Subcommittee on COVID & Infectious Diseases

Feb 29, 2024

·

01:00 PM

1 hr 2 min

A hearing on declining childhood vaccination rates in New York City, focusing on the impact of the COVID-19 pandemic on routine immunizations among kindergarten children, the resurgence of diseases s… Show More A hearing on declining childhood vaccination rates in New York City, focusing on the impact of the COVID-19 pandemic on routine immunizations among kindergarten children, the resurgence of diseases such as measles, and efforts to boost HPV vaccination coverage. Discussions include strategies for increasing vaccination access and compliance, the importance of vaccinations for public health and social justice, and addressing disparities in vaccine coverage. Features testimony from the Department of Health and Mental Hygiene (DOHMH) and the public. Show Less

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REMARKS

# Francisco Moya's opening remarks on children's health and vaccination

0:00:36

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4 min

Council Member Francisco Moya shares insights on the impacts of COVID-19 pandemic on children's vaccination rates and the resurgence of measles among unvaccinated individuals, emphasizing public health and social justice.

  • Moya highlights the decline in vaccination rates among kindergarten children since the COVID-19 pandemic began, with coverage falling below the 'Healthy People 2030' target.
  • He discusses the resurgence of measles outbreaks due to misinformation and the challenges in vaccine access, mentioning NYC as one of the epicenters in 2019.
  • Moya points out the social justice aspect of vaccinations, emphasizing the need to support vulnerable children, including refugees and asylum seekers.
  • He acknowledges colleagues, thanks the committee staff, and underscores the importance of collective action to fulfill our moral obligation of care.

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REMARKS

# Lynn Schulman's opening remarks (delivered by Carmen De La Rosa) on declining childhood vaccination rates

0:04:44

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3 min

Council Member Carmen De La Rosa delivers Council Member Lynn Schulman's opening remarks.

Council Member Schulman champions addressing the issue of declining childhood vaccination rates in New York City during the Committee on Health meeting.

  • Talks about the significant drop in vaccination rates among children ages 19 to 35 months, not returning to pre-pandemic levels.
  • Cites the COVID-19 pandemic, a decrease in birth rates, and inaccuracies in census estimates as key factors contributing to the decline.
  • Highlights a commitment to support childhood vaccination efforts and discusses strategies for vaccinating asylum seekers.
  • Emphasizes the need to address disparities and inequities in vaccine coverage among marginalized communities.
  • Concludes by thanking the Department of Health and Mental Hygiene (DOHMH) and her staff for their role in this public health effort.

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TESTIMONY

# Dr. Celia Quinn on Childhood Vaccination Programs and Efforts in New York City

0:08:49

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9 min

Dr. Celia Quinn discusses New York City's comprehensive childhood vaccination programs, emphasizing their importance and detailing efforts to enhance vaccine access and compliance.

  • Dr. Quinn stresses the critical role of vaccinations in protecting against numerous diseases, including hepatitis B, diphtheria, and HPV.
  • Highlights the utilization of the Citywide Immunization Registry (CIR) for surveillance, reporting, and guiding vaccination strategies.
  • Outlines various vaccine access channels, such as the Vaccines for Children program and school-based health centers.
  • Discusses the impact of the COVID-19 pandemic on vaccination rates among children and the efforts to recover these rates.
  • Advocates for increased HPV vaccination coverage and underscores the role of healthcare providers in encouraging vaccination compliance.

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QUESTION

# What vaccinations are required for children to enroll in pre-K in New York City, and what are the medical conditions that qualify for a vaccination exemption?

0:18:49

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100 sec

In New York City, children enrolling in daycare, pre-K, and school must have several vaccinations, with specific exemptions for medical conditions.

  • Required vaccinations include DTP/DTaP (Diphtheria, tetanus, and pertussis), MMR (measles, mumps, and rubella), Hepatitis B, polio, and varicella. Additionally, Hib and PCV are needed for daycare and pre-K enrollees.
  • Medical exemptions are rare but can be granted for severe allergic reactions to a vaccine dose or severe immunocompromise.
  • Medical exemptions are temporary, only valid for a year, thus requiring annual renewal.
  • Religious exemptions for vaccinations are not allowed in New York State as of June 13, 2019.

