By Rachana Pradhan and Hannah Recht
The national effort to vaccinate children has stalled even as the omicron variant upends schooling for millions of children and their families amid staffing shortages, shutdowns and heated battles over how to safely operate. Vaccination rates vary substantially across the country, a KHN analysis of the federal data shows. Nearly half of Vermont’s 5- to 11-year-olds are fully vaccinated, while fewer than 10% have gotten both shots in nine mostly Southern states.
Pediatricians say the slow pace and geographic disparities are alarming, especially against the backdrop of record numbers of cases and pediatric hospitalizations. School-based vaccine mandates for students, which some pediatricians say are needed to boost rates substantially, remain virtually nonexistent.
“You have these large swaths of vulnerable children who are going to school,” said Dr. Samir Shah, a director at Cincinnati Children’s Hospital Medical Center. Compounding the problem is that states with low vaccination rates “are less likely to require masking or distancing or other nonpartisan public health precautions,” he said.
In Louisiana, where 5% of kids ages 5 to 11 have been fully vaccinated, Gov. John Bel Edwards, a Democrat, added the shot to the list of required school immunizations for the fall, over the objections of state legislators, who are mostly Republicans. The District of Columbia and California, where about 1 in 5 elementary school kids are fully vaccinated, have added similar requirements. But those places are exceptions — 15 states have banned COVID vaccine mandates in K-12 schools, according to the National Academy for State Health Policy.
Mandates are one of multiple “scientifically valid public health strategies,” Shah said. “I do think that what would be ideal; I don’t think that we as a society have a will to do that.”
Vaccine demand surged in November, with an initial wave of enthusiasm after the shot was approved for younger children. But parents have vaccinated younger kids at a slower pace than 12- to 15-year-olds, who became eligible in May. It took nearly six weeks for 1 in 5 younger kids to get their first shot, while adolescents reached that milestone in two weeks.
Experts cite several factors slowing the effort: Because kids are less likely than adults to be hospitalized or die from the virus, some parents are less inclined to vaccinate their children. Misinformation campaigns have fueled concerns about immediate and long-term health risks of the vaccine. And finding appointments at pharmacies or with pediatricians has been a bear.
“One of the problems we’ve had is this perception that kids aren’t at risk for serious illness from this virus,” said Dr. Yvonne Maldonado, chair of the American Academy of Pediatrics Committee on Infectious Diseases. “That’s obviously not true.”
Parents are left to weigh which is more of a threat to their children: the COVID virus or the vaccine to prevent the virus. Overwhelmingly, research shows, the virus itself presents a greater danger.
Kids can develop debilitating long-COVID symptoms or a potentially fatal post-COVID inflammatory condition. And new research from the CDC found that children are at significantly higher risk of developing diabetes in the months after a COVID infection. Other respiratory infections, like the flu, don’t carry similar risks.
Katharine Lehmann said she had concerns about myocarditis — a rare but serious side effect that causes inflammation of the heart muscle and is more likely to occur in boys than girls — and considered not vaccinating her two sons because of that risk. But after reading up on the side effects, she realized the condition is more likely to occur from the virus than the vaccine. “I felt safe giving it to my kids,” said Lehmann, a physical therapist in Missouri, where 20% of younger kids have gotten at least one dose.
Recent data from scientific advisers to the CDC found that myocarditis was extremely rare among vaccinated 5- to 11-year-olds, identifying 12 reported cases as of Dec. 19 out of 8.7 million administered doses.
The huge variations in where children are getting vaccinated reflect what has occurred with other age groups: Children have been much less likely to get shots in the Deep South, where hesitancy, political views and misinformation have blunted adult vaccination rates as well. Alabama has the lowest vaccination rate for 5- to 11-year-olds, with 5% fully vaccinated. States with high adult vaccine rates such as Vermont, Massachusetts, Connecticut and Maine have inoculated the greatest shares of their children.
Even within states, rates vary dramatically by county based on political leanings, density and access to the shot. More than a quarter of kids in Illinois’ populous counties around Chicago and Urbana are fully vaccinated, with rates as high as 38% in DuPage County. But rates are still below 10% in many of the state’s rural and Republican-leaning counties. In Maryland, where 1 in 4 kids are fully vaccinated, rates range from more than 40% in Howard and Montgomery counties, wealthy suburban counties, to fewer than 10% along parts of the more rural Eastern Shore.
Nationally, a November KFF poll found that 29% of parents of 5- to 11-year-olds definitely won’t vaccinate their children and that an additional 7% would do so only if required. Though rates were similar for Black, white and Hispanic parents, political differences and location divided families. Only 22% of urban parents wouldn’t vaccinate their kids, while 49% of rural parents were opposed. Half of Republican parents said they definitely wouldn’t vaccinate their kids, compared with just 7% of Democrats.
The White House said officials continue to work with trusted groups to build vaccine confidence and ensure access to shots. “As we’ve seen with adult vaccinations, we expect confidence to grow and more and more kids to be vaccinated across time,” spokesperson Kevin Munoz said in a statement.
The Hunt for Shots
Just before her younger son’s 5th birthday, Lehmann was eager to book COVID vaccine appointments for her two boys. But their pediatrician wasn’t offering them. Attempts to book time slots at CVS and Walgreens before her son turned 5 were unsuccessful, even if the appointment occurred after his late-November birthday.
