
Provide consistent/persistent/creative family engagement “I mean what I mean.”
Prioritize ongoing, regular data entry into your immunization registry
Ensure ongoing, regular data tracking of individual, grade-level compliance rates
Share and celebrate progress/wins along the way
Enforce student exclusion (and welcome them back AS SOON as they get their needed shots)
DC asked schools to prioritize key grades for attention and focus and possible exclusion from school if they didn’t get their immunizations up to date. And this focus paid off! By the date that families needed to complete all immunizations or risk exclusion from school, childhood immunization rates had shot up, schools that had put in the time and effort had very few students at risk for exclusion, and they made their schools a safer place for everyone. Their proactive, personalized approach didn't just improve health—it also strengthened the bond between the schools and their communities.