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QUESTION

# What is the importance of the MMR vaccine and the diseases it protects against?

0:20:29

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28 sec

The MMR vaccine is vital for preventing outbreaks of measles, mumps, and rubella.

  • Protects against measles, mumps, and rubella
  • Helps in achieving high levels of coverage essential for preventing measles outbreaks
  • Measles virus is extremely infectious, necessitating widespread vaccine coverage

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QUESTION

# What is the importance of the 95% measles vaccination target for achieving herd immunity?

0:20:58

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89 sec

Dr. Celia Quinn explains that achieving the 95% vaccination rate for measles is crucial for preventing its spread and protecting vulnerable community members.

  • Communities need a specific level of vaccination to prevent disease spread and protect unvaccinable members.
  • The required vaccination rate varies by disease; measles requires at least 95% coverage to achieve herd immunity.
  • Lower vaccination rates increase the risk of outbreaks, particularly in places like New York City that have high travel activity.
  • High vaccination coverage is essential for preventing disease introduction and spread in densely populated and high-mobility areas.

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QUESTION

# Why is it important for young children in New York to receive the MMR vaccine, and what is the significance of the 75% immunization target?

0:22:30

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115 sec

Dr. Celia Quinn explains the importance of the 75% target for the 7 vaccine series for children 6 to 35 months old to prevent vaccine-preventable diseases.

  • The 75% target refers to the proportion of two-year-olds who are up to date on the entire 7 vaccine series, not just the MMR vaccine.
  • Children between 6 to 35 months need multiple vaccine doses within this period, requiring various healthcare visits.
  • Challenges in accessing care can affect the ability of parents to keep their children's immunizations up to date.
  • Following the ACIP guidance early in life protects children when they are most vulnerable to vaccine-preventable diseases.

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QUESTION

# What is the importance of the DTaP vaccine, and how does it differ from the Tdap vaccine?

0:24:25

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53 sec

The DTaP and Tdap vaccines protect against diphtheria, tetanus, and pertussis, with DTaP used in younger children and Tdap as a booster for individuals ten and older.

  • Both DTaP and Tdap vaccines offer protection against the same diseases: diphtheria, tetanus, and pertussis.
  • DTaP vaccine is administered to younger children to provide initial immunity.
  • Tdap vaccine serves as a booster dose, recommended for individuals aged ten and older.
  • The difference between DTaP and Tdap relates to the intended age groups and the immunity needs at different life stages.

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QUESTION

# What diseases must healthcare providers report, and what actions does the DOHMH take after reporting?

0:25:47

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46 sec

Healthcare providers are required to report over 90 diseases and conditions to the DOHMH, which uses the data to track, control, and prevent disease.

  • Over 90 diseases and conditions must be reported, as per the New York City health code.
  • Not all reported diseases are vaccine preventable.
  • The DOHMH uses surveillance information to track trends of diseases.
  • Immediate actions are taken in response to cases or outbreaks based on the data collected.

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QUESTION

# Does the Department of Health and Mental Hygiene anticipate stabilization or increase in vaccination rates?

0:26:33

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49 sec

The Department of Health and Mental Hygiene (DOHMH) has noted progress toward pre-pandemic vaccination levels but acknowledges that targets are not being met, particularly for young New Yorkers.

  • Vaccination rates are increasing towards pre-pandemic levels of 2019.
  • Goals and targets set for vaccination rates are still not being met, especially for young New Yorkers.
  • DOHMH is intensifying efforts to coordinate healthcare providers, school systems, parents, and communities.
  • The aim is to ensure the highest level of protection through vaccination for young children.

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QUESTION

# What agencies are involved and how quickly are asylum-seeking children vaccinated?

0:27:33

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119 sec

The Department of Health And Mental Hygiene (DOHMH) collaborates with the Department of Education and other city agencies to ensure newly arrived asylum-seeking children receive vaccinations, including the MMR vaccine, and comprehensive care as needed.

