by As a physician, I have witnessed firsthand the devastating impact of infectious diseases when not adequately prevented. This is why I am a vocal advocate for immunizations, especially against meningococcal infections. My commitment to this cause is not just about preventing disease, it is also about ensuring that our healthcare systems do not allow our patients to fall through the cracks. Recent discussions about changing a well-established immunization schedule for meningococcal disease are of great concern to me, as this could unnecessarily put young people at risk.
Seeing the care – and the gaps
Growing up in Mumbai, India, I often saw health workers visiting communities to administer vaccines, with the goal of protecting as many people as possible. My father, a trained pharmacist, knew that despite these efforts, the system often missed economically disadvantaged individuals who could not afford to take time off work to get vaccinated. He took it upon himself to bridge this gap by bringing the employees of our apartment complex together in our living room where they could receive their vaccines. This vivid memory stayed with me throughout my medical training.
The importance of reaching patients
These experiences sparked my passion for preventive medicine, which I eventually made my specialty. My career allowed me to observe other healthcare systems, such as in the Sultanate of Oman, where the vaccination rate among citizens among citizens was approximately 99%. The success of their public health system lay in its proactive approach: health workers traveled by helicopter to remote communities so that no one was left out.
When I moved to the United States, I was shocked to discover similar gaps in care to those I had seen in India. Despite being located in one of the most advanced countries in the world, quality care did not always reach underserved populations.
The success of meningococcal vaccination
Given these experiences, I am deeply concerned that the Centers for Disease Control and Prevention’s Advisory Committee on Immunization Practices (ACIP) is considering certain changes to the current meningococcal vaccination schedule. Since the introduction of the meningococcal vaccine in 2005, the number of meningococcal diseases among adolescents has fallen by 90% – a profound success story. The current ACIP recommendation includes a dose of the MenACWY vaccine at age 11-12, followed by a booster at age 16.
This scheme is widely implemented and supported by school entry requirements, ensuring high vaccination rates, especially among younger adolescents. The proposed elimination of the MenACWY dose at age 11-12 could have far-reaching consequences, potentially reversing the progress we have made. At the age of 11, most children still receive regular medical care, but by the age of 16 this is no longer the case for many. One factor that may contribute to this decline in quality care is that adolescents in rural areas or from socio-economically disadvantaged backgrounds do not have regular access to medical care or the means and time to travel to a healthcare facility. This is likely reflected in the significant discrepancy in vaccination rates between younger (89%) and older (61%) adolescents.
Keep the hole closed
Removing the 11- to 12-year-old vaccination recommendation or shifting it to shared clinical decision-making (SCDM) could widen the existing gap, exposing more families to the dangers of meningococcal disease. This disease progresses rapidly and can become life-threatening within hours. Although invasive meningococcal disease (IMD) is rare, its impact is severe, with a mortality rate of 10-15%. In addition, one in five survivors will experience long-term effects, such as limb loss, deafness or neurological damage.
When we allow the holes in our healthcare system to widen, it is always the most vulnerable who suffer the most. Our current healthcare system already places excessive burdens on patients when seeking care. ACIP must maintain its successful vaccination recommendation to protect vulnerable patients and prevent the already critical public health gap from widening.
By maintaining this proven strategy, we can continue to protect our children and adolescents. They are literally our future. That’s why we must take action today to ensure that no one is left behind in the fight against preventable diseases.
Photo: wildpixel, Getty Images
Dr. Paritosh Kaul, MD, is a board-certified pediatrician and specialist in adolescent medicine at Children’s Hospital Colorado and an adjunct professor at the University of Colorado School of Medicine. He received his medical degree from Seth Gordhandas Sunderdas Medical College in Mumbai and completed fellowships in adolescent medicine at Albert Einstein College of Medicine.
Dr. Kaul specializes in adolescent health care with an emphasis on mental health, substance abuse, sexually transmitted diseases and adolescent gynecology. He is co-director of the Culture, Health, Equity, and Society Thread and Associate Director for Education in Pediatrics Across the Curriculum (EPAC) at the University of Colorado. He also consults for Denver Public Schools and the Adolescent Championship Model. His contributions include numerous publications and active involvement in professional organizations such as the American Academy of Pediatrics and the Society for Adolescent Health and Medicine.
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