Covid injections for small children are finally here. Now for the hardest part

Covid injections for small children are finally here.  Now for the hardest part

In some pediatric practices, the shots are already going to the arms. Children’s Medical Group, a private practice in Atlanta, ordered doses as soon as cleared and received an initial shipment on Monday, the June 16 holiday. They started vaccinating at lunchtime. “We had a huge demand,” says Jennifer Shu, a pediatrician in the practice and editor of the American Academy of Pediatrics. “We’ve even had calls from patients from other practices whose doctors don’t carry any Covid vaccines for this age group.”

As it suggests – and as parents are report on twitter—Availability varies. This may be due to these early predictions of low absorption; practices and hospitals might not want to invest in freezer space and staff time if they don’t expect a lot of interest. But it may also be due to a bureaucratic hurdle that has hampered Covid vaccination since its early days. Unlike almost all other vaccines, this one does not come from a commercial distributor; it is provided by the federal government and channeled through state health departments. So, to receive it, health care providers must complete CDC paperwork. That’s true even though they already participate in other government programs, including Vaccines for Children (known as VFC), which guarantees vaccines to families without private health insurance.

“Participation from providers who usually go to the VFC program has been pretty good,” says Marcus Plescia, physician and chief medical officer for the Association of State and Territory Health Officials. “Getting him out into private practice sites was a slower process. They are not used to being part of government-run vaccination programs. Some of them don’t want to do it because of the paperwork and hassle.

The childhood immunization program can also be hampered by another long-standing problem: the size of vaccine vials. Each contains 10 doses and, once thawed and opened, should be used within 12 hours. “Paediatricians, in particular, don’t like wasting vaccines. They consider it a precious commodity,” says Hannan. “Getting them to order enough vials to have vaccine on hand every day, when they’re potentially going to give one person a vaccine and throw away nine doses because you don’t have nine other kids, that’s a challenge.”

Another complication is that all Covid protections so far, including vaccination, have been inequitably distributed. Half of those 19 million children under age 5 are children of color, according to an analysis by Kaiser; 41% rely on Medicaid for insurance and 4.5% are uninsured. With public sites, pharmacies and schools all unavailable to help younger children, there will be added pressure on qualified community and federal health centers to reach nearby children. “We know from every part of the rollout that some of the most disadvantaged groups weren’t getting vaccinated at the same rates early on,” says 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 more difficult access to this intervention.”

At this point, experts are hoping for slow adoption, rather than Nope absorption. Parents whose children will soon have health visits or summer appointments to prepare them for sports may choose to wait a few months rather than take a special trip. This has advantages and disadvantages: It leaves children vulnerable to Covid for longer, but it normalizes the vaccine as just one among the multitude of vaccines they receive in their early years.

For some parents, the problem will not be planning, but trust. They will need more patience from members of the medical system to solve their problems, perhaps as they solved them themselves last year. “At their next pediatrician appointment, they can ask for a chat — which is different from calling the office” to arrange the shot, says Angela K. Shen, visiting researcher at Children’s Hospital Philadelphia which studies attitudes towards vaccination. “It may take several conversations, with their brother, their sister, their pharmacist, as well as their pediatrician. These people in the middle are the ones public health messaging strategies will want to target, to answer their questions in a non-paternalistic way.

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