More than skepticism, vaccine challenge on Guam is a bureaucratic issue

By Jayvee Vallejera

Far beyond the troublesome issue of anti-vaccine sentiments, the bigger problem facing Guam is its large population of unvaccinated individuals who could potentially get sick and pass on preventable diseases to a large segment of the Guam population, according to Dr. Hoa Van Nguyen, a longtime family doctor.

Nguyen, president of the American Medical Center, said the segment of Guam’s population that relies on Medicaid lags behind acceptable immunization coverage, putting the entire island at risk. He estimates that 50 to 70 percent of Guam’s indigent population is significantly behind on their immunizations.

Hoa Nguyen

The Centers for Disease Control and Prevention recently reported a surge in measles cases in 30 U.S. states. So far, Guam doesn’t have any confirmed cases yet, according to Camilo Fernan, spokesman for the Guam Department of Public Health and Social Services. 

However, Guam’s measles-free status may be compromised if an unvaccinated resident travels off-island, is exposed to the disease, and brings the virus back to the island.

About 30,000 Guamanians are enrolled in Medicaid, accounting for nearly 20 percent of Guam’s population.

Those with private insurance don't have a problem with access to immunization,

Nguyen said, because all private clinics offer immunizations all day. “So the patient can walk in and get the immunization at any time they want. That's for those with privately insured patients,” he said.

Limited access to immunization is a problem that Guam’s indigent population runs into. Since most rely on Medicaid for their healthcare services, the only places where they can be immunized are Guam DPHSS or one of the very few smaller clinics that accept Medicaid.

“The challenge is at Guam Public Health. I think the North Public Health only gives immunizations from 8 a.m. to 10 a.m. and that only walk-ins are accepted,” he said.

Nguyen said he has heard accounts of indigent patients who walk into Public Health for their immunizations, wait for two hours, and then at 10 a.m., they are told to return the next day. He noted that working parents have limited time to bring their children to the immunization clinics. “That's why the indigent population is so far behind the immunization rate, which puts the whole island at risk for any type of infection that can be controlled by immunization or vaccination,” he said.

Nguyen suggested that public health clinics extend their immunization hours, similar to private clinics where immunization services are available from 8 a.m. to 6 p.m. “That's the only way you can catch up,” he added.

Another big issue for the indigent population is transportation, Nguyen said. This lack severely limits the number of hours during which parents can bring their children to immunization sites, and the narrow window of time further compromises their ability to get the shot.

However, there is positive news. Unlike in the U.S. mainland, where vaccine hesitancy is a divisive issue, this is not a problem on Guam, Nguyen said. “There are very, very few people who opt out on [immunizing] their children. This is not like in the [United] States [where] a lot of parents are refusing vaccination for their children,” he said.

Fernan acknowledges that vaccine hesitancy is a national concern, but he assures that Guam DPHSS will continue to educate the public about disease and vaccines. He said DPHSS prioritizes outreach and education, regardless of people’s sentiments toward vaccination.

The issue has become even more urgent due to the surge in measles cases in the U.S. mainland. “What raises our concern is Guam’s unique position as a transit point between the U.S. mainland and countries in Asia, where outbreaks are also occurring,” Therese Arriola, public health director, said in a news release. “We are not alarmed, but we are asking our community to take this seriously. Check your vaccination status, especially if you travel, work with the public, or care for children.”

Based on the 2022-2023 Kindergarten Assessment Progress Report for Guam, the current rate of two doses of the measles, mumps, rubella, or MMR vaccine is at 91.0 percent, Fernan said.

Public health officials said even one dose of the MMR vaccine is 93 percent effective against measles. The U.S. Food and Drug Administration has laid out new standards for the updated Covid-19 vaccine.

Under the new rules, Covid booster shots are now limited to adults aged 65 and older, as well as to children and younger adults with at least one high-risk health problem.  This is a break from the previous federal policy recommending an annual Covid shot for all Americans six months and older. The FDA’s top vaccine official said that more than 100 million Americans should still qualify for a booster under the new guidance.

Nguyen said that Covid booster shots are currently limited to very high-risk patients and are no longer recommended for healthy individuals.  The U.S Immigration and Citizenship Service no longer requires Covid booster shots for people who are applying for U.S. citizenship.

“Covid has changed so much that its severity regarding mortality is very, very small now. It's not the same as it was in the beginning,” he said. “The initial Covid was kind of deadly, but it changed so much that I’d rather have Covid than influenza.”

The 2025 National Immunization Survey, which tracks immunization rates, began on Guam in April and usually runs through June. Fernan encourages parents to respond to the phone survey sponsored by the Centers for Disease Control and Prevention. The survey is used to monitor vaccination coverage among children aged 19 through 35 months; teens aged 13 through 17 years; flu vaccinations for children aged six months through 17 years; and Covid-19 vaccination for children and teens in eligible age groups, as well as for adults aged 18 years and older.

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