Dear President Biden,

Thank you for your continued efforts to end the COVID-19 pandemic, strengthen vaccine confidence, and improve vaccination rates throughout the United States. We appreciate that the American Rescue Plan Act of 2021 dedicates $1 billion to build vaccine confidence, support vaccine education, and improve vaccination rates for COVID-19 vaccines as well as other vaccine preventable diseases (Section 3002).

As the COVID-19 pandemic continues to afflict individuals, families, and communities across the country, there is newfound attention on the importance of vaccines as an effective preventive health measure.1 Vaccines have always been one of greatest public health achievements, but especially in the midst of the pandemic, where there is overlap between populations that are vulnerable to the COVID-19, and other vaccine preventable disease.

Unfortunately, as result of the pandemic, routine vaccination rates, across all ages, have plummeted–leaving communities vulnerable to preventable disease, illness, and outbreaks.2 Data indicate up to a 26% drop for MMR, DTap, and Polio vaccines between January and September of 2020.3 Another analysis found that adult and adolescent CDC recommended vaccines declined between 41%-53% from March-August 2019 as compared to March-August 2020.4 Weekly vaccination rates among Medicare beneficiaries also declined drastically (70%–89% below 2019 rates).5 Long-standing health disparities are also laid bare in these trends. For example, emerging data shows traditionally underserved populations, such as those who are insured through Medicaid, have not only seen the greatest decline in routine vaccination rates but are also are recovering at a slower rate compared to those with private insurance.6 Further, data indicate that 35% of Black Americans and 42% of Hispanic Americans report wanting to receive the COVID-19 compared to 53% of white Americans.7 Meanwhile, Black Americans and Hispanic Americans are proportionally receiving less COVID-19 vaccinations than their share of the total population.8 Additionally, data on Asian American, Native Hawaiian, and Pacific Islander (AANHPI) populations is currently lacking and needs to be included in all aspects of COVID and public health. 

Recognizing these concerning trends and challenges could have serious consequences for the future, threatening to reverse decades of progress in achieving vaccine equity,9,10 the American Rescue Plan Act of 2021 targets funds to build vaccine confidence, support vaccine education, and improve vaccination rates for COVID-19 vaccines as well as other vaccine preventable diseases. To ensure disparate communities do not become even more vulnerable to preventable illnesses, outbreaks and death11 we ask that you expand CDCs Vaccinate with Confidence campaign12 to include all age groups – children, adolescents and adults. A sustained federal effort aimed at improving trust in recommended vaccines across the lifecourse and the systems that administer them—is essential to overcoming vaccine hesitancy and increasing acceptance of vaccines.13,14 We specifically recommend:

• Building the trust that patients, their families, and providers have in recommended vaccines. This includes expand education and outreach, with a focus on sustained partnerships with trusted community messengers on the importance of recommended vaccines. This includes targeted vaccination campaigns to areas where people are least likely to be reached by traditional health care infrastructure and where there are known pockets of vaccine hesitancy. Furthermore, we urge CDC to expand upon community level grants and resources to enable local leaders to test and tailor proactive messages, while countering anti-vaccination sentiments.
• Building trust for providers who administer vaccines. Efforts must seek to simultaneously educate and inform healthcare professionals (HCPs) to ensure they make a strong recommendation to patients, in order to raise awareness among patients regarding the need to receive all ACIP-recommended vaccinations and the alternative vaccination locations that may be available to them.
• Helping communities understand and have confidence in the process and policies that lead to vaccine development, licensure or authorization, manufacturing, and recommendations for use.

Our country and public health infrastructure cannot afford to follow a pandemic with an increase in cases or large outbreaks of other vaccine preventable diseases. We are optimistic that this funding can support the ongoing work across the United States to not only recover from the pandemic but continue to protect our communities from vaccine preventable diseases and future outbreaks.