POLITICO contacted each state, the District of Columbia and Puerto Rico to ask how many of the recently approved Moderna and Pfizer-BioNTech vaccines they ordered, and 38 jurisdictions have provided that data. Several of the states that reported placing some of the lowest orders relative to their under-5 populations also have low Covid-19 vaccination rates for 5- to 11-year-olds, an early indication that vaccinations for the youngest children are an issue. similar pattern.
Since becoming eligible last fall, 36.6 percent of 5- to 11-year-olds have received one Covid-19 shot and only 30 percent have been fully vaccinated, compared to 69 percent of adults aged 18 to 49. the slow uptake, in part due to the fact that many parents don’t believe the vaccine is necessary or effective, or that its benefits outweigh its risks.
For example, in Alabama, where 16 percent of 5- to 11-year-olds received at least one Covid-19 vaccine dose, the state ordered enough doses of the youngest childhood vaccines to cover about 13 percent of the population under 5 with a single dose.
Mississippi, where single-dose vaccination rates from 5 to 11 are just over 16 percent, ordered enough injections to cover about 16 percent of the population under the age of 5 with one dose, while Oklahoma, where single-dose vaccination 5 to 11 dose vaccination coverage is over 20 percent, ordered enough to cover about 19 percent.
Florida — the only state to explicitly advise against Covid-19 vaccines for young children — has not pre-ordered any of the 5-and-under vaccines. It has now allowed practitioners and health systems to order the injections through a state portal, but does not make them available in state-run health programs.
The state did not respond to questions about its order, but GOP government Ron DeSantis said last month the vaccine hadn’t undergone enough testing and clinical trials to determine its effectiveness in children.
That worries Lisa Gwynn, a pediatrician and president of the Florida division of the American Academy of Pediatrics. “You don’t let parents choose,” she said. “You close the delivery.”
POLITICO calculated the percentage of the population under 5 for which each state ordered vaccines using census data including neonates under 6 months of age who are not yet eligible for vaccination. So the percentages slightly underestimate the proportion of children who are under vaccine orders.
States, whose orders can cover requests from doctors, health care systems and state and local health departments, say they have adequate doses on hand and can order more if needed.
The Mississippi State Department of Health “has ordered enough to meet initial demand from suppliers ordering vaccines and to cover our county health departments, but we have the ability to order as much as we need,” Liz Sharlot, communications director for the department, said in a statement to POLITICO. “Anyone who wants their baby or child to be vaccinated can do that.”
A few states noted that practitioners are ordering smaller amounts of the vaccine due to storage restrictions, and one state reported that some suppliers say they will wait for full FDA approval of the injections before applying for the vaccine.
A CDC spokesperson said the rollout of the vaccines over two holiday weekends may have impacted both demand and appointment availability, warning it may be too early to correlate orders of the 5-and-under vaccines with vaccination rates. of older children.
So far, about 2,671,800 children under the age of 5 — of the nearly 19 million newly eligible — have received at least one dose of the vaccine since the FDA gave emergency clearance to the two manufacturers’ drugs on June 18. According to the CDC†
The government expected an early spike in vaccinations under 5 years of age due to pent-up demand from parents who have long wanted to vaccinate their children, but predicted that spike would diminish as a much larger group of parents wait to decide.
The CDC is now targeting doctors to help convince those parents and refine its case that vaccination is worthwhile.
“While we try to reassure… we also need to be very understanding of the families who say, ‘I just need a minute. I want to think about it,” Sara Oliver, the working group leader of the CDC Advisory Committee on Immunization Practices, said during a June 29 webinar† “Giving people the space to answer very reasonable questions is how we get those numbers up.”
Asking providers for help
State vaccine orders do not take into account the total number of Covid-19 shots available to children in a state. For example, pharmacies and federally qualified health centers can order vaccines through separate channels.
But federal health officials expect that parents are most likely to have their youngest children vaccinated while visiting a trusted pediatrician, primary care physician or nurse. The CDC says it is encouraging practitioners to vaccinate more children — and to help correct widespread misconceptions, including that vaccines aren’t safe, or that Covid-19 doesn’t affect young children.
