Getting a Fair Shot: Progress and Disparities in Early Childhood Vaccination in New York State

Vaccines are widely considered among the greatest public health achievements of the last century.

Yet New York State has seen outbreaks of vaccine-preventable diseases in recent years. In addition, children of color have historically faced barriers to vaccine access, creating disparities in vaccination coverage.

This report examines early childhood vaccination coverage in New York State from 2018 to 2020. It assesses the percentage of children who completed a 7-vaccine series before the age of 24 months; this series protects against 11 illnesses, including measles, mumps, and chickenpox. Data on childhood vaccination were made available through the New York State Immunization Information System and represent trends for the 57 counties outside of New York City.

The report presents disparities in vaccination coverage by race, ethnicity, and geography to identify communities of undervaccinated children in need of targeted outreach. It also discusses factors that may have increased vaccination coverage over time, including the elimination of religious exemptions from school vaccination requirements and improvements in information exchange between providers and the State’s immunization registry. Additional steps to protect all children from vaccine-preventable diseases could include training providers to communicate with vaccine-hesitant parents; leveraging the State’s immunization registry to identify children who have fallen behind on immunizations during the COVID-19 pandemic; and implementing standing orders to allow a wider range of health care professionals to administer vaccines.

Key Findings

• Overall early childhood vaccination coverage increased in New York State (all data are exclusive of New York City) from 2018 to 2020. In 2020, 64.5% of children ages 24–35 months had completed the entire early childhood vaccine series by age 24 months. By comparison, 59.4% of similarly aged children completed the early childhood vaccine series by age 24 months in 2018.
• Early childhood vaccination rates have increased for children of all races and ethnicities. Rates improved the most for Asian children during the study period.
• While there was improvement across all groups, racial and ethnic disparities in early childhood vaccination coverage largely persisted. The gap between Black or African-American and white children increased slightly from 2018 to 2020 (from a rate 9% lower than their white counterparts to a rate 11% lower), remained consistent for Hispanic or Latino children (approximately 7% lower), and narrowed for Asian children (from 15% to 3% lower).
• There was substantial variation in early childhood vaccination coverage across counties in New York State, with more than half of counties having rates below the State’s Prevention Agenda goal of 70.5%. The 2020 coverage rate in the county with the lowest rate, Rockland, was approximately half as high as the county with the highest rate, Livingston (42% compared with 82%).
• The lowest regional rates of early childhood vaccination coverage were consistently found in the Lower Hudson and Long Island regions (in 2020, 54% and 59%, respectively).