  • DOHMH works closely with the Department of Education, Health and Hospitals, the Mayor's Office, DHS, and agencies involved in sheltering to provide vaccine-preventable disease expertise.
  • At accommodations sites, efforts are made to help families find nearby clinics for healthcare, ensuring children not only get vaccinated but also have their vaccinations documented for school.
  • In certain shelters, vaccinations might be available onsite, while Health and Hospitals can provide more detailed information.
  • The city-wide immunization registry does not collect information about immigration status, making it challenging to specify vaccination timing relative to arrival.

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QUESTION

# What are the school attendance rules for children not fully vaccinated in NYC?

0:29:35

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44 sec

Children in New York City must start their vaccine series to attend school but are not excluded if they are in the process of completing it.

  • Children attending school must receive the required vaccines but are not excluded if they have begun the vaccination process.
  • The vaccination series may take months to complete, but starting the process ensures the child can attend school.
  • Children coming from out of state or living in temporary shelters must start their vaccine series within 90 days of enrollment.

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QUESTION

# How are child vaccination records tracked and shared among schools in New York City?

0:30:19

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82 sec

New York City utilizes a robust citywide immunization registry to track and share vaccination records among schools, ensuring children are vaccinated as per requirements.

  • The Department of Education (DOE) monitors school vaccination requirements compliance through their system.
  • All vaccines administered in the city are recorded in the citywide immunization registry, accessible by the DOE to verify a child's vaccination status.
  • Vaccination records from outside the city can be manually entered into the registry by healthcare providers.
  • The registry is accessible to any provider in the city, and individuals can retrieve their or their children’s vaccination records online.
  • The system promotes transparency and accessibility, making it easy for families to check vaccination records through the 'my vaccine record' online feature.

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QUESTION

# Is there a way to test if asylum seekers and their children have been vaccinated?

0:31:45

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64 sec

The New York City Department of Health and Mental Hygiene indicates blood tests can confirm a child's vaccination status.

  • Blood tests or serologic tests can be used to determine immunity to vaccines, serving as proof of immunity similar to vaccine administration records.
  • When documentation is unavailable, it may take time for serologic test results to return, complicating matters especially for populations that move frequently.
  • As a standard practice, it's recommended to administer a vaccine instead of waiting for serologic test results, deemed safe and more practical for mobile populations.

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QUESTION

# Is revaccination for pertussis necessary for teenagers and adults who received it in childhood?

0:33:34

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47 sec

Revaccination for pertussis (whooping cough) in adults and teenagers is recommended, dependent on individual circumstances and time since the last vaccination.

  • Dr. Celia Quinn confirms that pertussis cases still occur, mainly in individuals not fully vaccinated or those whose last vaccination was a long time ago.
  • Pertussis was once a widespread childhood disease and remains a serious condition.
  • Adults and teenagers may require booster shots, but it is essential to consult with a primary care provider for personalized guidance.
  • The timing between boosters varies by individual, emphasizing the need for medical advice.

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QUESTION

# How are vaccines tracked for adults in New York City?

0:34:21

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60 sec

Vaccines for individuals over 18 in New York City require patient consent to be reported, differing from the mandate for reporting vaccinations in children.

  • Vaccines administered to individuals 18 and under must be reported to the Citywide Immunization Registry (CIR).
  • Adults must provide consent for their vaccination records to be included in the CIR.
  • There is no requirement for adult vaccinations to be reported to the CIR without patient consent.
  • Adults can track their vaccination records through 'my vaccine record' if their provider reports to the CIR and they have given consent.
  • Tracking of adult vaccine doses is limited due to the consent requirement, affecting the ability to recall patients without vaccination records.

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QUESTION

# What caused the measles outbreak in NYC in 2019?

0:35:41

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51 sec

Delayed vaccination and increased contact among young children in specific neighborhoods contributed to the 2019 measles outbreak.

  • The outbreak occurred in 2019, with a total of 649 cases reported.
  • Contributing factors included delayed vaccination in very young children and high contact rates in certain neighborhoods.
  • Travel introducing measles into communities with low vaccination coverage was another significant factor.
  • The outbreak was declared over by September 2019.

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QUESTION

# How many migrant children in school are fully vaccinated?

0:36:33

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35 sec

DOHMH cannot provide specific vaccination data on migrant children due to policy restrictions on inquiring about immigration status.