The agency has also encouraged states to enroll providers who are part of Vaccines for Children — the federal program that gives free injections to children who are Medicaid eligible, uninsured or underinsured, or who are American Indian or Alaska Natives — to administer Covid-19 vaccines.
Many practitioners are on board. A recent study of Vaccines for Children providers, for example, found that nearly three-quarters of respondents planned to administer the Covid-19 vaccine to the under-5 age group.
But in some parts of the country it can be more difficult to get their help.
In Louisiana, where Covid-19 vaccination rates among older children are also low, a group of pediatricians in the Shreveport area cited numerous doubts about administering the 5-and-under vaccines in a recent survey conducted by the Northwest Louisiana Pediatric Society. They were concerned about reimbursement, logistical challenges and pushback from parents who do not want to vaccinate their children.
“About half of the offices that responded plan to offer the vaccine to the younger age group. That means half of them aren’t,” said John A. Vanchiere, pediatric infection specialist and associate director for Community Outreach at LSU Health Shreveport’s Center for Emerging Viral Threats.
While that doesn’t seem to have created an immediate barrier for parents seeking the vaccine, it does reflect a problem, Vanchiere said. “Parents who want to get it can, but the vast majority of parents are still hesitant to vaccinate their young children.”
Practitioners in rural parts of the country are less likely to recommend pediatric Covid-19 vaccines, according to a March CDC MMWR report† It found that nearly 40 percent of parents in rural areas said their child’s pediatrician did not recommend a Covid-19 vaccine, compared with just 8 percent of parents in urban areas.
The federal government’s emphasis on practitioners could also have the unintended consequence of discouraging some smaller pharmacies that have served as community centers for Covid-19 vaccination from administering the injections.
Ritch’s Pharmacy in Mountain Brook, Ala., isn’t administering the vaccine to the youngest children because co-owner Rebecca Sorrell decided it was better for pediatricians to handle given the complicated multi-dose courses. The Pfizer injection requires three doses, with the first two three to eight weeks apart and the third at least eight weeks after the second. The two shots of Moderna are four to eight weeks apart.
“We got quite a few calls the first week,” Sorrell said, referring to the period after the FDA approved the shots. When people in town learned where the vaccines were available, the phone calls stopped, she said.
The case for childhood vaccination
The CDC is trying to better explain to skeptical parents why they should vaccinate their children. Getting that message out is becoming increasingly urgent as the Omicron subvariant BA.5 spreads across the US, epidemiologists say.
The strain is causing an increase in cases that disproportionately affect unvaccinated and undervaccinated children, including children, said Buddy Creech, a pediatric infectious disease specialist and the principal investigator of Moderna’s pediatric studies.
“We’re seeing more kids die from Covid than in our worst flu year and we don’t know how to predict which kids that will happen to,” he said.
While it is primarily children with underlying health conditions who experience serious illness and die from Covid-19, that is not the case among children who have developed fatal cases of Covid-19-related multi-inflammatory syndrome, Creech said. “Some of these are healthy kids.”
The CDC says: 70 children have died of the syndrome since May 2020.
Since 2020, there have been more than 2 million cases of Covid-19 in children aged 6 months to 4 years, as well as more than 20,000 hospitalizations and more than 200 deaths. In children ages 5 to 17, there were 10 million cases, more than 45,000 hospitalizations and more than 600 deaths, according to CDC data.
By comparison, in 2020, firearms were the leading cause of death among Americans ages 1 to 19, with 4,357 deaths, according to an analysis of CDC data by the Kaiser Family Foundation. The leading natural cause was congenital disease, which killed 3,166 in that age group, followed by cancer in 1,767 and heart disease in 687.
Long Covid is also a threat to children. While estimates vary widely on the percentage of children infected with the virus who develop long-term Covid symptoms, some pediatric long-term Covid clinics across the country have months-long waiting lists for children with a wide range of symptoms.
Jason Newland, an infectious disease physician at the University of Washington at St. Louis Children’s Hospital, says his concerns have shifted from the immediate chaos of a big wave to thinking about the long-term and broader impact of children becoming infected.
“I’m not too worried that we’ll be overrun like January 2022,” he said. “Am I afraid that there will be many people with serious illness? Yes… we must continue to push for more people to be vaccinated.”