Covid vaccines recommended for kids under 5; questions remain

Filed Under: Costs, Patients, Providers

Covid vaccines for kids chart
- photo by Your Local Epidemiologist

(Updated) Covid vaccines for under-5 kids have been recommended for approval by the Food and Drug Administration’s advisory committee, but there are still a lot of questions about the rollout.

The White House said last week that it has a plan for vaccinating kids under 5 years old against Covid, with the first shots for the nearly 18 million children that age available next week. The plan relies heavily on pediatricians, the White House said.

“With the goal of the first shots being given the week of June 19, the Biden administration has already made 10 million doses available to states and health providers, with roughly 85 percent of children in that age group living within five miles of possible vaccination sites, according to White House estimates shared with reporters,” The New York Times reported. Here’s the administration’s fact sheet.

But where should parents take their kids? After an initial period of delay, with anguished parents wanting to know how and when they could get kids vaccinated, the delivery mechanism seemed to start to fall into place before and during the Juneteenth weekend.

New York City announced on Friday, June 17, that it would open 10 Moderna-only sites for only kids under 5, starting on Wednesday, June 22. The list is here on this Tweet and also below. New York State law allows pharmacies to vaccinate only 3 and up; pediatricians and the dedicated city cites can vaccinate 6 months and up.

In Connecticut, Public Health Commissioner Dr. Manisha Juthani issued a statement regarding COVID-19 vaccines for children under age five In addition to pharmacies and pediatricians, the statement said, “ DPH organizes mobile, COVID-19 vaccine clinics through its Yellow Vans program. The updated clinic schedule can be found  here  or by visiting ct.gov/coronavirus.

In Chicago — not Cook County — there’s a signup site, getvaxchi.gov.

Urgent care and pediatricians

MiDoctor, an urgent care center at 715 Ninth Ave. in Manhattan plans to start vaccinating as soon as possible, said Babu Dinesababu, a consultant there. In an email, he wrote that they would accept walk-ins and appointments, from 6 months and up. They plan to offer both Pfizer and Moderna, and will vaccinate undocumented and uninsured people, he wrote. They prefer that people register online.

Pace Pediatric Practice at 1545 Atlantic Ave., in Brooklyn (718-771-8435) has pre-ordered Pfizer, Dr. Bolanie Olajide said. They will vaccinate both by appointment and walk-in if a person calls ahead and walks in on the same day, she said.

Bayside Pediatric at 221-16 Union Turnpike in Flushing (718-465-5888) said they were waiting on a shipment from Pfizer; they do have authorization to vaccinate ages 6 months to 21 years old. People don’t have to be patients.

Besscription Pharmacy at 460 Glen Cove Ave. in Sea Cliff (866-237-9419)said their shipment is supposed to arrive Monday, with both Pfizer and Moderna. As a pharmacy, they will be limited to 3 and up.

Pharmacist orders vaccines

One New York City pharmacist, Omar Elsayed of Downtown RX Pharmacy at 180 Atlantic Ave. in Brooklyn, said he has ordered both Moderna and Pfizer. Moderna arrived over the weekend, he said.

vaccine fact sheet

He himself has vaccinated more than 5,000 people, he said.

He expects that “there will be more steps required for us to get the vaccine” after it’s approved, he said. There might be extra training, and also there are federal laws restricting pharmacists from giving vaccines to young children, he said. While he’s eager to vaccinate, he said, there are obstacles.

“My personal opinion – I think that’s too many kids to be vaccinated in hospitals and doctors’ offices,” he said. “I think there will be an exemption, but nobody knows.” The Centers for Disease Control and Prevention earlier this year made an exemption to existing vaccine dispensation rules, saying that pharmacies can vaccinate children age 3 and over even if they are prohibited by state law, and a further exemption could allow younger children, he said.

Even if pharmacies are allowed to vaccinate children under 3, though, some pharmacies might not want to have the task of vaccinating very young children who are afraid of shots.

