Vaccination rates have been declining for several years, suggesting a shift in popular thinking that could eventually challenge long-held assumptions in healthcare planning.
Flu shots are just one example. According to the CDC, juvenile vaccine coverage was 55% in the 2023-2024 flu season, a drop of more than 8 points from pre-pandemic levels. Among adults, the CDC notes that “coverage has steadily declined since the 2020–21 season.”
Another CDC report shows falling rates of MMR, DTaP, and polio vaccinations for kindergartners. For more than a decade pre-Covid, all these vaccines had coverage rates above the 95% benchmark for community protection. In the years since Covid, vaccination rates have fallen to 93% or less.
New federal policies are likely to perpetuate or accelerate this trend. For instance, recent media reports indicate that the CDC is discontinuing paid ads promoting the flu vaccine and weighing an “informed consent” requirement that would highlight the possible risks associated with vaccination.
Meanwhile, NIH is canceling research studies on vaccine uptake, and the FDA is canceling meetings of the federal vaccine advisory committee that guides drugmakers on which flu strains should be included in the next round of flu shots.
Planning, Not Politics
To be clear, none of this is meant to suggest a political position. Ascendient provides healthcare planning services – and planning, almost by definition, is pragmatic rather than political.
So, here’s the pragmatic reality:
From service line planning to bed planning, broad declines in vaccination rates will have direct implications for hospital utilization. Again, let’s start with influenza. We know that people who get their annual flu shot are up to 60% less likely to need a doctor visit and about 40% less likely to require hospitalization. For those patients who do end up in the hospital, research has shown that vaccination is associated with a shorter length of stay and a 60% reduction in ICU admissions.
In our healthcare planning work, Ascendient has always based utilization forecasts on a kind of “steady state” for vaccine uptake. With the flu, for instance, we understand that vaccination rates vary each year based on reports of effectiveness or side effects, but those swings wouldn’t affect planning efforts because they tend to even out over time.
What we’re seeing now is more of a secular, long-term change in vaccine uptake. If the steady state is moving lower – if fewer people are even willing to consider getting their flu shot – that could change industrywide projections for primary care visits, ED utilization, ICU utilization, average daily census, length of stay, and more.
Beyond seasonal concerns like influenza, Covid, and RSV, a decline in childhood vaccinations could have even bigger implications for healthcare planners. In late February, an unvaccinated child in Texas died in a measles outbreak – the first such death since 2015 and a worrying signal for providers.
With a highly contagious infection like measles, about 25% of cases will require hospitalization. Because the MMR vaccine grants long-lasting immunity, reducing the vaccination rate today will have long-lasting implications for healthcare planning. For children born between 1994 and 2013, the CDC estimates that immunization will prevent 21 million hospitalizations over the course of their lifetimes.
Now, imagine what your utilization rates might look like today if all those children hadn't been vaccinated years ago.
What's a Planner to Do?
Based on years of data, we know that falling vaccination rates will lead to an increase in preventable hospitalizations – a trend that may not be reflected in your planning. It’s probably too early for a wholesale change in utilization models, but Ascendient is starting to monitor vaccination trends in ways that we never had to before.
Here are 3 ways that you can monitor trends in your own market:
- Watch the National Immunization Surveys (NIS). For seasonal infections such as Covid and influenza, the CDC publishes state-level vaccination data every week (for now, at least). Beyond the current number of jabs in your state, look at trends in the “no intention” cohort to get a better idea of attitudinal shifts that might affect your strategic planning.
- Look beyond Washington. Turmoil in Washington gets most of the attention these days, but state capitals can have an even bigger influence on childhood vaccination rates such as polio and DTaP. All but 5 states allow parents to opt their children out of required vaccinations for personal or religious reasons. Though the process varies widely, there is a clear trend toward making exemptions easier to obtain – for instance, removing requirements for parental education or attestation by a healthcare provider.
- Talk to school officials and local health departments. Because state-level policies can play out very differently across local jurisdictions, it pays to talk to experts on the ground. In Wisconsin, for instance, where individual school districts are responsible for enforcing state regulations, compliance rates vary by 30 points or more. In areas with high levels of homeschooling – like the West Texas counties seeing a spike in measles – official vaccination data may be woefully incomplete.
Conclusion
If the current trends continue, declining vaccination rates will almost certainly affect hospital utilization, creating a new concern for planners. Beyond beds and providers, there are major implications for financial planning, as well: For both childhood vaccines and Covid vaccines, we know that poverty is correlated to low vaccination rates, meaning that hospital budgets will likely be strained by an influx of uninsured or under-insured patients.
At Ascendient, we have long urged greater cooperation between healthcare and public health, our two biggest client groups. At the very least, consider a countywide CHNA process that brings together the local health department with every provider organization in the county. As we have written previously, priorities tend to change when hospitals look beyond their immediate service area – and vaccination rates are a perfect example.
If ever there were a time for strategic alignment and tactical partnership, this would be it. Public health is reeling from policy changes in Washington, while nonprofit hospitals face mounting pressure to justify their tax exemption with more tangible community benefits. Working with the local health department, hospital leaders should consider strategic investments of time, talent, and treasure to boost community vaccination efforts.
.jpg)
