Parents of young children are scrambling to find still-scarce doses of the updated Covid-19 vaccine, which was recommended in mid-September for everyone ages 6 months and older.
When they can find it, some say they’re running into additional barriers that prevent their children from getting the shot: Appointment scheduling snafus, age cutoffs at pharmacies, insurance reimbursement confusion and guidelines that discourage mixing and matching different brands of vaccines for younger children have all created headaches for families.
The frantic search comes as Covid-19 hospitalizations among young children raised new concern. Since June, hospital admissions in people younger than 18 have risen fivefold, from 237 to nearly 1,200 in the week ending September 9, according to data compiled by the American Academy of Pediatrics. Hospitalization rates in adults rose about threefold over the same period. Children under 5 are at highest risk.
Kristin Kessler doesn’t want her 3-year-old son, Jackson, to be one of them. Jackson has asthma that’s triggered by respiratory infections. He had his initial shots to protect him from Covid-19, but is due for an update, Kessler said.
“He was hospitalized last year for a couple of days. For — we’re not even sure what the respiratory virus was, but something that just kind of pushed him over the edge,” said Kessler, who lives in the Washington area.
His pediatrician is part of a large medical group with several locations in the northern Virginia area, but when Kessler called to ask if they had any Covid-19 vaccines, staffers told her they weren’t going to offer it and advised her to go to the federal government’s Vaccines.gov site, which offers a location finder for people searching for available shots.
Pharmacies in her area will vaccinate children as young as 3, and in-store clinics will sometimes vaccinate kids as young as 18 months, but she said she scoured pharmacy and clinic websites with no luck.
The closest appointments for kids Jackson’s age are two to three hours away.
“If it comes down to that, that’s what I would do, but I’m trying to find something that’s closer,” Kessler said. She and her husband both work full-time. Jackson goes to day care, and every time he gets a cold, she tracks his blood oxygen levels and counts his breaths to make sure he’s OK.
“It’s concerning that it’s been such a struggle, in that I have to put in so much effort just to try to find him a vaccine,” Kessler said. In the Minneapolis area, Jennifer Coleman said her family is very Covid cautious after her husband had long Covid for a year following an infection early in the pandemic.
Their pediatrician wasn’t sure when or if the office would offer updated Covid-19 vaccines, so Coleman started searching elsewhere. She was able to schedule an appointment for her teen next week, but finding a shot for her 4-year-old has been much harder.
“There’s just been no priority around the pediatric vaccines,” Coleman said. “And these are the kids that are in kind of viral Petri dishes that are their day cares, and my daughter’s day care did have a pretty large outbreak.”
During the health emergency, the US Department of Health and Human Services gave pharmacists nationwide the ability to immunize children as young as 3. Since it ended, pharmacies in Minnesota can’t vaccinate kids under age 6.
“We’re completely locked out of all the pharmacies,” Coleman said.
Coleman said she tried to get into several local children’s hospitals that were having vaccination events, but they all had Pfizer vaccines. Her daughter previously had Moderna shots, and the US Centers for Disease Control and Prevention recommends that children under 5 get the same product for all their vaccine doses. So she’s still looking.
“Honestly, I think it’s maddening,” Coleman said. “And we really are just trying to protect these kids from what we know could be very seriously damaging virus through the modern science that we should have accessible to them.
“It seems like poor planning that the rollout has been this way, and unfortunately, these kiddos have been on the receiving end of this.”
Some doctors won’t stock new shots
Adults saw some of the same scheduling and insurance issues when the updated Covid-19 vaccines first rolled out last month, but government and insurance officials say they’ve largely resolved. For kids, the list of things still slowing the rollout is lengthy.
First is cash flow. The pediatrician’s office is the medical home for kids, where young children get most of their routine immunizations. But pediatricians operate on tight margins, and some say the economics of these vaccines don’t work for them. The updated Covid-19 vaccines now cost about four to five times the average price that the government was paying for them, according to the health policy think tank KFF.
When the government was paying for the Covid-19 vaccines, the only thing doctors had to figure out was how to store them, since the shots require ultra-cold storage or refrigeration for up to a month. But since commercialization, when companies began selling the Covid-19 vaccines on the open market, some offices have been reluctant to buy them, said Dr. Jesse Hackell, a pediatrician in Pomona, New York.
For the first time, “they’re laying out money in advance to get the vaccine,” Hackell said.
“When we used to get it for free, it was easy,” he said. “It’s a tremendous burden on the pediatrician to order it in advance and to pay for it.” These offices are also taking a risk, he said, because they don’t know what the demand for the vaccine will be. He’s heard from some of his fellow pediatricians they won’t offer the shots.
Covid-19 vaccination rates have consistently lagged for children. In May, when the public health emergency ended, less than 1% of children under 5 had received the bivalent booster, and less than 10% of children ages 5 to 17 had received it, CDC data shows.
The explanation for those low numbers is often that parents are hesitant to vaccinate their kids, but Fatima Khan, co-founder of the nonprofit advocacy group Protect Their Futures, thinks these numbers may also tell a story about access and how difficult it is to get young kids vaccinated.
