As a physician, I’ve witnessed firsthand the devastating impact of infectious diseases when they aren’t 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 diseases, it’s also about ensuring our healthcare systems don’t allow our patients to fall through the cracks. The recent discussions around changing a well-established immunization schedule for meningococcal disease concern me deeply because it could unnecessarily endanger young people.
Seeing the care — and the gaps
Growing up in Mumbai, India, I often saw health workers visiting communities to administer vaccines, aiming to protect as many people as possible. My father, a trained pharmacist, knew that despite these efforts, the system often missed economically disadvantaged individuals who couldn’t afford to take time off work to get vaccinated. He took it upon himself to bridge this gap by gathering our apartment building’s workers 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 fueled 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 childhood vaccination rates among citizens reached about 99%. The success of their public health system lay in its proactive approach — healthcare workers traveled by helicopter to remote communities, ensuring no one was left out.
When I moved to the United States, I was shocked to find similar gaps in care as those I had seen in India. Despite being in one of the most advanced countries in the world, quality care did not always reach disadvantaged populations.
The success of meningococcal vaccination
Given these experiences, I am deeply concerned about the Centers for Disease Control and Prevention’s Advisory Committee on Immunization Practices (ACIP) considering certain changes to the current meningococcal vaccination schedule. Since the introduction of the meningococcal vaccine in 2005, there has been a 90% decline in meningococcal disease rates among adolescents — a profound success story. The current ACIP recommendation includes a dose of the MenACWY vaccine at 11-12 years old, followed by a booster at 16.
This schedule is widely implemented and supported by school-entry requirements, ensuring high vaccination rates, particularly among younger adolescents. The proposed elimination of the MenACWY dose at age 11-12 years could have far-reaching consequences, potentially undoing the progress we’ve made. At age 11, most children are still receiving regular medical care, but by age 16, many are not. One factor that may contribute to this decrease in well care is that adolescents in rural areas or from socioeconomically disadvantaged backgrounds do not have regular access to medical care or the resources and time to travel to a healthcare facility. This is likely reflected in the significant discrepancy in vaccination coverage rates between younger (89%) and older (61%) adolescents.
Keeping the gap closed
Removing the 11 to 12-year-old vaccination recommendation or shifting it to one of shared clinical decision-making (SCDM), could widen existing gaps, 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 fatality rate of 10-15%. Additionally, one in five survivors will suffer long-term effects such as limb loss, deafness, or neurological damage.
When we allow gaps in our healthcare system to widen, it’s always the most vulnerable who suffer the most. Our current health system already places undue burdens on patients to seek care. ACIP should retain its successful vaccination recommendation to protect vulnerable patients and prevent an already critical gap in public health from widening.
By maintaining this proven strategy, we can continue to safeguard our children and adolescents. They are literally our future. That is why we must act in the present 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 adolescent medicine specialist at Children’s Hospital Colorado and a Professor Adjoint at the University of Colorado School of Medicine. He earned 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, focusing on mental health, substance abuse, sexually transmitted infections, 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. Additionally, he consults for Denver Public Schools and the Adolescent Championship Model. His contributions include numerous publications and active involvement in professional organizations like the American Academy of Pediatrics and the Society for Adolescent Health and Medicine.
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