  • DOHMH's policy prohibits asking about immigration status for those receiving services.
  • Specific vaccination statuses of migrant children are not tracked in the City Immunization Registry (CIR).
  • The department has general data on overall school compliance with vaccination requirements, but not specific to migrant children.

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QUESTION

# What is the current student vaccine compliance rate in NYC schools?

0:37:12

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36 sec

95.3% of students in NYC public and charter schools are in compliance with vaccination requirements.

  • The compliance rate is for students attending grades pre-K through 12.
  • The reported rate is as of earlier this week, similar to the rate at the end of last year.
  • Prior to the COVID pandemic, the compliance rate was higher, at 98.5%.
  • The decrease in compliance is attributed to issues discussed during the hearing.

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QUESTION

# What insurance and access to healthcare are provided to asylum seekers and migrants in New York City?

0:37:49

·

53 sec

Asylum seekers and migrants may be eligible for various healthcare programs depending on their immigration status, including free vaccinations for children under the federal Vaccines for Children program.

  • Eligibility for health programs varies with immigration status.
  • The federal Vaccines for Children program is key for providing free childhood vaccinations.
  • Children eligible for Medicaid, uninsured or underinsured, Native American or Alaskan Native, or enrolled in Child Health Plus B can receive free vaccinations.
  • Approximately 75% of New York City children are eligible for this program, with 1300 participating providers.

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QUESTION

# Why are newborns vaccinated for hepatitis B if the risk and mother's status are negative?

0:39:03

·

34 sec

The vaccination of newborns for hepatitis B is a longstanding ACIP recommendation to protect against unknown diagnoses and provide lifelong protection.

  • The Advisory Committee on Immunization Practices (ACIP) advises on this preventive measure.
  • The aim is to protect children right from birth regardless of the mother's hepatitis B status.
  • This approach ensures protection throughout life against hepatitis B.
  • The practice addresses the possibility of unknown hepatitis B diagnoses at birth.

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QUESTION

# Do hospitals test mothers for hepatitis B during childbirth, and is there a full panel test?

0:39:38

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28 sec

Hospitals' testing for hepatitis B during childbirth varies based on provider recommendations and the individual's risk factors, not as part of standard vaccine guidelines.

  • Testing practices for hepatitis B at the time of childbirth are dependent on the healthcare provider and the mother's risk factors.
  • The primary goal is to eliminate neonatal transmission of hepatitis B.
  • The American Academy of Pediatrics (ASAP) recommends measures to prevent neonatal transmission of hepatitis B.
  • Standard vaccine guidelines do not include mandatory testing for hepatitis B for mothers in hospitals during childbirth.

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QUESTION

# Why is the HPV vaccine recommended at age 13 despite the legality of sexual activity for those under 18?

0:40:07

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31 sec

Dr. Celia Quinn highlights that the recommendation for children to complete the HPV vaccine series by age 13 is to ensure full coverage against HPV well before potential exposure.

  • The HPV vaccine series can start as young as age 9.
  • Completing the series by age 13 ensures protection against HPV.
  • The goal is to provide full coverage long before children might be exposed to HPV.

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QUESTION

# Is the Department of Health and Mental Hygiene (DOHMH) utilizing reminder systems for immunization?

0:40:48

·

69 sec

The Department of Health and Mental Hygiene (DOHMH) occasionally uses reminder systems through the Citywide Immunization Registry (CIR), but primarily promotes providers' use of these tools for patient recalls.

  • The American Academy of Pediatrics recommends reminder or recall systems to enhance immunization rates.
  • DOHMH acknowledges the effectiveness of reminders coming directly from providers than the health department.
  • Despite low immunization rates, DOHMH uses the CIR for direct outreach sparingly, favoring provider-initiated contact.
  • Council Member Julie Menin suggests considering additional outreach methods due to persistently low immunization numbers.

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QUESTION

# What roles do other city agencies play in supporting the Department of Health and Mental Hygiene (DOHMH) with immunization vaccine outreach?

0:41:59

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56 sec

Dr. Celia Quinn highlights the partnership with the Department of Education (DOE) as a critical component in vaccine outreach, especially for childhood vaccines.

