Vaccines play an important role in keeping us healthy. They protect us from serious and sometimes deadly diseases.¹ The increase in child life expectancy is largely due to reductions of mortality by infectious diseases through the administration of vaccines. Early childhood immunization has been proven to be a safe and cost-effective means of controlling vaccine-preventable diseases.

2018-2023

The NJDOH Vaccine-Preventable Disease Program (VPDP) works to reduce and eliminate the incidence of vaccine-preventable diseases affecting children, adolescents, and adults by raising the immunization coverage rates of New Jersey’s citizens. The VPDP promotes timely vaccination through education and collaboration with private and public health care stakeholders such as: the NJ Department of Education, NJ Department of Children and Families, Health Service Grantees (HSG), private practitioners, local health departments (LHD), Federally Qualified Health Centers (FQHC) and through collaboration and funding of our statewide immunization coalitions, the New Jersey Immunization Network (NJIN) and the Essex Metro Immunization Coalition (EMIC).

The VPDP is funded with a combination of Federal and State funding, with most of the funding deriving from a Cooperative Agreement with the Centers for Disease Control and Prevention. The program’s annual operational budget is approximately $10 million which funds the program’s staff of 40 as well as activities carried out by our HSGs. The Centers for Disease Control and Prevention also provided annual funding assistance with approximately $90 million in vaccine support. In addition, in 2020 the Program received a COVID-19 supplemental funding opportunity for approximately $181 million to prioritize the COVID-19 pandemic response. 

In New Jersey, with the exception of ≥2 doses of influenza vaccine, ≥2 doses of Hep A, and the combined seven-vaccine series (all of which were between 59-69%), coverage exceeded 70% for ≥1 MMR (97.0%), ≥1 Varicella (96.3%), Rotavirus (72.7%), ≥4 DTaP (80.9%), ≥3 Hep B (81.6%), Hib (full series--80.0%), ≥4 PCV (77.7%), ≥3 Polio (96.8%).  New Jersey reached the Healthy People 2020 targets of 90% for children by age 35 months for the following vaccines: ≥3 Polio (96.8%), ≥1 MMR (97.0%), and ≥1 Varicella (96.3%).

Projects

• Maintained and promoted health equity through the Vaccines for Children (VFC) Program, a federally funded, state-operated vaccine supply program that provides pediatric vaccines at no cost to doctors who serve children who might not otherwise be vaccinated because of inability to pay. 
• Promoted pediatric and adolescent immunization standards to health care providers through the creation and distribution of educational tools used to provide information and tips on how to improve vaccination practice including assessment, recommendation, administration, referral, and documentation.
• Supported health service grantees through various immunization activities including:
  