“There are a lot of parents out there that want to do the right thing. They want to protect their children. And again it’s the red tape that is just not allowing kids to get protection,” she said.
Khan said it’s especially frustrating to hear public health officials tout the vaccines and urge people to get them when so many parents are fighting to do just that.
“It would be good to really hear from our leaders about what is going on and not just sort of the platitudes of like, ‘Be patient. It’ll happen,’ but really like explain to parents and doctors alike why this is so complicated and what can be done to fix it,” she said.
Frustrating search continues
Kaley Beins of Rockville, Maryland, has been scouring websites trying to get her toddler vaccinated. At 23 months, Petra is too young to get her shot in a pharmacy.
“Unfortunately, our pediatrician reported they had issues with insurance reimbursement,” Beins said.
Her doctor’s office said it would carry the updated Covid-19 vaccine for kids but only through its cash-only travel clinic. Patients could pay out of pocket if they wanted the vaccine and then file with their insurance companies for reimbursement on their own.
Beins discussed it with her husband. “We talked about it we decided that we were going to pay this $150 out of pocket for a vaccine.” They have a health care savings account, and they figured they’d pay for it that way.
But when they went to schedule Petra’s appointment, they learned that the clinic has only Pfizer shots in stock. Petra previously had Moderna, and because of the CDC guidance not to mix and match, they decided to wait. Beins next called the Maryland Department of Health. She said she was transferred and transferred until she reached a dead-end line that didn’t take messages.
She tried calling the CDC number on the Vaccines.gov website, and it gave her the name of three clinics near her that had kids’ vaccines in stock. But when she called the clinics, none of them had the pediatric doses, and they didn’t know why the CDC was telling people that they did.
So she wrote a long, venting post on Facebook about her travails, and another member of the Protect Their Futures group shared a link to the CDC’s Vaccine Administration Management System, which can help people schedule appointments. Beins says she found a health fair that was giving Moderna shots for kids. She and several members of the group eagerly booked appointments.
But when they tried to call to confirm, they couldn’t get anyone on the phone.
“Everyone’s kind of chatting each other on Facebook saying, ‘hey, have you heard anything? Do they have it?’ We don’t really know. There’s a rumor that there’s a refrigeration issue, but we can’t get any answers,” she said.
Not wanting to risk missing a shot for her daughter, she went anyway.
“It was about an hour’s drive, with my almost 2-year-old who does not like car rides,” Beins said. “We showed up at the health fair, and they said there’s not enough refrigeration on-site to handle the Covid vaccines, would I like a flu shot?”
She drove home disappointed and got an email from the CDC canceling the appointment at 7 p.m. — hours after the fair had ended.
Petra is registered for another clinic in Manassas, Virginia, on Tuesday. When Beins got the confirmation email, however, there was another surprise: It said the clinic would not vaccinate kids under age 3. But when she called, she got a different story: It wouldn’t be a problem to vaccinate Petra.
“We have no idea if we’ll actually be able to get this vaccine,” Beins said, but her husband is taking the day off work and driving her daughter there just in case.
Coincidentally, Beins is a toxicologist who works in public health. She’s supposed to know how all these systems work.
“If I can’t figure out how to do this, how does the administration expect parents to do this and actually have uptake of this vaccine?”
She has another fear: that this “abysmal” rollout will lead to fewer vaccine resources for kids in the future.
“They’re going to use these data to say that people don’t want the vaccine for their kids, when really, the failures are too great for kids to get it.”
Equity issues for kids
“Access is a problem,” said Hackell, the pediatrician.
About half the kids in the United States get free shots through the CDC’s Vaccines for Children program, which many doctors participate in. But Hackell said orders for those vaccines opened on a state-by-state basis.
“Some states also allowed ordering even before the vaccine was released, whereas others didn’t open up their ordering supply until just this week,” he said. Some pediatricians say they plan to carry the vaccine, but they haven’t received any doses and don’t know when they will arrive.
Hackell said he has some colleagues across the country who have gotten their allotment of free vaccines, but others are still waiting.
“So that’s a real problem, and it’s an equity problem as well, because kids who depend on VFC are the ones who are covered by Medicaid or uninsured. And so those kids can often have a tougher time accessing the vaccine,” Hackell said.
CDC Director Dr. Mandy Cohen said Friday at a briefing sponsored by the National Foundation of Infectious Diseases that adult doses had been prioritized over vaccines for kids.
“We do know that our manufacturers and distributors were getting out the adult vaccines first. So that was what was shipping in the first number of days, and now they are shipping pediatric vaccine,” Cohen said.
On Monday, one vaccine manufacturer said they were filling orders as fast as they come in. They stressed that while some orders go directly to individual purchasers, others first go to large distributors, who then must process them and send them out, and those additional steps take time.
“All orders are being fulfilled as received, and 100% of orders are being shipped within days of an order being placed,” said Kit Longley, a spokesperson for Pfizer.
Longley said Monday that the drug manufacturer had shipped 10 million doses of its Covid-19 vaccine, including more than 1 million pediatric doses. Moderna, the other manufacturer of Covid-19 vaccines for children, didn’t respond to a request for comment.
— CutC by cnn.com