  • The Department of Education (DOE) works closely with the DOHMH to disseminate vaccine information through schools.
  • Information about vaccines and vaccine requirements is distributed through backpack letters.
  • This partnership is specifically important for childhood vaccines.
  • Council Member Julie Menin emphasizes the need for a wide-reaching, multiagency approach to vaccine outreach.

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QUESTION

# What are the reasons behind the decline in vaccination rates and the stance of parents on this issue?

0:43:00

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87 sec

Dr. Celia Quinn explains that misinformation, disinformation, access barriers, and various other factors contribute to the decline in vaccination rates.

  • Misinformation and disinformation have accelerated during the pandemic, affecting parents' decisions on vaccinations.
  • Access issues and barriers make it difficult for parents to prioritize vaccinations on the recommended schedule.
  • In New York City, religious exemptions are not allowed, and all medical exemptions must be reviewed by the health department.
  • The medical exemption rate in New York City is only 0.01%.

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QUESTION

# Why have vaccination rates not fully recovered post-pandemic, especially among young children?

0:44:31

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60 sec

Dr. Celia Quinn explains that a combination of factors led to the delay in vaccination rates post-pandemic, particularly among four to six-year-olds.

  • The most significant gap in vaccination rates is found among children aged four to six, who were infants to three years old during the pandemic's peak.
  • There were considerable barriers to vaccine access during the pandemic, which have since been somewhat addressed for the 0 to 2 age group, allowing their rates to improve.
  • However, four to six-year-olds still face challenges in accessing the full catch-up vaccination schedule.
  • As vaccinations become required for entry into pre-K and kindergarten, it is expected that these rates will improve, helping to close the gap.

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QUESTION

# How are unvaccinated school-age children and their families handled by DOHMH and DOE?

0:45:36

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46 sec

Children not complying with school vaccination requirements may be required to leave school.

  • Dr. Celia Quinn, Deputy Commissioner, explains that the Department of Education handles the specific procedure for non-compliant children.
  • Quinn also mentions efforts to educate families about vaccination requirements and help them access care.
  • Federally qualified health centers and community providers are identified to assist families in catching up with vaccinations.
  • Assistance is provided in ensuring families receive the necessary documentation to allow children to stay in school.

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QUESTION

# What happened to the vaccination buses for migrant camps, and is there a reduction in vaccination activities?

0:46:22

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29 sec

Dr. Celia Quinn clarifies that the Department of Health And Mental Hygiene does not oversee vaccination programs at migrant camps and advises consulting the managing agencies for detailed information.

  • Council Member Joann Ariola inquires about vaccination buses serving migrant camps and a specific micro based camp at fluid battlefield.
  • She questions whether there has been a decrease in vaccination activities at shelters and base camps.
  • Dr. Quinn states that the Department of Health And Mental Hygiene does not manage these programs and recommends contacting the responsible agencies.

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QUESTION

# Can anyone access vaccinations at any hospital regardless of insurance status?

0:46:51

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79 sec

Access to vaccinations depends on insurance coverage and eligibility for federal programs, with a dedicated clinic in Fort Green for those uninsured or financially unstable.

  • Vaccination access varies based on insurance, coverage, and eligibility for federal programs, requiring some to search for specific options.
  • The Fort Green vaccine clinic in Brooklyn welcomes individuals regardless of immigration status or ability to pay, specifically for those aged four and older.
  • Vaccinations for children are ideally conducted in a comprehensive pediatric setting to address their overall health and developmental needs.
  • Efforts are focused on linking individuals to care within the framework of New York City's healthcare system.

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QUESTION

# What are New York City's current vaccination rates by demographic factors, and which borough has the lowest vaccination rates for specific vaccines?

0:48:18

·

3 min

Dr. Celia Quinn provides vaccination rates by borough and race/ethnicity in New York City, highlighting significant disparities.