Previous rollouts have been messy. Here’s a vaccine rollout report from December  2020 and one from January 2021. While there are some answers, there were also a lot of questions.

Is it all kids under 5?

No. Kids 6 months and up.

Starting when?

In the past, it has gone like this:

  • The F.D.A. advisory committee recommends the vaccine for full approval.
  • If the F.D.A. committee recommends, the Centers for Disease Control and Prevention give their approval. That C.D.C. approval came on Saturday.
  • Then the various vaccine dispensers –- city and state agencies, primary care providers, chain drugstores, independents, government agencies -– make their plans.
  • It’s expected June 20 or 21 will be the first date.
  • It takes a bit for the supply chain to be set up. It’s frustrating for people who want to be at the front of the line, because the line is different depending on where you want to receive your vaccine

Why is this not clear now?

The past rollouts for different age groups have been similarly confusing: The White House announces something, but the actual vaccine dispensers are not quite ready yet.

Will my pediatrician give the vaccine?

Some pediatricians will, and some won’t. You will need to ask. The White House pointed out that “pediatricians continue to be one of the most trusted sources of information about COVID-19 for parents and will play a critical role in the nationwide effort to get our youngest children vaccinated—as they are the most common, trusted location for routine childhood vaccines.” We have learned that some pediatricians have limited hours for vaccine distribution, as they did with the previous children’s rollouts.

What about hospitals?

Some will, but some won’t. “The Administration will make vaccinations available at more than 100 children’s hospitals and health systems nationwide,” the White House said. “Through the Administration’s partnership with the Children’s Hospital Association, more than 120 children’s hospitals across 47 states and D.C. will provide pediatric vaccinations across their health care systems and in trusted community sites.”

Will there be any mass vaccine sites as there were with the other rollouts?

There’s little concrete information yet about that. The White House said in its rollout plan that the “Association of Children’s Museums, a champion for children’s museums with more than 460 members in 50 states and 19 countries, will work with local member museums to: host vaccine pop-up clinics” and informational events.

On Friday, June 17, Mark Levine, the Manhattan Borough President, announced that there would be 10 Moderna-only sites citywide serving exclusively kids 6 months to 5 years.

“These City-run sites will be either by appointment or walk-in,” he wrote in an email. “For appointments call 877-VAX-4NYC or visit vax4nyc.nyc.gov. The system will begin to accept appointments for children under 5 starting on Tuesday (6/21).

“Locations and hours of these City-run sites can be found in the chart below. Beginning Tuesday (6/21), NYC’s Vaccine Finder website (vaccinefinder.nyc.gov) will be updated with info on non-City sites – such as pharmacies – offering vaccination to children under 5.”

Other mass vaccine sites that existed earlier in the pandemic have closed. In New York City, the remaining big site, at Aqueduct Race Track in Queens, has been vaccinating kids age 5 to 11, but it is scheduled to close June 30, officials say.

The New York Health + Hospitals has fielded a fleet of mobile vaccine vans, but those too are to stop June 30, H+H told us as part of our VEPE vaccine delivery grant. 

What about pharmacies?

“Federal law bars pharmacies from vaccinating kids under 3, so many are opting not to carry the vaccine, which has a unique dosage, for kids under 5,” Roll Call reported. “CVS will offer the vaccines for kids under 5 at their 1,100 Minute Clinics locations, not its nearly 10,000 pharmacies. This leaves the vaccinations largely to pediatricians, not all of whom plan to give out the vaccine.”

Over the weekend, Walgreen’s pharmacies started allowing people to make appointments for kids 3 and up.

Dr. Ashish K. Jha, President Biden’s coronavirus response coordinator, said “that health officials expected many children under 5 to be vaccinated by pediatricians and primary care physicians, a contrast to other age groups,” The Times reported. “But he and other officials on Thursday said they had organized a network of other locations that would work to get shots to families, including pharmacies and children’s hospitals.”

How do I figure this out?

