COVID vaccines are finally here for young kids. But the logistics aren't easy

My daughter was only just starting to walk when the pandemic started. Now she's almost four, and in all that time — growing up, going to school — she's had no access to any protection from COVID-19 vaccines.

That changes this week. The White House has rolled out a plan for vaccinating the 19 million kids under 5 in the U.S., but if you're just coming out of the holiday weekend trying to figure out where to find an appointment, you're not alone.

Claire Hannan has been helping immunization managers from all 50 states navigate COVID-19 vaccine rollouts since fall 2020 as the executive director of the Association of Immunization Managers. She told NPR what's been happening behind the scenes to get this new low-dose formulation of Moderna and Pfizer's vaccines out so that little kids can finally get protected.

This interview has been edited for length and clarity.

What's the state of the rollout right now? Have pediatricians been able to order these new shots?

There were two waves of pre-orders. The first wave closed earlier in June, and the provider had to be able to accept vaccine [Monday] — on the holiday — so the wave one pre-orders were small. There were significantly more orders in wave two of the pre-orders, which begin being delivered [Wednesday] or Thursday. So I think that it'll be easy to find vaccines by the end of the week.

The CDC advisory meeting where vaccine experts reviewed all the data was on a Saturday of a long weekend. You watched it – what did parents miss?

The committee was unanimous, very passionate about the benefit of the vaccine for kids. I think if anyone has doubts as to whether they should get it for their child, this should take any of those doubts away.

They reviewed data of the disease and the hospitalization and the deaths. There were no serious adverse events [from the vaccine]. It's something that they continue to track as the vaccine rolls out, but there's no reason to suspect that there might be, given the millions of doses of the vaccine on a bigger scale [that] have been given to adults. The effectiveness is not quite what it was with adults, but – with two doses and potentially a third dose of Moderna and three doses of Pfizer – the effectiveness against hospitalization and death is very good.

A lot of parents say, 'Well, my child has had COVID already.' The data they were looking at, it doesn't seem to show any benefit if your child has had COVID as far as preventing future hospitalization and death while the vaccine does [protect against that.] So even if your child has had COVID, I would recommend getting the vaccine and making sure that you get all three doses if it's Pfizer and the two doses if it's Moderna, and just watch for a booster to come.

How much will this rollout rely on pediatricians versus pharmacies?

I think this rollout will be much more reliant on pediatricians and family physicians. From what we've been told by CDC, 70-80% of pediatricians who are enrolled in the Vaccines For Children program are also enrolled in the COVID [vaccine] program. There are a number of challenges for providers, but I think that there will be much more vaccine given in the medical home for kids [their doctors office] than what we saw with older kids, and with adults where pharmacies can serve a big role.

[Pharmacies] can vaccinate down to age three right now while we're in the pandemic, but we've been told by CDC to expect 10% of pharmacies to vaccinate the under five-year-olds because many of them are not comfortable vaccinating the younger kids, they don't necessarily have that relationship with the parents, [or] the space.

Some pediatricians (including mine) do not plan to order the vaccine or offer it in the office. What are some reasons pediatricians may not be participating?

[With other vaccines], pediatricians normally get single-dose vials. When a child comes in, they take the vial out of the fridge and they give it. They don't have to worry about waste.

With the COVID vaccine, it's a 10-dose vial. So if they give a shot to a child, they've got to give nine more shots within 12 hours or they're going to waste – they have to discard the rest of the vial. It's just very, very difficult to get them to order [when they will have to likely] discard unused doses. We've just really been pushing to providers [with the message that] it's better to waste a dose and not waste an opportunity to vaccinate a child.

This is also a new formulation, right? The 5-11 year old vials were different – with an orange label.

Yes, this is a new formulation. The new Pfizer vials are maroon and [the Moderna ones] have a magenta label. So now you have something like six different formulations that a pediatrician would carry if they were carrying both Pfizer and Moderna for all age groups from six months to 18. That's another real challenge.

What we're seeing is that providers only want to carry one or the other brand. They want to reduce their chances of having a storage error or an administration error because the vaccines are so different.

With 5-11 year old vaccines, doctors had to order a minimum of 100 doses. Is that the case with these vaccines?

Yes, the minimum order is 100 doses. That's definitely a challenge. The thing is with a 10-dose vial, if you're a rural provider or if you have a small practice, If you only have 10 kids in your practice in that age group, you know you're potentially opening 10 vials on 10 different days and throwing out the other nine doses every single time. And that's where a provider says, 'You know what? I'm probably not the right provider to be giving this vaccine out.' That's why we have providers, especially small providers in rural areas, saying that they don't want to order it.

But health agencies have done analyses of orders by zip code. They're using local health departments as a place where vaccine will be available in communities. And they're also setting up clinics at the school or mobile clinics if there aren't providers in a certain area that have ordered vaccine.

What should you do if your pediatrician isn't giving out shots and you want to get your under-5 kid vaccinated?

Check vaccines.gov. That shows providers [near you] that have supply of the vaccine for the kids under five. You can see, 'OK, well, this pediatrician is not my pediatrician, but they do have supply and they are vaccinating.' And you can call them. So I would start with the vaccines.gov — you can put in your zip code, you can look.

And then I would call my local health department, or just or go on their website, [or] the state health department website and look and see. They might be having a [vaccine] clinic in your area. I would also check with my pharmacy. CVS minute clinics and some of the urgent care clinics have capacity to vaccinate [kids] under 3.

The Florida governor has been making news by declaring the state would not order any COVID vaccines for this age group? Is vaccine being shipped to Florida?

What happened in Florida is that the state did not order any doses in that [initial] preorder. Providers [like family doctors] are ordering vaccine now, and they were able to order over the weekend, so there will be deliveries to providers probably starting Wednesday or Thursday.

So providers are ordering the vaccine, it is being delivered to them. The retail pharmacies were able to pre-order it, so some of them have it [already].

[So for parents there,] I think it will be harder, and it may be a couple more days before there's more vaccine, but it is being shipped to Florida.

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