How doctors are getting COVID shots to kids ages 5-11

For as long as the pandemic has been disrupting daily life, families have been waiting for this moment, and they hope the health care system is ready: Twenty-eight million children ages 5-11 across the United Stated are now eligible to receive Pfizer’s two-dose COVID-19 vaccine, and care providers and public health workers are working behind the scenes to meet a surge in demand from parents eager to vaccinate their school-age children.

Caitlin Givens pushed the wheelchair carrying her daughter, Penelope Porter, 6, into an exam room Wednesday morning at Children’s National Research Institute in Washington, D.C. Dr. Nicola Brodie was waiting for them with an alcohol wipe and a COVID-19 vaccine dose. Penelope, who lives with cerebral palsy and is fed through a G-tube, was among the first children ages 5-11 to get vaccinated in the nation’s capital.

“I know you’re smiling under there,” Givens said as she knelt beside her daughter, who was wearing a mask. Givens rolled up the gray shirt sleeve over Porter’s left arm, and Brodie wiped sanitizer in a circle before administering the dose.

Givens said she followed the Centers for Disease Control and Prevention deliberations over the vaccine closely. Any time Porter develops fevers or chills, Givens said, seizures often follow. “Even a cold can take her down for weeks.”

Now, in the doctor’s office, she was thrilled that her medically fragile daughter would be vaccinated against a virus that could have especially devastating effects.

Though kids in this age group are less likely to suffer severe illness from the coronavirus, parents have plenty of reason to feel relief now that their children can get their “pokes.” Four out of 10 have been infected with the coronavirus, according to federal estimates released Tuesday. Of those children, about 150 have died from COVID-19, and more than 8,000 have been hospitalized. A third of those patients had no prior medical complications. As schools opened for in-person learning this fall, millions of parents have worried that their kids might come home sick, infect someone else or have to stay home for days to quarantine.

Dr. Kurt Newman, president and CEO of Children’s National Hospital, which recruited volunteers for Pfizer’s age 5-11 vaccine clinical trials, said he sees more hope and excitement among pediatric frontline workers this week with the vaccine now available for younger children and patients. Throughout the pandemic, he and his staff have watched kids on ventilators “gasping for breath,” and wondered how the virus would affect the long-term development of their brains and hearts. “You haven’t seen what I’ve seen,” he said.

And yet surveys suggest most parents are not ready to get their school-aged children vaccinated — many are waiting to see how things go during this initial rollout. Just three out of 10 parents with children aged 5-11 said they wanted to get their children vaccinated against COVID-19 as soon as doses were authorized, according to a survey released Oct. 28 from the Kaiser Family Foundation.

So pediatricians, who are among the most trusted people in health care, must focus “not only on making vaccines available, but also making information available,” said Amy Wimpey Knight, president of the Children’s Hospital Association. “That’s what a lot of folks are focused on right now.”

How rollout is happening around the country

Before the CDC endorsed the vaccine, shipments of age-appropriate doses began arriving at hospitals and public health departments in some parts of the country. In D.C., delivery trucks on Monday dropped off packages filled with 10 microgram vaccine doses, a third of the size of adult doses, so staff could prepare to administer them to young children. Being able to squeeze more doses out of the vaccine supply is one of the advantages of this rollout. The Biden administration said in late October it had already procured enough vaccine doses for all children within this age group and committed to getting those doses “quickly distributed and made conveniently and equitably available to families across the country.”

But that doesn’t mean there will be no wait. “It’s important to know not every location is going to have vax on day one,” said Patrick Ashley, senior deputy director for Health Emergency Preparedness and Response Administration for D.C. Department of Health, who noted that more doses are on the way to Washington.

When the Pfizer vaccine was first made available to adults, it was very sensitive to temperature and required ultra cold storage, which many health care providers did not have. Doses had to be tossed if refrigerated but unused after a month. Those conditions complicated distribution efforts in some parts of the country. For the age 5-11 rollout, Pfizer has tweaked the formula so doses can sit in a conventional refrigerator much longer — up to 10 weeks — before expiring.

In Milwaukee, Dr. Smriti Khare, president of Children’s Wisconsin-Primary Care,said pediatricians and nurses, along with the city’s Department of Public Health, have got it “down to a science” — a process they honed for educators and children age 12 and older earlier in the pandemic. To reach as many as 49,000 children within their service area, they are rolling out the vaccine through mass vaccination sites, clinics, pharmacies and school gyms and cafeterias, Khare added.

And because health experts say children can safely receive their COVID-19 and influenza vaccines at the same time, Khare said she is hoping these visits offer kids and families a chance to get back on track with preventive care, something millions of households neglected during the pandemic and “all those complexities that happen in life,” Khare said.

In Little Rock, Arkansas, Dr. Rick Barr said pediatricians there and throughout the state were awaiting delivery of vaccine supplies and planned to offer children doses through their primary care physicians this week. Barr said Tuesday he has been eagerly awaiting the vaccine’s arrival for young children because “it’ll help kids get back to a normal lifestyle.”

Registered nurse Jennifer Dearman at University of California-San Francisco Benioff Children’s Hospital said doses arrived Tuesday at her Bay Area hospital system, and staff plan to use drive-thru lanes to help distribute pediatric doses, starting Friday at some locations. Dearman said the hospital system would have a separate lane and a nurse devoted to dolling out COVID vaccines to younger children as quickly as possible. To manage vaccine inventory, Dearman said, hospital staff preferred appointments, but they will allow walk-ups.

“We recognize that for some people accessing an electronic portal or even getting a phone is not so easy,” Dearman said. “Whoever walks up is not going to get turned away.”

Answering questions, calming fears

While some aspects of distribution are easier now, many pediatricians and health care providers are reporting they are getting more parent questions about this younger cohort than with children age 12 and up, said Knight of the Children’s Hospital Association.

Childhood immunization schedules are bread-and-butter issues for pediatricians, Knight said. But with the COVID-19 vaccine, Knight said “the hesitancy piece is real.”

Some parents have expressed concern about reports of myocarditis — or inflammation of the heart muscle that can cause shortness of breath and chest pains — in children who get the vaccines, particularly boys, Barr said. But, he noted, “It’s less with the vaccine than what we’re seeing with COVID infections.”

Those infections more frequently contributed to cases of myocarditis than the vaccine across any age group, according to data shared Tuesday by experts for the CDC’s Advisory Committee on Immunization Practices. When COVID-linked cases occurred, they produced more severe cases of myocarditis than what was reported from participants who received shots during vaccine clinical trials or after millions of doses were administered to the public.

So far, the most common side effects linked to the COVID-19 vaccine in the 5-11 age group include initial pain and swelling at the injection site, followed by fever, fatigue, headache and chills, according to data presented Tuesday. These side effects greatly resemble those observed following other childhood vaccines.

Givens, a health care worker, is one of those parents who did not want to hang back and wait to see how the vaccine worked. Along with 6-year-old Penelope, she also has a toddler who is almost 3 and a 6-month-old infant, and since getting vaccinated, she has given all three children her breast milk, hoping they could acquire her antibodies. For months, the family has lived in self-imposed isolation to protect Porter.

“We’ve been living the past two years holding our breath,” Givens said. And now, relief.