  • Implemented childhood immunization tracking programs.
  • Increased access and resources (e.g., translation services) to assist with back-to-school immunizations.
  • Promoted community-based immunization services in underserved areas.
  • Promoted vaccine-specific educational offerings.
• Collaborated and offered annual immunization education to health care providers, stakeholders (e.g., local health departments), and community partners (e.g., faith-based organizations) through webinars, in-person trainings, and conferences (e.g., New Jersey Immunization Conference).
• Annually collected, maintained, and analyzed the immunization status of students attending public and non-public schools, including licensed childcare and preschool facilities, via the Annual Immunization Status Report (ASR) and local health department school immunization audits.
  • Students must be vaccinated in accordance with N.J.A.C. 8:57-4, Immunizations of Pupils in School regulations. The mandatory ASR is a self-reported survey that is used to assess immunization coverage with mandated vaccines among students enrolled in childcare/preschool, Kindergarten/Grade 1 (entry level), Grade 6, and Transfer students in any grade. These data also assist NJDOH and local health departments in identifying areas of low vaccination coverage. 
  • Local health departments must conduct immunization audits of school, preschool, and childcare facilities in accordance with N.J.A.C. 8:52, Public Health Practice Standards of Performance. Annual auditing is considered a best practice to capture accurate, current, and relevant data for assessing immunization status of a community and vulnerability during a potential outbreak. These public health audits serve to validate the self-reported ASR data submitted by facilities and assist with portraying a more accurate snapshot of immunization rates among New Jersey children attending schools, childcare, and preschool facilities.   
  • NJDOH continued to enhance its data collection reports to ensure comprehensive reporting and improve ease of use.
• Annually hosted the Hot Shots for Tots (HSFT) Immunization Campaign for childcare facilities to encourage childhood vaccination. The campaign is a voluntary, point-based incentive program for childcare facilities. Participating facilities select from qualifying immunization-related activities (which include flu-related activities) to earn points toward reaching one of the three award levels: Gold, Silver, or Bronze. The campaign encourages and facilitates a collaboration with immunization stakeholders to promote best practices and improve immunization coverage.
• Continued to collaborate with the Partnership for Maternal and Child Health of Northern New Jersey for the annual Protect Me With 3+ (PMW3+) poster and video campaign. The campaign was rebranded for the 2022-23 cycle with a newly designed website, logo, and a new tagline of “Create. Educate. Vaccinate.” The contest challenges New Jersey middle and high school students in grades 5 through 12 to raise awareness about the importance of adolescent immunizations: tetanus, diphtheria, acellular pertussis (Tdap), human papillomavirus (HPV), meningococcal (MenACWY), flu, and COVID-19 vaccines.
• Trained health care providers to utilize the New Jersey Immunization Information System (NJIIS), statewide immunization registry, to track immunization coverage rates and utilize reminder/recall for children who are due or overdue for vaccinations.
• Provided consultation and technical assistance to schools, physicians, local health agencies, and others regarding compliance with school-based immunization regulations/policies and reporting through the development and/or creation of educational webinars, frequently asked questions, toolkits, checklists, brochures, NJLINCS messages, E-Blasts, etc. 
• Used national immunization awareness events (National Influenza Vaccination Week, National Infant Immunization Week, and National Immunization Awareness Month) as opportunities to promote routine immunizations through press releases and social media campaigns.
• Continued its collaboration with the Partnership for Maternal and Child Health of Northern New Jersey for its Power to Protect NJ statewide flu campaign to encourage residents to get vaccinated and take steps to protect themselves and others. This campaign features social media shareables, posters, and frequently asked questions that can be shared with various audiences.
• Developed two initiatives to help promote flu prevention among our partners, the New Jersey Influenza Honor Roll and the NJ College & University Flu Challenge. The Honor Roll recognizes institutions that encourage and promote flu prevention within their communities across the state. There are four eligible categories to participate: businesses, community-based organizations, institutions of education, and health care facilities. The Flu Challenge is a separate initiative designed to engage college students in a friendly competition to improve flu vaccination coverage on their campuses. 
• Developed the Capture/Recapture Hepatitis B project. This project matches records in the Communicable Disease Reporting Surveillance System (CDRSS) of cases of hepatitis B virus (HBV) with New Jersey’s electronic birth registry to identify any live births to hepatitis B positive mothers that may have been missed from birth cohorts 2021 and 2022. Additionally, analysis will be conducted on the hepatitis B vaccine birth dose for all live births in hospitals in New Jersey. All infants are recommended to receive their first dose of hepatitis B vaccine within 24 hours of birth. This recommendation is regardless of mother's hepatitis B infection status at time of birth.
• Promoted catch-up on routine immunizations and COVID-19 vaccine through public service announcements, Facebook Live events, and statewide advertising campaigns.

Legislation

• New Jersey’s influenza vaccination law enacted in January 2020, N.J.S.A. § 26:2H-18.79-18.81 (P.L. 2019, c. 330) requires all employees of hospitals, nursing homes, and home health agencies to get an annual flu vaccine. The only exception is if an employee is medically contraindicated from receiving the flu vaccine.
• P.L. 2019, c.332 requires students at institutions of higher education to receive immunization for meningitis in accordance with recommendations of the Advisory Committee on Immunization Practices (ACIP).

Outreach

• All outreach conducted by VPDP or grantees are included in the projects listed above.

Grants given by NJDOH

• CDC Cooperative Agreement:  Health service grants, provided by federal funds, were given to Health Service Grantee agencies to reduce and eliminate the incidence of vaccine-preventable diseases affecting children, adolescents, and older adults by raising immunization coverage rates.

• COVID-19 Supplemental Grant

  • New Jersey Department of State: Support COVID-19 vaccine outreach, education, and administration and monitoring for New Jersey’s three state-recognized tribes and inter-tribal people.
  • NJDOH Office of Local Public Health: Coordination of local health departments (LHD) to increase COVID vaccinations across New Jersey including high risk and underserved areas. 
  • NJDOH Division of Family Health Services: Collaborate with community and faith-based organizations to deliver COVID-19 vaccine education in multiple languages, outreach, and administration to vulnerable populations. 
  • NJDOH Office of Primary Care, Rural and Public Health: Expansion of COVID-19 vaccination for at-risk and vulnerable populations through a competitive grant opportunity open to FQHCs, urgent care centers, pharmacies, and community-based providers.
  • NJDOH Office of Population Health: Conduct key informant surveys to inform vaccine planning and implement best practices to improve vaccine equity.
  • NJDOH Division of HIV, STD, and TB Services: Collaborate with community-based networks to deliver comprehensive COVID-19 vaccine education, outreach, and administration to the people they service.
  • Partnership for Maternal and Child Health of Northern New Jersey: Expand on Protect Me With 3+ (PMW3+), Adolescent Immunization Initiative to include COVID-19 vaccine along with implementing the COVID-19 College Initiative.
  • NJDOH Office of Communications (COMMS) implemented several COVID-19 public health communications campaigns in various languages using trusted health professionals and community members in public service announcements, Facebook Live events, statewide advertising campaigns, webinars, etc., to highlight the importance of receiving the COVID-19 primary series and booster shots. COMMS also promoted the national We Can Do This media campaign, which provided health education, and encouraged COVID-19 vaccination.

