Where Are the Pediatric COVID Vaccines?

Oct. 13 2023— It’s been a month since the CDC  recommended  the updated COVID-19 vaccine for everyone 6 months old and older, and promised the vaccines would be “available by the end of this week at most places you would normally go to get your vaccines.” But since that recommendation on Sept. 12, legions of parents are still searching for the vaccine, especially for their youngest children, and growing increasingly frustrated. Public health officials say the situation is improving and will continue to do so. But that’s not comforting for parents like Christina Sellers. In late September, she was busy preparing for her family’s move from the Atlanta area to Lansing, MI. Anticipating that movers would be in and out of the house, her to-do list included not just the usual packing up but also getting the updated COVID vaccine for her, her husband, and their 4-year-old son. She’s immunocompromised, so keeping the whole family up to date on the vaccine is important. She and her husband got their vaccines before the move, but they are still waiting for their son’s. While still in Atlanta, she reached out to pharmacies, the health department, and her pediatrician’s office. No one had it for his age group. The day after the family got to Lansing, “I started calling CVS, Walgreen’s, Rite Aid, a few independent pharmacies, the health department and the big health systems in the area,” she said. She was willing to drive 100 miles, which in Lansing generally takes about an hour and a half, she said. Finally, the Ingham County Public Health Department scheduled her son for the vaccine Oct. 20. “They did book us, but I’ve been trying to persist to see if I can get it sooner.” Sellers’ story is not uncommon. She and about 7,000 others belong to the Facebook group Protect Their Future, an advocacy group for access to childhood vaccines and other health care. Members post their efforts and share information about vaccine availability. On  X, formerly known as Twitter, users who can’t find the vaccine point out how many days have passed since the 2023-2024 COVID vaccine was recommended by the CDC and call out inaccurate or outdated information about availability on such sites as  Vaccines.gov. The number of children under age 18 with confirmed COVID-19 when admitted to a hospital increased almost five times from mid-June to early September, from 237 to 1,175, an analysis by the American Academy of Pediatrics found. More than half of children under age 17 hospitalized with COVID have no underlying conditions, according to the CDC.  Obstacles, Solutions Public health officials and COVID vaccine manufacturers have acknowledged the obstacles, especially in obtaining the vaccine for the youngest children, but point to solutions that are in progress or in place. Supplies: Adult vaccines were rolled out first, but more pediatric doses are coming, said spokespeople for both Pfizer BioNTech and Moderna, the two vaccines approved for ages 6 months and older.  According to a Pfizer spokesperson, “Pfizer shipped and delivered more than 18 million doses of its 2023-2024 COVID-19 vaccine, including more than 1.5 million pediatric doses for children under 12. We’re continuing to meet demand from wholesalers and customers and anticipate delivering millions of additional doses each week.” A Moderna spokesperson said, “Our pediatric COVID vaccine is currently available, and we’ve completed our shipments to the CDC, which manages much of the distribution. We also continue to ship to retail pharmacies and other points of care.” She didn’t immediately provide the number of pediatric doses shipped.  Mixing and fitness matching: The CDC has said parents should stick with the same vaccine manufacturer for children’s vaccines if possible, which can complicate finding the updated vaccine. However, at a  town hall hosted by the American Academy of Pediatrics on Oct. 4, CDC Director Mandy Cohen, MD, MPH, said that for children who completed the primary series with one manufacturer, “going to an updated vaccine with a different one is perfectly OK.”   Pharmacy availability and age cutoffs: In August 2020, the U.S. Department of Health and Human Services (HHS) allowed pharmacists in all states to give the COVID vaccines to children 3 years and older to expand the availability of vaccination options.  In May, that declaration was amended, extending it until December 2024.  “Pharmacies in all states can administer the COVID-19 vaccine to individuals ages 3 and up,” an agency spokesperson said. COVID-19 vaccines for ages up to 2 years “must be administered in a provider’s office,” she said. Even so, policies vary from pharmacy to pharmacy as to which ages they will vaccine. For instance, pediatric COVID-19 vaccine appointments for those age 5 years old and older can be made online at CVS or via the CVS Pharmacy app, said Matthew Blanchette, a spokesperson. Those 18 months old and older can get the vaccine at the CVS’ MinuteClinic, the in-store clinics, and make the appointment at Minuteclinic.com. The rationale: MinuteClinic locations are staffed with providers such as nurse practitioners, physician assistants and physician associates as well as support staff who are experienced in giving vaccinations to younger children, he said. It’s best to call ahead and verify any online information, even appointments — as parents in the Facebook group can attest after scheduling appointments, going, and being told there is no vaccine for their child.  Doctors’ buy-in: As the vaccine supplies became commercialized and doctors now have to pay, some pediatricians were reluctant to order the vaccines, citing tight profit margins and uncertainty about how many of their patients would opt for the updated vaccine. Now, Pfizer is allowing a 100% return policy, which is expected to result in more pediatrician offices ordering the vaccine, which comes in three-dose vials. In an email, a Pfizer spokesperson confirmed that “Pfizer has a 100% return policy for wasted/expired vaccines for under 5 and [buyers] will receive credit within 60 days of Pfizer receiving the return.”  Moderna’s pediatric COVID vaccine is provided in single-dose vials, a spokesperson said, noting that pediatricians “have more precision when ordering and there is therefore less waste. Moderna does allow for a percentage of an order to be returnable.” These policies seem to have helped.  “I have seen increased willingness from pediatricians to order the vaccine,” said Pia Pannaraj, MD, MPH, a professor of pediatrics at the University of California, San Diego, and a member of the American Academy of Pediatrics’ Committee on Infectious Diseases.  Efforts Continue, Sometimes Success For some parents, improved availability can’t come soon enough.  “In our group, we have so many families right now clamoring to figure out where they can find the vaccine,” said Fatima Khan, parent to a 5- and 7-year-old and a co-founder of Protect Their Future. “We’ve had parents drive 2 hours to be told the vaccine is not available [after making an appointment]. What was really disturbing was that even last week we were hearing from people in Manhattan not being able to find it.”  Khan, of Novi, MI, found the vaccine for her children but had to drive about an hour to get it. The vaccine is sometimes hard to find even for older children, and parents often report that information on vaccine websites is out of date or entirely inaccurate. After one appointment was made, then canceled by the pharmacy because they had no supply, Lynn Fingerhut of Peoria, IL, managed to get the updated vaccine for herself, her husband and her 14-year-old son.  She had to make multiple phone calls to find the vaccine for her 10-year-old son. “I spent about 2 hours, 20 minutes on calls on hold just on Tuesday,” she said. She has a home-based sales job and a dog-walking business, and often multi-tasked on the walks, staying on hold for a long time.  Finally, she struck gold. The pharmacy at a Kroger in East Peoria told her she can just walk in this week. She did on Thursday and her son got the vaccine. Sellers, the mother of the 4-year-old who’s not vaccinated, is a nurse practitioner and is hoping for similar success. “If I could get my hands on the shot, I’d stick my own kid.”