Childhood immunizations have fallen sharply so far this year amid the new coronavirus outbreak, state data shows.

From January 1 through April 23, there was a 19 percent decrease in non-influenza vaccinations administered and reported to the state among children 0-8 years old compared to the average for the same period in 2018 and 2019 and a 27.5 percent decrease among those 9 to 18 years old, said data from the Department of Health and Human Services Division of Immunization.

The decline has affected adults as well with an 11 percent decrease among those 19 to 105 years old.

The situation has concerned one physicians’ group, the Michigan State Medical Society, which has called for Governor Gretchen Whitmer to rescind or revise her executive order banning "nonessential" medical procedures.

There have been concerns in some quarters of the health care community that the order, which the governor issued to assure hospital capacity as the COVID-19 pandemic hit Michigan in March and threatened to overrun hospitals, is now discouraging patients and their physicians from tending to important medical needs that may not fit the definition of "nonessential." Dr. Joneigh Khaldun, the state's chief medical executive, has defended the order and given guidance to providers that they have the freedom under the order to schedule procedures physicians deem necessary.

"Vaccines have reduced and, in some cases, eliminated many diseases that killed or severely disabled people just a few generations before," said Dr. S. Bobby Mukkamala, president of the Michigan State Medical Society. "For most Americans today, vaccines are a routine part of health care but, for some, routine health visits have halted. There could be some very real consequences which would be dire if our patients can't get back to their routine health care."

DHHS spokesperson Lynn Sutfin said the state recognizes the importance of vaccinations. The Division of Immunization recently sent the data on falling immunization rates to providers with guidance from the U.S. Centers for Disease Control and Prevention that urges offices that can only provide limited well-child visits to prioritize newborn care and vaccination visits through age 24 months.

Ms. Sutfin also pointed to the guidance Ms. Khaldun issued to providers earlier this month that urged providers to systematically prioritize in-person patient interactions and in doing so "consider allowing medical visits for immunizations." She asked providers to consider reaching out to families to schedule immunization visits in future months to keep patients up to date.

On March 30, the Division of Immunization sent a memo to providers regarding what to do about a falloff in immunizations because of the pandemic and reminded them to use the immunization catch-up schedule.

"Keep in mind that vaccinating can indirectly help our state respond to COVID-19," the memo said. "When we vaccinate against influenza, pertussis, pneumonia, etc., and thereby decrease hospitalizations from vaccine-preventable disease, this contributes to flattening the curve with regard to preventing additional burden on the health care system."

Ms. Sutfin did not answer a question about whether the situation would prompt a change to the medical services order but did say the state recognizes "the pandemic is affecting immunization services differently across providers in the state."

She also said the state works with the Franny Strong Foundation on the IVaccinate campaign and will use the partnership to promote vaccination efforts throughout the state in the upcoming months.

Dr. Pamela Rockwell, an associate professor in the University of Michigan Department of Family Medicine, said she does not attribute the fall in immunization rates to Ms. Whitmer's order.

"I believe some of this falloff is attributed to patients' 'fear of going to the doctor' combined with physicians and healthcare systems' initial advice for patients to stay home and avoid health care facilities if at all possible, to lessen the risk of COVID-19 exposure during the height of the pandemic," she said. "Pediatric visits are now ramping up in my area: children due or overdue for their immunizations are being called and scheduled for both 'drive-through' immunization stations and 'well-only' office visits."

Ms. Rockwell said DHHS has provided "excellent guidance" for health care providers and said avoiding office visits and procedures for low acuity issues makes good public health sense to help keep COVID-19 infection rates down. Still, Ms. Rockwell said the decline in pediatric immunization rates is during the pandemic is alarming.

She suggested the state engage in public service announcements in all forms of media to educate the public on the importance of vaccinations as physician offices ramp up their vaccination services.

"If this declining curve is not 'flattened' soon, children will be at risk of outbreaks of vaccine-preventable diseases, notably Pertussis and Measles as social distancing requirements are soon to be relaxed," she said. "Though this falloff in immunization rates is concerning, I believe it can be rectified in the next several months with a concerted effort by family physicians and pediatricians to prioritize childhood immunization administrations."