“It was not easy,” she said. Wanting to avoid separate trips for her 10-year-old and 5-year-old, she nabbed appointments at a hospital a half-hour away.
“Both of my kids have gotten all their vaccines at the pediatrician, so I was kind of shocked. That would have certainly been easier,” Lehmann said. “And the kids know those nurses and doctors, so I think it would have helped to not have a stranger doing it.”
The Biden administration has pointed parents to retail pharmacies and 122 children’s hospitals with vaccine clinics. Nationwide, more than 35,000 sites, including pediatricians, federally qualified health centers and children’s hospitals have been set up to vaccinate young kids, according to the administration. Yet administering the COVID vaccine to children presents obstacles that haven’t been as prominent for other inoculations.
Enrolling pediatricians in the COVID-19 vaccine program is a challenge because of the application process, reporting requirements for administered doses, and staffing, said Claire Hannan, executive director of the Association of Immunization Managers.
“Many of them are short-staffed right now and don’t necessarily have huge capacity to serve,” she said. Plus, “it’s not as easy to engage the schools in school-based clinics in certain areas just due to the political environment.” Health centers, government officials and other groups have set up more than 9,000 school vaccination sites for 5- to 11-year-olds nationwide.
The CDC’s long-standing program, Vaccines for Children, provides free shots for influenza, measles, chickenpox and polio, among others. Roughly 44,000 doctors are enrolled in the program, which is designed to immunize children who are eligible for Medicaid, are uninsured or underinsured, or are from Native or Indigenous communities. More than half of the program’s providers offer COVID shots, although the rates vary by state.
Pharmacies have been heavily used in Illinois, where 25% of 5- to 11-year-olds are fully vaccinated.
Dr. Ngozi Ezike, a pediatrician and the director of the Illinois Department of Public Health, said 53% of shots administered to younger children as of Jan. 5 were done at pharmacies. Twenty percent occurred at private clinics, 7% at local health departments, 6% at federally qualified health centers and 5% at hospitals.
“You need all pieces of the pie” to get more kids vaccinated, Ezike said.
Kids Respond to ‘the Greater Good’
The Levite Jewish Community Center in Birmingham, Alabama, tried to boost vaccinations with a party, offering games and treats, even a photo booth and a DJ, along with shots given by a well-known local pharmacy. Brooke Bowles, the center’s director of marketing and fund development, estimated that about half a dozen of the 42 people who got a dose that mid-December day were kids.
Bowles was struck that children were more likely to roll up their sleeves when their parents emphasized the greater good in getting vaccinated. “Those children were just fantastic,” she said. In parts of the Deep South like this one, pro-vaccine groups face a tough climb — as of Jan. 12, only 7% of Jefferson County’s children had gotten both shots.
The greater good is what pediatricians have emphasized to parents who are on the fence.
“Children are vectors for infectious disease,” said Dr. Eileen Costello, chief of ambulatory pediatrics at Boston Medical Center. “They’re extremely generous with their microbes,” spreading infections to vulnerable relatives and community members who may be more likely to end up in the hospital.
Seventy-eight percent of the hospital’s adult patients have received at least one dose. For children 5 and up, the figure is 39%, with younger children having lower rates than adolescents, Costello said. Particularly amid an onslaught of misinformation, “it has been exhausting to have these long conversations with families who are so hesitant and reluctant,” she said.
Still, she can point to successes: A mother who lost a grandparent to COVID was nonetheless reluctant to vaccinate her son with obesity and asthma whom Costello was seeing for a physical. The mother ultimately vaccinated all four of her children after Costello told her that her son’s weight put him at higher risk for severe illness.
“That felt like a triumph to me,” Costello said. “I think her thinking was, ‘Well, he’s a kid — he’s going to be fine.’ And I said, ‘Well, he might be fine, but he might not.’”
This story was produced by KHN (Kaiser Health News), a national newsroom that produces in-depth journalism about health issues and one of the three major operating programs at KFF (Kaiser Family Foundation). It has been republished with permission.
Vaccination numbers are from the Centers for Disease Control and Prevention as of Jan. 12.
National vaccination rates are calculated by the CDC and include vaccinations provided by federal programs such as the Indian Health Service and the Department of Defense, as well as U.S. territories. To compare the vaccination rollout for kids and adolescents, we counted day 0 as the day the CDC approved the vaccine for each age group: May 12, 2021, for 12- to 15-year-olds and Nov. 2, 2021, for 5- to 11-year-olds.
The CDC provides vaccination numbers at the state and county level. These numbers do not include the small fraction of children who were vaccinated by federal programs. To calculate rates for 5- to 11-year-olds, we divided by the total number of kids ages 5 to 11 in each state or county.
To calculate the number of children ages 5 to 11 in each state, we used the U.S. Census Bureau’s 2019 Population Estimates Program “single year of age” dataset, the latest release available. For county-level data, we used the National Center for Health Statistics’ Bridged Race Population Estimates, which contain single-year-of-age county-level estimates. We selected the 2019 estimates from the 2020 vintage release so the data would reflect the same year as the state-level estimates.
Vaccination data by age is unavailable for Idaho, counties in Hawaii and several California counties. For county-level vaccination data, we excluded states in which the county was unknown for at least 10% of the kids vaccinated in that state.