One issue is that pediatricians, the primary point of contact for vaccination, are having trouble with vaccine financing. Offering vaccines is a costly part of their practices, even with insurance coverage and government funding programs — but ultimately, most pediatricians still want to ensure that children get the vaccinations they need to be safe from infection. This is actually one thing Obamacare is supposed to fix: Under ACA, routine vaccinations will be covered.
If vaccines are available, why aren’t kids getting them? Because parents are refusing them — which brings us back around to the issue of which parents are refusing them. For relatively privileged parents, refusing vaccines is seen as an action with little consequences, and one that will benefit their children (while those parents are relying on terrible science and making terrible choices, it would be beyond unreasonable to suggest they aren’t trying to act in the best interests of their children). In the West, the incidence of vaccine-preventable diseases became so low at the end of the 20th century that many people hadn’t seen such illnesses first hand.
Meanwhile, in the Global South, parents of all social classes had ample incentive to vaccinate their children, because they knew what outbreaks looked like and they wanted to take steps to prevent them.