White House faces uphill challenge getting kids under 5 vaccinated

The Biden administration faces an uphill battle to convince parents to give COVID-19 shots to children under 5 years old.

More than a year and a half after the first vaccines were authorized for adults, federal regulators and outside advisory panels will finally meet on Wednesday to examine data from Moderna and Pfizer-BioNTech about their shots’ effectiveness in the youngest children.

If all goes well and the vaccines get authorized, the administration is planning a massive public education campaign to help make sure parents can have their questions answered and learn about the importance of getting their children vaccinated.

Officials have outlined a plan that includes partnering with the online What to Expect community, as well as a range of national organizations, including a “speaker’s bureau” of pediatricians and family physicians who will be able to answer questions about the shots at community events. 

Vaccines will be distributed across thousands of different sites, but the administration will focus on front-line providers including pediatricians and primary care doctors, as that is where they expect many families will want to go. 

“Our lessons from the past have taught us that in addition to us speaking directly to the public, that our partnerships — partnerships we built over the last 18 months — are going to be critical here — partnerships with doctors and nurses, with faith leaders, with educators, and with community organizations across the country,” Surgeon General Vivek Murthy said.

Children under 5 are the last group eligible to be vaccinated, and there are about 18 million of them who would become eligible. But infectious disease experts think it’s an open question just how strong demand will be.

White House coronavirus response coordinator Ashish Jha said vaccination campaigns and building vaccine confidence takes time, especially if you need to earn peoples’ trust. 

“It builds with trusted voices, physicians, faith leaders, others helping people get vaccinated. This is not a one-and-done, this is not an automatic. That’s what we have seen for kids 12 and above. We’re continuing to see that with kids 5 to 11. And we expect that to be an ongoing journey for kids under 5,” Jha said. 

But Jha said the administration doesn’t have internal targets for the initial vaccination rate.

Julie Morita, a pediatrician and executive vice president of the Robert Wood Johnson Foundation, said it’s important for trusted providers to listen to and address parents’ concerns, and that won’t happen overnight. 

“The reason that parents pause or may not get their children vaccinated is because they’re trying to do what they think is best for their children. And they may have questions or concerns about the safety or the efficacy of the vaccine. And so as pediatricians, as health care providers … it’s really in our best interest and in the patient’s best interest to really spend the time to talk with the parents, understand what their specific questions and concerns are, and then really address those questions and concerns and over time, work with them to get their children vaccinated,” Morita said.

While some parents of tots are eager to get them vaccinated as soon as possible, the numbers have lagged for older children. Only about 30 percent of kids ages 5 to 11 have been vaccinated with two doses, according to Centers for Disease Control and Prevention data. 

An April poll from the Kaiser Family Foundation found that less than a fifth of parents of kids under 5 were eager to vaccinate them right away. About half said they definitely wouldn’t, or would do so only if required. 

Some parents have expressed concerns about side effects, or that the vaccine is worse than the disease. Others are just ready to get back to normal.

Rupali Limaye, a vaccine expert at the Johns Hopkins Bloomberg School of Public Health, said the widespread acceptance of the virus as a part of everyday life will likely contribute to reduced vaccination rates among the youngest kids.

“Most people here in the states kind of think COVID is over. I think there’s a lot of complacency even compared to a few months ago. And as a result, I think that’s gonna be a key factor here with regards to risk perception,” Limaye said. 

The administration’s efforts to partner with trusted messengers are commendable, Limaye said, but the public’s risk perception ultimately matters more.

“I think if people are done with the pandemic, I think that supersedes everything else. I think the trusted messengers, obviously, are very critical and are important. But honestly, I think at this point, people are like, it’s here to stay, what’s the point, why would we get a shot?” Limaye said.  

Rachael Piltch-Loeb, a fellow at the Harvard T.H. Chan School of Public Health, said the long gap between the initial rollout of adult vaccines and the expected authorization of kids’ shots will also likely prove to be an enthusiasm barrier.

“I think that initial excitement around the vaccine would have been significantly higher if we were talking about a year ago,” Piltch-Loeb said, but added that it was important to rush out shots for the most vulnerable first.

“I think the fact that initial data on COVID was showing that there were other populations that were at higher risk for severe infection, morbidity and mortality meant that those populations should be prioritized,” Piltch-Loeb said. “But I do think that the point in time we are at in the pandemic is not necessarily incentivizing parents to get the vaccine for their kids.”