  • Vaccination rates vary by borough and race/ethnicity, with Staten Island and the Native Hawaiian/Pacific Islander group showing the lowest rates for certain vaccines.
  • Coverage rates for 2-year-olds by borough show the lowest rates in Brooklyn (51%) and Staten Island (50%), while rates for the MMR vaccine are higher overall due to school requirements.
  • Significant disparities exist in vaccination coverage among different races and ethnicities, with non-Hispanic black and Hispanic/Latino populations generally showing higher coverage than white and other minority groups.
  • Dr. Quinn emphasizes the importance of vaccine access, uptake, and confidence in addressing these disparities.
  • Detailed vaccination coverage numbers will be provided to the council, highlighting the ongoing effort to understand and improve vaccination rates across New York City.

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QUESTION

# What trend in vaccination rates is the DOHMH observing, and which vaccines have seen changes?

0:51:56

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85 sec

Declining vaccination rates among New York City children show partial recovery for some vaccines, but significant decreases for others, with the MMR vaccine being a particular concern.

  • Two-year-olds up to date with the combined 7 vaccine series as of December 31, 2023, are at 60%, nearly recovering to the pre-pandemic rate of 62% from 2019.
  • The MMR vaccine coverage for four to six-year-olds has dropped to 85% from the pre-pandemic rate of 99%, a decrease of 14 percentage points.
  • This decrease in MMR vaccination rates arises from the children who were aged 0 to 2 during the 2020-2021 period.
  • The data indicates a close to recovery situation for some vaccines while highlighting significant concerns for the MMR vaccination among a specific age group.

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QUESTION

# How is the agency addressing disparities in vaccination rates among different demographic groups?

0:53:21

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95 sec

The agency addresses vaccination disparities through strategic outreach and leveraging community partnerships to improve vaccination rates among various demographic groups.

  • Community partnerships and collaborations with other agencies, like the Department of Education, are essential in delivering targeted messages.
  • Engagements with community leaders and healthcare providers are emphasized to enhance vaccine advocacy.
  • Special emphasis is placed on vaccinating four to six-year-olds for school requirements, including MMR vaccines.
  • Back-to-school campaigns and reminders for vaccinations during spring break or before summer travels are key strategies, especially for areas with higher measles risks.

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QUESTION

# How can the City Council support efforts to address the decline in vaccination rates?

0:54:56

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54 sec

Dr. Quinn highlights the role of City Council members as trusted messengers to amplify reputable vaccine information and suggests partnerships with community groups.

  • Council members can act as trusted messengers in their communities.
  • Directing people towards reputable sources for vaccine information such as the New York City Department of Health And Mental Hygiene and the Centers for Disease Control and Prevention is crucial.
  • Suggests partnering with community groups identified by council members.
  • Encourages reaching out to the community affairs group to facilitate partnerships.

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TESTIMONY

# Christopher Leon Johnson, Member of the Public on the Impact of Non-Compliance and Disinformation on COVID-19 Vaccination Rates

0:56:37

·

135 sec

Christopher Leon Johnson addresses the impact of non-compliance in schools and disinformation spread by certain organizations on COVID-19 vaccination rates.

  • Johnson highlights the decrease in vaccination rates due to schools not adhering to compliance and insufficient effort from the health department in funding vaccine education.
  • He criticizes groups such as Teachers of Choice and Child Health Defense for spreading anti-Semitic conspiracy theories related to vaccines.
  • Johnson emphasizes the need to dismiss false narratives about vaccines and mentions his personal experience with COVID-19 and measles vaccinations.
  • He calls for unity among city council and state assembly members against harassment faced by individuals promoting vaccination efforts, specifically mentioning Korina Reyes.

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TESTIMONY

# Molly Senack, Representative for the Center for Independence of the Disabled New York on Vaccine Accessibility and Barrier Removal

0:59:25

·

124 sec

Molly Senack discusses the significance of vaccine accessibility for students with disabilities and the importance of removing barriers to vaccination.

  • Highlights the strict vaccine requirements for school enrollment in New York and the dual problem created by lack of herd immunity.
  • Points out the additional barriers faced by students from immigrant families, low-income backgrounds, and those living in temporary housing.
  • Proposes solutions such as vaccine reimbursement programs, providing information in multiple languages, and strengthening partnerships with community organizations.
  • Criticizes cuts to funding for community schools and school nurses, emphasizing the risk to student health from inaccessibility to vaccines.

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