Our best advice: Ask your pediatrician. Go to vaccines.gov and search (as of now, there are no sites for under 5, though that will probably change with approval). In New York City, go to vaccinefinder.nyc.gov.

How many vaccine shots do kids need to be protected?

Pfizer-BioNTech wound up with a 3-dose regimen of 3 micrograms, after trying two doses. Moderna is 2 doses of 25 micrograms.

Which vaccine is best: Moderna, Pfizer, Johnson & Johnson?

There is no Johnson & Johnson for children.

The administration reported that their orders were for “equal numbers of Pfizer-BioNTech and Moderna vaccines, the two that federal regulators are reviewing and could authorize as soon as next week,” The Times said.

Pfizer is nearly 3 months to “fully vaccinated” while Moderna is 4 weeks.

“Moderna has said two 25 microgram shots of its vaccine were around 37% effective in preventing infections in children ages 2 to 5 and 51% effective for children ages 6 months to 2 years,” Reuters reported. “Pfizer and BioNTech said that three shots of a 3 microgram formulation of their vaccine generated a similar immune response in that age group as in 16 to 25-year-olds who had received two doses of the 30 microgram formulation of the vaccine in an earlier clinical trial.”

Katelyn Jetelina, who writes as Your Local Epidemiologist, and is the parent of two under-5 girls, wrote:

We have a hard choice. Which vaccine should my kids get?

“You cannot make a wrong decision. Either vaccine is better than nothing, and both help with severe disease and death.

“To me, though, the choice is clear. My girls will get Moderna for four reasons:

  • The confidence in Pfizer’s efficacy is not strong… at all. Efficacy was only based on 3 cases in the vaccine group and 7 cases in the control group. Pfizer didn’t meet the standard protocol of 21 cases. This means the “true” effectiveness is unstable—it could be anywhere between 14% and 81%. We don’t know exactly where. Take 81% with a grain of salt.
  • Antibodies with Moderna reach the same levels in half the time compared to Pfizer (6 vs. 13 weeks). Kids are not protected until Dose 3 of Pfizer, which is a while.
  • Moderna confirmed they already started testing Dose 3 (booster) and will have data by this summer. We know that this vaccine is at least a 3-dose series. So, once we get Moderna and Pfizer on the same playing field, efficacy will be comparable. Importantly, Moderna is testing an Omicron-specific booster, not the original vaccine. This is different from the Pfizer trial, in which Dose 3 is the original formula. This is huge. By the end of summer, Moderna kids will likely be on the same playing field as adults, who will likely get a bivalent vaccine this fall.
  • FDA said they do not know whether the primary series for Pfizer is 3 doses or if this third dose is considered a booster. In other words, it may very well be that Pfizer kids will need a fourth dose for primary efficacy.”

My kid is about to turn 5. Should I wait to get the 5-and-up vaccine?

There are a lot of questions involved here — but many experts agree that the first and most important thing is to get a child vaccinated as quickly as possible. If a child turns 5 in the process, before receiving a third dose of Pfizer, say, they are likely to get bumped up to the higher dose. It doesn’t matter if you have a big 4-year-old, who you might think would get a bigger dose, experts say. The New York Times delved into these issues here.

Who should NOT get vaccinated?

We’re not medical experts – this is a question better directed at your pediatrician or primary care provider.

My kids are afraid of needles. What can I do?

This is a valuable New York Times article that tells you more than I ever could. Here’s a taste:

“First, figure out the logistics of when and where you will vaccinate your child. Think about the qualities of the location that would make your child more comfortable: Do the providers have experience vaccinating children? Are they patient and do they have a pleasant bedside manner? If your child’s own health care provider has appointments and vaccine supply, you could try starting there. If that is not an option, consider somewhere that has experience with pediatric vaccines, like school-based vaccination sites, pediatric urgent cares or retail pharmacies. Some pediatric practices also have devices that make vaccinations less painful, like the Buzzy Pain Relief Device, which vibrates against the skin as a distraction.”

vaccine sites for children