Meeting the Challenge of Giving COVID Vaccines to Younger Kids

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On Tuesday, the Centers for Disease Control and Prevention (CDC) endorsed vaccination with the Pfizer/BioNTech COVID-19 vaccine for children aged 5 to 11 years. What are some best practices for meeting the challenges of immunizing this younger age group?

Medscape Medical News spoke to several pediatric experts to get answers.

More than 6 million children and adolescents (up to age 18 years) in the United States have been infected with SARS-CoV-2. Children represent about 17% of all cases, and an estimated 0.1% to 2% of infected children end up hospitalized, according to October 28 data from the American Academy of Pediatrics (AAP).

Physicians and other healthcare practitioners are gearing up for what could be an influx of patients. "Pediatricians are standing by to talk with families about the vaccine and to administer the vaccine to children as soon as possible," Lee Savio Beers, MD, FAAP, president of the AAP, said in a statement.

In this Q&A, Medscape asked for additional advice from Sara "Sally" Goza, MD, a pediatrician in Fayetteville, Georgia, and immediate past president of the AAP; Peter Hotez, MD, PhD, dean of the National School of Tropical Medicine at Baylor College of Medicine and co-director of the Texas Children's Hospital Center for Vaccine Development, Houston, Texas; and Danielle M. Zerr, MD, professor and chief of the Division Pediatric Infectious Disease at the University of Washington and medical director of infection prevention at Seattle Children's Hospital, Seattle, Washington.

Q: How are smaller pediatric practices and solo practitioners going to handle the additional vaccinations?

Dr Sara Goza

Dr Goza: It's a scheduling challenge with this rollout and all the people who want it and want it right now. They're going to want it this week.

I've actually had some children asking their moms, "When can I get it? When can I get it?" It's been very interesting ― they are chomping at the bit.

If I give the vaccine to a patient this week, in 3 weeks the second dose will be right around Thanksgiving. No one in my office is going to want to be here to give the shot on Thanksgiving, and no patient is going to want to come in on Thanksgiving weekend. So I'm trying to delay those parents ― saying, let's do it next week. That way we're not messing up a holiday.

Children are going to need two doses, and they won't be fully protected until 2 weeks after their second dose. So they won't get full protection for Thanksgiving, but they will have full protection for Christmas.

I know there are a lot of pediatricians who have preordered the vaccine. I know in our office they sent us an email yesterday to let us know our vaccines are being shipped. So I think a lot of pediatricians are going to have the vaccine.

Q: How should pediatricians counsel parents who are fearful or hesitant?

Dr Peter Hotez

Dr Hotez: It’s important to emphasize the severity of the 2021 summer Delta epidemic in children. We need to get beyond this false narrative that COVID only produces a mild disease in children. It's caused thousands of pediatric hospitalizations, not to mention long COVID.

Dr Zerr: It is key to find out what concerns parents have and then focus on answering their specific questions. It is helpful to emphasize the safety and efficacy of the vaccine and to explain the rigorous processes that the vaccine went through to receive US Food and Drug Administration (FDA) approval.

Q: How should pediatricians counter any misinformation/disinformation out there about the COVID-19 vaccines?

Dr Goza: The most important thing is not to discount what they are saying. Don’t say, "That's crazy" or "That's not true." Don't roll your eyes and say, "Really, you're going to believe all that?"

Instead, have a conversation with them about why we think that is not true, or why we know that's not true. We really have to have that relationship and ask, "Well, what are your concerns?" And then really counter [any misinformation] with facts, with science, and based on your experience.

Q: Do the data presented to the FDA and the CDC about the safety and effectiveness of the COVID-19 vaccine for 5- to 11-year-olds seem robust to you?

Dr Zerr: Yes, and data collection will be ongoing.

Dr Hotez: I’ve only seen what's publicly available so far, and it seems to support moving forward with emergency use authorization. The only shortfall is the size, roughly 2200 children, which would not be of sufficient size to detect a rare safety signal.

Q: Do previous controversies around pediatric vaccines (eg, the MMR vaccine and autism) give pediatricians some background and experience so they can address any pushback on the COVID-19 vaccines?

Dr Goza: Pediatricians have been dealing with vaccine hesitancy for a while now, ever since the MMR and autism controversy started. Even before then, there were certain groups of people who didn't want vaccines.

We've really worked hard at helping teach pediatricians how to deal with the misinformation, how to counter it, and how to help parents understand the vaccines are safe and effective ― and that they save lives.

That [experience] will help us in some ways. Unfortunately, there is more misinformation out there ― there is almost a concerted effort on misinformation. It's big.

Pediatricians will do everything we can, but we need help countering it. We need the misinformation to quit getting spread on social media. We can talk one on one with patients and families, but if all they are hearing on social media is the misinformation, it's really hard.

Q: Are pediatricians, especially solo practitioners or pediatricians at smaller practices, going to face challenges with multidose vials and not wasting vaccine product?

Dr Goza: I'm at a small practice. We have 3.5 FTEs [full-time equivalents] of MDs and three FTEs of nurse practitioners. So we're not that big ― about six providers.

You know, it is a challenge. We're not going to buy the super-duper freezer, and we're not going to be able to store these vaccines for a long period of time.

So when we order, we need smaller amounts. For the 12- to 18-year-olds, [maximum storage] was 45 days. Now for the 5- to 11-year-olds, we're going to be able to store the vaccine in the refrigerator for 10 weeks, which gives us more leeway there.

We try to do all of vaccinations on 1 day, so we know how many people are coming in, and we are not going to waste too many doses.

Our Department of Public Health in Georgia has said: "We want these vaccines in the arms of kids, and if you have to waste some doses, don't worry about it." But it's a 10-dose vial. It's going to be hard for me to open it up for one child. I just don't like wasting anything like this.

Our main goal is to get this vaccine in to the arms of children whose parents want it.

Q: What are some additional sources of information for pediatricians?

Dr Zerr: There are a lot of great resources on vaccine hesitancy from reputable sources, including these from the CDC and from the National Academies of Sciences, Engineering, and Medicine:

Damian McNamara is a staff journalist based in Miami. He covers a wide range of medical specialties, including infectious diseases, gastroenterology and neurology. Follow Damian on Twitter: @MedReporter.

Kelly Wairimu Davis joined WebMD in June 2021. Prior to that, she interned at CNN as a researcher and at C-SPAN in the American History TV department. She received her bachelor’s degree from UCLA, where she was a reporter for the UCLA Daily Bruin, and a master’s degree in journalism from Columbia University. Kelly also runs a 501(c)(3) nonprofit organization based in Kenya. She lives in Atlanta.

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