Grants received by NJDOH

• CDC Cooperative Agreement: Through this application, the Vaccine Preventable Disease Program (VPDP) will continue work on the Vaccine for Children Program, Population Assessment, Epidemiology and Surveillance, and Acute Flaccid Myelitis Surveillance.
• COVID-19 Supplemental Grant: In 2020, VPDP received a funding opportunity for approximately $181 million to prioritize the COVID-19 pandemic response. 

Assets/resources

• The CDC launched the Routine Immunizations on Schedule for Everyone (RISE) initiative in 2022 to provide actionable strategies, resources, and data to support getting all Americans back on-schedule with their routine immunizations to protect everyone from vaccine-preventable disease and disability.
  • CDC is encouraging health care professionals, schools, and partners to promote vaccinations and communicate why being up to date on routine vaccinations is critical for staying healthy so that families and adults can make informed decisions.
• Vaccinate with Confidence is CDC’s strategic framework to strengthen vaccine confidence and prevent outbreaks of vaccine-preventable diseases in the United States. The Vaccine Misinformation Management Guide was created by UNICEF to aid organizations through the development of strategic and well-coordinated national action plans to rapidly counter vaccine misinformation and build demand for vaccination that are informed by social listening. The NJDOH VPDP supplemented these tools to create state-specific toolkits for New Jersey parents, guardians, and health care providers.

Challenges

• The COVID-19 pandemic caused disruptions in routine health services including vaccinations for adults and children. Routine vaccine orders and administration are rebounding but unevenly. The rebound may be insufficient to catch up everyone that missed a vaccine dose in 2020 and 2021.
• Unvaccinated and under-vaccinated children continue to contribute to a growing pool of susceptible individuals, thus the risk for new infectious disease outbreaks increases.  Over nearly three decades, non-medical exemption rates have continued to increase, particularly in states with more lenient exemption criteria. Public health officials and health care providers worry that non-medical exemptions can compromise herd immunity leaving schools and communities vulnerable to outbreaks of vaccine preventable diseases. 
  • The elimination of non-medical exemptions may improve immunization coverage rates.   High childhood vaccination coverage has reduced the morbidity and mortality due to vaccine-preventable diseases. 
  • Currently, six states have enacted legislation to eliminate non-medical exemptions: California, Connecticut, Maine, Mississippi, New York, and West Virginia.  States with a less convenient process to attain an immunization exemption, or with disincentives for noncompliance with vaccination policies (e.g., exclusion from attendance in public schools), often have lower overall rates of vaccine exemptions among their kindergarten populations and, in turn, an overall greater rate of vaccine compliance. 
  • Although the removal of non-medical exemptions has reduced the non-medical exemption rate, some states saw increase in medical exemptions, which may mitigate efforts to improve vaccine coverage. Therefore, ensuring that medical exemptions are evaluated using Advisory Committee on Immunization Practices (ACIP) guidelines is critical to improving overall vaccination rates.
• Parental concerns and vaccine hesitancy are key barriers to children being immunized. The COVID-19 pandemic disrupted access to routine care, including routine childhood vaccination. Vaccine misinformation and disinformation during the pandemic may have further contributed to a decline vaccine confidence. 

Disparities/inequities

• Data collected through the CDC’s National Immunization Survey illustrate coverage rate variation by age and socioeconomic status. Data are available on ChildVaxView and TeenVaxView.
• According to the vaccination coverage estimates for survey year 2022 obtained through the CDC National Immunization Survey-Child (NIS-Child), vaccination coverage by age 35 months remains high, but disparities by race and ethnicity, poverty status, health insurance status, and urbanicity persist and are widening for some subgroups both nationally and in New Jersey. A significant widening of the gap in vaccination coverage was seen for children living at or above the poverty level compared to those living below poverty.
• Non-Hispanic Black children and those below the federal poverty level of <133%, had lower coverage with ≥4 doses of diphtheria and tetanus toxoids and acellular pertussis vaccine (DTaP), ≥4 doses of pneumococcal conjugate vaccine (PCV), and the combined seven-vaccine series compared with non-Hispanic White children.  
• Non-Hispanic White children had the lowest coverage for the hepatitis B birth dose.

Final Assessment

• One Immunization target was achieved by 2020.
  • The target was achieved for birth dose of the Hepatitis B vaccine.
• Seasonal flu vaccination among persons age 65 and over improved but the target was not met.
• The remaining Immunization objectives had little or no change over the decade.

For more information, please refer to these resources:

• NJ Immunization Requirements 
• NJDOH Vaccine Preventable Disease Program
• Healthy People 2030

Reference:

1. Vaccine Basics. Office of Infectious Disease and HIV/AIDS Policy, USHHS. 4/29/21.