School‐based health centers could be key to increasing vaccination rates for children who otherwise lack access

Vaccination rates for children have fallen below critical disease-prevention thresholds in more than 8,000 schools across the United States, and vaccine hesitancy is not the only reason, according to a health policy expert with the Texas A&M University School of Public Health.

Simon Haeder, PhD, and other researchers note that a lack of access to health care services, including vaccines, is also behind this trend.

“The outbreaks of measles and other preventable diseases we are seeing today are partly the result of lower vaccination rates in children,” Haeder said. “Too often, the issue is lack of access to health care in general, especially for racial and ethnic minorities, low-income families and people living in rural areas.”

One example is a national study from 2022 that found that Hispanic and Black children had substantially lower rates of preventive care visits compared to non-Hispanic white children, Haeder said. Similar gaps were also found based on socioeconomic status.

Now, in the first assessment of its kind, Haeder analyzed public opinion about a childhood vaccination option already in use: the 2,500 school-based health centers that serve more than 6.3 million K-12 students across the country.

Most of these centers provide care from advanced practice nurses, physicians or physician assistants and licensed behavioral health providers, as well as mental and reproductive health care experts. Some also offer dental and vision care.

“School-based centers are very effective in increasing vaccination rates, but until now we did not know how the public felt about this service or whether broader concerns about vaccinations in general affected public support for this service,” Haeder said. “With this information, we could explore this option as a way to reduce children’s barriers to health care.”

For the study, published in World Medical & Health Policy, Haeder asked a nationally representative sample of 4,196 people across the United States their opinions about each of seven vaccines commonly offered in school-based health centers: diphtheria, tetanus and pertussis (DTaP); polio; chickenpox; measles, mumps and rubella (MMR); hepatitis; human papillomavirus (HPV); and COVID-19.

Respondents were asked about their political ideology, trust in school principals, attitudes toward vaccines and whether they thought that vaccines can cause autism. In addition, they specified whether they lived in an urban, suburban or rural area and provided information about their education levels.

“The study found substantial support for providing all seven vaccines in school‐based health centers, ranging from a low of 73.6 percent for COVID-19 to a high of 84.2 percent for MMR—a point worth emphasizing given the levels of disagreement on health-related issues in the United States,” Haeder said.

Several factors consistently influenced support across all vaccines, including political ideology, partisanship, trust in principals, various common measures of vaccination hesitancy and whether a person lives in a rural area. Cumulatively, common vaccination hesitancy measures had substantial effects on public attitudes toward immunization.

Haeder said research on how decisions are made regarding which vaccination services school-based health centers offer or do not offer would be helpful in policy development.

“In the meantime, though, it appears that vaccination services in school‐based health centers are broadly popular and may be particularly important for increasing vaccination rates among underserved populations,” he said.