In some pediatric practices, shots are already involved. Children’s Medical Group, a private practice in Atlanta, ordered doses as soon as it was authorized and received a first shipment on Monday, the June holiday. They started vaccinating during lunch. “We’ve had a huge demand,” says Jennifer Shu, a pediatrician in practice and editor for the American Academy of Pediatrics. “We’ve even gotten calls from patients in other practices whose doctors don’t have a Covid vaccine for this age group.”
As that suggests – and as parents are – report on Twitter—availability varies. This may be due to those prior predictions of low uptake; practices and hospitals may not want to invest in freezer space and staff time if they don’t expect a lot of interest. But it could also be due to a bureaucratic hurdle that has haunted Covid vaccination since the earliest days. Unlike almost any other vaccine, this one does not come from a commercial distributor; it is provided by the federal government and funneled through the state health departments. So in order to receive it, health care providers must complete the CDC paperwork. That’s true, even if they already participate in other government programs, including Vaccines for Children (known as VFC), which guarantees shots for families without private health insurance.
“The participation of the providers who usually participate in the VFC program has been quite good,” said Marcus Plescia, a physician and medical director for the Association of State and Territorial Health Officials. “It was a slower process to get it to private practice sites. They are not used to being part of government-run vaccine programs. Some don’t want to do that because of the paperwork and red tape.”
The childhood vaccination program may also be hampered by another long-standing problem: vaccine vial size. Each contains 10 doses and, once thawed and opened, must be used within 12 hours. “Paediatricians in particular don’t like wasting vaccines. They consider it a precious commodity,” Hannan says. “Getting them to order enough vials to have a vaccine on hand every day when they may give a vaccine to one person and throw out nine doses because you don’t have nine other kids — that’s a challenge.”
Another complication is that all Covid protections to date, including vaccination, have been unfairly distributed. Half of those 19 million children under 5 are children of color, according to an analysis by Kaiser; 41 percent rely on Medicaid for insurance and 4.5 percent are uninsured. With public sites, pharmacies and schools all unavailable to help the youngest children, there will be added pressure on community and federally qualified health centers to reach children near them. “We know from every part of the rollout that some of the most disadvantaged groups were not vaccinated at the same rate to begin with,” said Jen Kates, director of global health and HIV policy at the Kaiser Foundation. “These are children who are vulnerable for many different reasons, and the last thing anyone wants is for them to suffer disproportionately or have poorer access to this intervention.”
Right now, experts are hoping for a slow shot rather than no shot. Parents whose kids are coming to see a good kid soon, or have an appointment in the summer to get them ready for sports, may choose to wait a few months rather than make a special trip. That has pros and cons: it makes the children more vulnerable to Covid for longer, but it normalizes the vaccine as just one of many injections they receive in their early years.
For some parents, the problem will not be planning, but trust. They will need extra patience from people within the medical system as they work out concerns, perhaps like they worked for themselves last year. “At their next appointment with the pediatrician, they can ask for a conversation — what’s different than calling the office” to arrange the injection, says Angela K. Shen, a visiting research scientist at Children’s Hospital in Philadelphia, who leads the injection. attitude to vaccination. “It can take multiple conversations, with their brother, their sister, their pharmacist and their pediatrician. These people in the middle are the ones who want to pursue public health messaging strategies, to answer their questions in a non-paternalistic way.