US Covid-19 vaccine rollout for under-fives must overcome hesitancy

For some American families, it was a much-anticipated and badly needed victory: Covid vaccines for children under five began rolling out in the US last week.

“I’ve already been waiting a year and a half since I got my first dose, and that’s been intolerable,” says Dr Roby Bhattacharyya, an infectious diseases doctor at Massachusetts general hospital and parent of a four-year-old who received his first dose of the Pfizer vaccine on Tuesday.

But others still have questions as America’s problem with vaccine hesitancy has not gone away. Less than one in five families want to get their children vaccinated as soon as possible, while the majority say they want to “wait and see” first.

Only 18% of parents plan to have their children under five vaccinated right away, while 38% want to see how the vaccine rollout goes, according to an April survey from the Kaiser Family Foundation (KFF). Another 11% say they will only get their kids vaccinated if they are required to, while 27% say they definitely won’t do it.

This trend mirrors hesitancy among families with older children. Less than a third – 29.6% – of children aged five to 11, and 59.8% of children 12 to 17, are fully vaccinated, according to data from the US Centers for Disease Control and Prevention (CDC).

“Most parents are not rushing to do this,” says Jen Kates, senior vice-president and director of global health and HIV policy at KFF.

More than half of the families of young children say they need more information on the safety and effectiveness of vaccines for this age group.

On top of the questions families have about vaccines, there may also be significant access issues in this younger age group. When vaccines for five- to 11-year-olds rolled out, Kates got an email from her son’s school about the vaccination clinics they were holding.

But younger kids may not be in school, and even if they are, pre-schools and daycares probably won’t hold similar clinics. That makes it harder to schedule a vaccination – and, for families that haven’t followed the vaccine news closely, they may not know the vaccines are available until someone, like a pediatrician or family doctor, offers them.

“It may be the case that a parent isn’t even going to encounter an offer for it until they go to a routine visit,” Kates said. That means it’s important for “trusted messengers” like pediatricians, family doctors and local public health officials to get the word out quickly, she said.

“There’s no magic here. It really is the hard work of letting people know, and then educating them about how safe these are.”

More than 4m doses of the under-fives vaccine have been delivered to about 13,000 sites in the US, the White House coronavirus coordinator, Ashish Jha, said on Thursday. The federal government plans to deliver a total of 10m doses.

Nearly 20 million children in the US are under the age of five.

More than 20,000 children in this age group have been hospitalized, and more than half – 63% – of the young children hospitalized during the first Omicron wave had no underlying conditions.

“It’s hard to predict which young children are going to develop severe disease and need to be hospitalized,” said Kristina Bryant, a pediatric infectious diseases specialist at Children’s hospital in Louisville and professor of pediatrics at the University of Louisville.

Dr Sophia Jan administers a coronavirus vaccination to Kevin Lazarus, four, at Long Island Jewish Medical Center in the Queens borough of New York this week.
Dr Sophia Jan administers a coronavirus vaccination to Kevin Lazarus, four, at Long Island Jewish Medical Center in the Queens borough of New York this week. Photograph: Justin Lane/EPA

And 442 children under five have died from Covid since January 2020.

“Some parents just have not yet heard the message that Covid-19 can be a serious illness in young kids,” Bryant said.

An estimated three in four American children have recovered from Covid at least once. But new variants are increasingly able to overcome immunity from prior infection – and “there’s no guarantee that the second time will be mild,” Bryant said. Vaccination can help shore up protection, especially against severe illness and death.

Families may also not understand how much data officials have on the safety and efficacy of the vaccine.

“They also don’t realize that there have been so many millions of these vaccines administered, with such good safety results – that it’s really incredibly safe,” Kates said.

Some parents are also hesitant because of the long-delayed timeline on vaccines for America’s youngest. The independent vaccine advisers for the US Food and Drug Administration (FDA) planned to meet in February to discuss trial data, before the meeting was abruptly canceled.

Anything that creates any level of uncertainty or anxiety or questioning can backfire in this environment,” Kates said

“Parents want to protect our children as much as possible,” she said. When it comes to Covid, they need to know the risks of infection and the benefits of vaccination – which means answering their questions and offering reliable information to battle the wealth of misinformation they encounter.

“It comes down to the trusted messengers and as many access points as you can provide,” Kates said, to help make vaccination quick and easy.

“Parents who have questions should definitely work with their pediatricians or primary care providers to get those questions answered. As pediatric clinicians, we need to meet those families where they are,” Bryant said.

A recommendation from a pediatrician or trusted primary care provider is one of the most important factors in parents’ decision to immunize their child against a variety of diseases, she said. “Pediatricians and other primary care providers need to be ready to speak about the vaccines and make a strong recommendation.”

Having two options on vaccines for children now could help with some of the hesitations and access issues that some parents have.

Pfizer is a lower dose, which means that maybe parents who are concerned about side-effects might go for that one, while Moderna is only the two doses for now, which may be helpful for parents or guardians taking time off work or finding transportation – both of which can be important equity issues in getting vaccinated.

It’s important to move as quickly as possible, the experts said.

The vaccines offer protection two weeks after the last dose in the series – which is after dose 2 for Moderna and dose 3 for Pfizer among this age group.

“If families wait until there’s a lot of Covid in their communities, or they say, ‘I’ll wait until school starts,’ well, then their child is not going to be protected at that time, because immunity is not immediate,” Bryant said.

Vaccinating children now could help prevent a surge in fall or winter, particularly as kids head back to school in a few weeks.

Dr Bhattacharyya, for his part, was relieved that his son will soon be protected by vaccines. His son was thrilled, too – especially when they celebrated with ice-cream.