Buses and home visits boost child vaccinations in Louisiana | Louisiana Health

Two trays of needles sat on either side of 10-year-old Naomi Varela inside Children’s Hospital’s immunization bus on a recent Thursday.

By the fourth shot, she winced. But six vaccines later, she was still free of tears — and she’s up-to-date on her school vaccinations after moving to the New Orleans area two weeks ago.

Varela, her sister and mom were one of a long line of families standing outside the Children’s Hospital immunization bus outside an Algiers library in October. The bus is one way health care workers are reaching children in need of vaccines.

“It’s convenient,” said Noel Puentas, mobile director of the bus who signs in children and parents outside the bus five days a week, year-round. “They don’t have to make an appointment.”

As Louisiana’s rate of fully vaccinated children slips as part of blowback related to the COVID-19 pandemic, health care providers are leaning on creative ways to change that.

By the numbers

About 85% of Louisiana’s kindergarteners had complete records for standard childhood vaccinations during the 2023-24 school year, according to state data. That’s a drop of almost 5% from just two years earlier.

The vast majority of parents still choose to vaccinate their kids. But even small drops in vaccination rates can impact the spread of certain preventable diseases. Measles, for example, requires 95% of the population to be protected in order to halt spread, because it is extremely infectious.

Vaccinations took a hit during the COVID-19 pandemic. First, it was because kids were out of school, clinic appointments were canceled and hospitals were overwhelmed by COVID patients. Then, they became politicized. 

It’s not clear yet if Louisiana’s dropping rates will recover, said Charles Stoecker, a health care economist at Tulane University who covers vaccine policy. Kids born during the pandemic will enter kindergarten in the next couple of years, which is when most kids get fully caught up on their shots.

“It is taking time for people’s preferences to reveal themselves,” Stoecker said. “I think that the pandemic really undermined a lot of people’s confidence in the system.”

Motivators

One of the biggest motivators for children to get vaccinated is the school requirement, Stoecker said.

“You want your kids to have opportunity, you want free babysitting, you want to do good by them,” Stoecker said. “And you can get that if you do those immunizations.”

Louisiana requires a handful of vaccinations to enter school, though parents can opt out. Standard vaccinations include DTaP, which protects against diphtheria, tetanus and pertussis; polio; MMR, which protects against measles, mumps and rubella; HepB, which protects against hepatitis B; and VAR, which protects against varicella, or chickenpox.

That’s why the majority of parents and caregivers come to the vaccine bus, Puentas said. Many are sent by the schools or their doctors, who may not carry every vaccine a child needs.

On a busy day, over 100 kids might sign in, Puentas said.

The immunization bus has been trekking around New Orleans for 25 years as part of the Greater New Orleans Immunization Network at Children’s Hospital New Orleans. In 2023, over 27,000 vaccines were given to over 13,000 kids.

Another big factor is cost. Under the federal Vaccines for Children program, immunization is free for kids who are publicly insured, which is nearly 70% of the kids in Louisiana. It’s also typically covered under private insurance plans.

In-home vaccinations

But even with free shots and school requirements, some parents come up against obstacles, said Dr. Rebekah Gee, an OB-GYN and founder and CEO of Nest Health, a New Orleans-based health care company that provides in-home visits to families with Medicaid. Transportation is a big challenge, especially for parents with little time off and more than one child.

“You’re having to take buses on multiple days with multiple kids within a city or state that doesn’t have affordable childcare or paid parental leave,” said Gee, the former health secretary at the Louisiana Department of Health. “So it just becomes impossible.”

Nest packs up vaccines in special coolers, depending on the storage requirements, and brings them into homes. About 65% of Nest’s clients are children, so vaccinations are a big part of visits.

In the home, a kid can cuddle their favorite stuffed animal and get a vaccine on the couch. For patients with special needs like autism, it can make a world of difference, said Kelsie Brandt, a certified pediatric nurse and vice president of strategic operations at Nest. 

“They’re already mad about the blood pressure cuff, the physical exam, and now you’re trying to poke them,” Brandt said. Not having to leave the home makes it easier for the whole family. 

So far, the results are significant. About 36% of Louisiana’s teens have the HPV vaccination, which prevents cervical, vaginal, vulvar, anal, head and neck cancers, and also prevents genital warts. Among Nest’s patients, 83% of teens are vaccinated for it.

That comes down to the trust created when a provider creates patient-centered relationship, said Gee, pointing out that historically, appointment times and locations are not designed around family life.

“We designed the whole care system around us as providers — when do I want to be in the office, where is my office, what is convenient for me?” Gee said. “Instead of saying, OK, what does this family need? I think it’s just so powerful to meet people where they are.”