Don’t forget about our youngest children: Most remain unvaccinated

Throughout the COVID-19 pandemic, many parents have been patiently reminding us: Don’t forget about our youngest children. But time and again it felt like the youngest, most vulnerable children in our society were being forgotten and left behind. This included the development and testing for vaccines for children ages 6 months to 5 years of age.

While we understandably must be careful with all vaccine testing, especially for young children, it felt like an extremely long wait until these vaccines became available, a full 18 months after the initial roll out for adults. But now, for the most part, it seems that everyone has moved on.

After the tremendous wait, vaccines for the youngest kids are now available — but where is the fanfare, celebration and movement to get these children vaccinated? Where is the mass vaccination events, the coordinated public health efforts from states, communities and health systems?

While the White House, Centers for Disease Control and Prevention (CDC), American Academy Pediatrics (AAP) and even Elmo have been promoting vaccination, the world seems otherwise quiet. The movement to vaccinate children 6 months to 5 years of age has been slow, and uptake has been reportedly low. There are already many challenges to vaccinating this population of kids with these vaccines. First, they require three doses separated by a total of at least 11 weeks for the Pfizer vaccine and two doses separated by at least four weeks for the Moderna vaccine. The dosages are different, the two options cannot be easily compared, there’s a slight difference in the age range for each, and more. In short: it’s complicated.

Second, this population of children accounts for only 6 percent of the U.S. population, almost 1-in-5 live below the federal poverty line, and rates of population, poverty and insurance vary widely from state to state.

Third, there will likely be far fewer locations for children this age to get vaccinated. Providers who have stocked vaccines for other ages may be hesitant to do so for these ages due to the complexity or perceived lack of demand. Many community vaccine sites have long packed up and gone home. Parents are going to be less likely to take their children to a pharmacy for vaccination and most pharmacies can’t vaccinate children less than 3 years of age. It’s a tough road when many are already facing exhaustion, vaccination rates for routine childhood immunizations are down, so many barriers exist.

While many of us have benefited tremendously from vaccination, we must remember that we have an entire population of young children that are unvaccinated and have not had that opportunity yet. COVID-19 hospitalization rates for children 4 years old or under were five times higher during the omicron variant peak compared to the delta wave, according to a recent CDC report. Pediatric COVID-19 cases are rising once again at a time when only a small fraction of cases are being reported nationwide due to home testing and other factors. Another recent study has found that the rate of children admitted to the intensive care unit  (ICU) for COVID-19 or multisystem inflammatory syndrome (MISC) during the first 15 months of the pandemic was twice that for influenza during the two years prior to the pandemic. This was despite significant public health measures put in place during the COVID-19 pandemic. It also showed that over half of these children had no underlying comorbidities. These and many other studies speak to the importance of vaccinating all children against COVID-19.

Concerningly, only a small percentage of parents are reporting that they are certain to vaccinate their children immediately. Even more concerning, states are even taking steps to further limit availability to these vaccines and legislators and officials have even been spreading misinformation about COVID-19 and the vaccines.

In Tennessee for example, legislators have asked the governor to block distribution of the vaccine to young children and to block the Department of Health from distributing, promoting or recommending it to children under 5 years old.

Our organization, the Tennessee Chapter of the American Academy of Pediatrics, sent a letter to the governor noting that30,000 children under 5 have been hospitalized with COVID-19, more than 500 children in this age group have died from it and outlining the drastic effects any efforts to hamper distribution would bring to our state. This would remove the parental option of having their child vaccinated for many parents, and leave many of our rural, underserved children with limited access to vaccination.

Vaccines remain a safe, effective and important tool in our arsenal to prevent severe disease and death from COVID-19 in children. We encourage parents to talk to their pediatrician and ask any questions that they may have about vaccinating their child. We call on lawmakers, policy makers and health officials to support distribution and promote vaccination in this age group. We ask that our state health departments, providers, pharmacies and health systems to pull together to offer these vaccines. We can’t grow tired, and we must not forget about these parents and children.

Jason Yaun, MD, FAAP, is president of the Tennessee Chapter of the American Academy Pediatrics. Follow him on Twitter: @JasonYaunMD

Carlenda Smith, MD, FAAP is vice president of the Tennessee Chapter of the American Academy Pediatrics.