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Vaccinating kids for COVID-19 poses additional challenges for officials

White House has yet to release distribution plan that incorporates school clinics

Public health advocates who expect COVID-19 vaccines to become available for younger teens soon are concerned that a government-led distribution effort that may rely in large part on pediatricians could create glaring inequalities among children.

With only three months before the next school year starts in some areas, advocates are calling on the Biden administration to develop a more detailed outreach strategy, encourage schools to offer shots and provide more funding to get kids vaccinated. 

Distributing vaccines to kids will likely present many of the same challenges that plagued the United States’ efforts to vaccinate adults, experts say, including issues with equity, access and skepticism. Kids’ dependence on adults adds another layer of complexity that could make vaccinating them even more difficult. But the Biden administration has not yet released a plan to get kids vaccinated, which public health experts call a problem. 

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“Vaccinating kids is going to look very different from vaccinating adults. They need a plan tailored to them that’s specific to them and to their needs,” said Averi Pakulis, vice president for early childhood and public health policy at the First Focus on Children advocacy group.

Experts anticipate the shot will be available to young teens in May or June. Those working on the ground are waiting to see formal guidance from the Biden administration.

“We have to start talking about it. Getting kids vaccinated, getting adolescents vaccinated is the next big frontier,” said Claire Hannan, executive director of the Association of Immunization Managers.

A central concern is how to ensure that minorities have opportunities to get vaccinated. The virus is already disproportionately hurting kids in communities of color. Black and Hispanic children under age 14 are both 3.3 times more likely to die of COVID-19 compared with white children the same age, according to data from the COVKID Project.

Sara Bode, a member of the American Academy of Pediatrics’ Council on School Health, said the AAP plans to soon release recommendations about setting up COVID-19 vaccination clinics in schools to reach more kids. These recommendations would be made in coordination with the Centers for Disease Control and Prevention.

“You’re going to end up with school districts that have an 80 percent vaccination rate and school districts that have a 10 percent vaccination rate of their student population. And those same school districts that are at the 10 percent are likely the same districts that have struggled to get back to in-person learning,” Bode said, warning about what will happen if vaccines aren’t offered in schools. 

Black and Hispanic adults are getting vaccinated at a lower rate than white adults, largely because it’s more difficult for them to access a vaccine, not because they are more likely to say no to the shot.

These access issues will only be magnified in kids, explained Kelly Murphy, a maternal and child health policy expert with Families USA. 

“Kids have to rely on their parents, who also may not be able to take off work to get their own vaccine, let alone to then also take their kids another time to get their vaccine. It just kind of creates additional layers of barriers,” Murphy said.

Debate over distribution

This problem will likely be pronounced among children of essential workers and immigrant families and in communities of color. Although health experts say it’s unlikely many public school districts will require the COVID-19 vaccine this school year, they say vaccinating as many students as possible this summer would decrease community spread and help create a more normal school year.

Leaving kids unvaccinated could lead to new, more dangerous virus mutations and slow down protections through herd immunity. Already, virus variants are causing more infections in children. States across the country have reported an uptick in pediatric COVID-19 hospitalizations, largely due to the prevalence of the highly contagious B.1.1.7 variant. 

Offering the vaccines through school clinics as well as other channels could remove obstacles, Bode said. 

The administration is not telling schools at this point to prepare to offer the shots. When asked about plans for vaccinating children, a White House spokesperson pointed to administration officials’ comments about distributing COVID-19 vaccines to pediatricians. 

“As it relates to kids, there is a well-established route of vaccinations, through the pediatrician’s office,” Andy Slavitt, the White House senior adviser on the COVID-19 response, said in April. 

Pediatricians are often a trusted source of health care for children. The Academy of Pediatrics is working to register pediatric practices as COVID-19 vaccine providers and ensure they have the setup to provide vaccines.

But relying largely on pediatricians’ offices may not be enough. Some vulnerable populations that don’t often go to their pediatricians will face more challenges.

Some schools across the country already have vaccine clinics for students who are 16 to 18, but extending these clinics would take coordination and cooperation from public health departments. Bode said these clinics may require federal funding, but she was unclear on how much.

First Focus on Children recently sent a letter to Biden administration officials encouraging them to set aside funds for children’s vaccination, including at places like schools, child care centers, recreation centers and youth sports venues.

The recent COVID-19 relief law set aside $20 billion to establish a national vaccination program but does not specifically dedicate funds for pediatric vaccines. The plan also offered nearly $130 billion to help K-12 schools reopen safely, and some experts said they hope that money can go toward vaccination. 

Convincing parents

State laws generally dictate school vaccine requirements. Many colleges are already saying they will require vaccinations for students to return to campus. Public school systems have yet to make decisions, and experts say it’s unlikely the coronavirus shot will be mandated for this school year.

Every state requires specific vaccines for students, but the COVID-19 vaccine is more tricky because there is no precedent for requiring an authorized, although not fully approved, vaccine in schools, Hannan noted. 

The vaccines are not yet authorized for children. Pfizer is the furthest along, and the company said clinical trials proved its two-shot COVID-19 vaccine to be 100 percent effective in kids ages 12 to 15. Moderna and Johnson & Johnson are also testing their COVID-19 vaccines on kids. 

The Food and Drug Administration has yet to take any action on Pfizer’s request to authorize its COVID-19 vaccine for kids ages 12 to 15, which was submitted on April 9. The agency will not hold a Vaccines and Related Biological Products Advisory Committee meeting before making a decision, as it did with other COVID-19 vaccine authorizations, because this is an already authorized vaccine being considered for a different age group. 

Paul Offit, a member of that vaccine advisory committee, said recently that he expects the FDA to authorize the vaccine soon and is “not sure what the delay is.” 

Vaccine-hesitant parents may also be a barrier. Parents who get vaccinated themselves may be reticent to give their children the shot or wait for more information. A recent Parents Together survey found 70 percent of parents plan to get vaccinated, but only 58 percent plan to vaccinate their children.

The administration should retool parts of its COVID-19 public education campaign to target parents and caregivers once the vaccine is available to kids, Pakulis suggested. Much of that messaging could happen locally in pediatricians’ offices or schools.

“That should be happening as soon as possible. Now is not too soon. … You also don’t convince parents in a day, right? It’s going to take more work than that,” Pakulis said.