With child vaccinations, will we be able to put the pandemic in the rearview mirror?

Are we there yet? This time of year, we are typically singing about going over the river and through the woods to grandma’s house while the children perpetually ask the age-old family road trip question from the backseat. Now, it has become a question that we have asked ourselves many times during the COVID-19 pandemic.

When will this be over? What can we do to help mitigate further illness and death? And how can we protect the children in the backseat while ensuring a safe return to school, activities and holiday celebrations?

In the coming months, as our vaccination rates increase and we return to more typical behaviors, will we be able to put the pandemic in our rearview mirror? As much as we would love to be at grandma’s house or through this pandemic, we need to remain cautious this winter.

We are optimistic that the latest developments in the pandemic signal that we are indeed beginning to see signs of hope. The COVID-19 surge in the South caused by the Delta variant is subsiding. And now that our patients over age 5 have access to a COVID-19 vaccine, we see a glimmer of light at the end of this very long tunnel. That light only stays lit if we can achieve adequate vaccination rates combined with sustained, low transmission rates. Unfortunately, here in Tennessee, our vaccination numbers lag in both adults and teens with little reason for us to hope that the 5- to 11-year-old age range will be different.

How do we get to adequate vaccination numbers? We became pediatricians to care and to advocate for children. We do it because we love our patients, our jobs and we believe whole heartedly that children are the future. Families consistently report that their pediatricians are trusted sources of information. Pediatricians are experts in childhood immunizations, are here to administer vaccines and are ready to answer questions from our families.

But in our state, few pediatric offices have signed up to administer the COVID-19 vaccine in the 5- to11-year-old age group. Why? Because there are numerous barriers to COVID-19 vaccine administration in pediatric clinics: the administrative effort required to schedule the appointment, the nursing effort required to prepare the dose, administer the injection, observe the patient after, upload the vaccination data to our state system within 72 hours — not to mention, the provider time to answer questions or concerns about the vaccination.

These requirements come just as many pediatric offices are overburdened and struggling with staffing shortages. Then consider that unlike other states, thus far Tennessee has required larger volume orders for vaccination doses and has not developed a robust system to split the vaccine allotments into smaller quantities. This means that many practices don’t have the bandwidth to store and dispense COVID-19 vaccinations in their offices in an efficient manner, especially for smaller practices and those in rural areas.

This leaves the vaccination effort to academic centers or larger groups which are typically in the metro areas or health department sites and pharmacies that may not be convenient or as comfortable to families as their pediatrician’s office.

Younger children may have more anxiety around vaccinations and will benefit from being vaccinated in their usual place of care with providers who are trained to provide medical care to children. Parents may have more questions about the vaccine in this age group, again benefiting from the ability to seek this type of care and this vaccine in their child’s medical home. While this has been a focus nationally, it seems to be an afterthought in Tennessee. These barriers need to be considered and overcome for our vaccination rates to improve and for vaccine access to be equitable.

How do we restore confidence in public health? Tennessee legislators just held a special session with a seeming bias that public health measures are an infringement on a citizen’s rights rather than a way to protect citizens. They passed legislation that has the potential to make early mitigation impossible should we experience another surge. They continue to undermine the public health department’s authority in our metro areas even while giving lip service to local decisions are best made locally.

There is also continual disinformation and anti-vaccination sentiments that are promulgated with the justification of personal freedom. The anti-public health messaging has deadly consequences. We are tired of hearing the refrain that children don’t die from COVID-19 as a rationale to not vaccinate or not to follow mitigation measures. The death of a single child is one too many and should be enough for us to follow public health guidance to our best abilities. Our children deserve it.

So, we proceed with cautious optimism this holiday season with a wish list that includes increased vaccination rates and efforts, promoting vaccination in the medical home and taking steps to make this feasible, and a restored faith in public health during the time of year where we set aside our differences and celebrate together. We look forward to children celebrating the holidays with their families with an added sense of protection from vaccination. Just as we have them buckled up in the backseat as we go over the river and through the woods, we want to provide all the safety and protection that we can from the COVID-19 virus, knowing that we have a safe and effective tool to prevent sickness and death.

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

Anna Morad, MD, FAAP is president of the Tennessee Chapter of the American Academy of Pediatrics. Follow her eon Twitter: @morad_aw