Addressing Gaps in Pediatric COVID-19 Vaccine Access and Uptake
Children younger than 12 are the least likely to have received a COVID-19 vaccination of any age group in the U.S. As of May 3, 2023, the Centers for Disease Control and Prevention (CDC) recorded that only 13 percent of U.S. children ages 6 months to 4 years have received at least one dose of COVID-19 vaccine, and 39 percent of U.S. children ages 5–11 have received at least one dose of COVID-19 vaccine. With low vaccination rates and thousands of new children becoming eligible for these vaccines every day, efforts to protect children against vaccine-preventable diseases require innovative strategies and multi-sector partnerships.
Fostering Cross-Sector Immunization Partnerships
Between March and June 2023, the National Academy for State Health Policy (NASHP), the Association of Immunization Managers (AIM), and AcademyHealth convened eight regional meetings, bringing together 63 teams of state, local, and territorial leaders from immunization programs; state officials from Medicaid agencies and other state agencies; immunization coalitions; the American Academy of Pediatrics (AAP); the American Academy of Family Physicians (AAFP); pharmacist associations; organizations representing historically marginalized communities; early childhood leaders; and other key partners to discuss how to improve pediatric vaccination rates for COVID-19. By working with partners across the immunization spectrum, these regional meetings focused on identifying collaborative strategies in each state for improving pediatric access and uptake of COVID-19 vaccines and other immunizations.
Tackling Common and Jurisdiction-Specific Immunization Challenges
In each Vaccine Access Cooperative (VAC) regional meeting, the multidisciplinary teams developed workplans to address jurisdiction-specific challenges to pediatric COVID-19 vaccination and discussed solutions to common challenges. While each jurisdiction and region faced its own unique challenges, three main common challenges emerged across all eight regional meetings: parental hesitancy, lack of access, and lack of awareness of the importance of COVID-19 protection for children. Common challenges discussed by state teams and addressed through jurisdiction workplans included:
Parental Hesitancy |
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Lack of Access |
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Lack of Awareness |
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Developing Unique State Action Plans and Partnerships
Cross-sector state teams spent two days together identifying challenges and potential solutions, sharing ideas, and developing strategies to improve vaccination rates. Hundreds of strategies were discussed across the 63 participating teams, many of which look to expand vaccine access (especially for young children), provide public and health care professional education about the importance of protecting children against COVID-19, and address public confidence in vaccines. A breakdown of the types of strategies that were included in jurisdiction action plans is outlined in Figure 1.
Promising Strategies to Improve Pediatric COVID-19 Vaccine Access and Uptake
While jurisdictions identified a range of strategies to improve COVID-19 immunization rates, promising strategies being advanced by VAC teams included:
Expand Partnerships with K-12 Schools and School-Based Health Centers
Several teams reported on successful efforts to provide school-based vaccination services, not only for COVID-19 vaccinations but also for school-required vaccinations. Chicago Public Schools (CPS) has a robust school vaccination program. The City of Chicago not only brought partners together to meet with a larger team from Illinois at the Great Lakes VAC meeting, but also volunteered for an ongoing community of practice where representatives from the Department of Health, CPS, the Illinois Chapter of the American Academy of Pediatrics, and the Illinois Pharmacist Association meet monthly to discuss challenges and develop strategies to improve COVID-19 vaccination rates among Chicago’s children.
Increase Provider Awareness and Support
Many teams agreed that health care professionals need to be on board with protecting children against COVID-19 before major public education efforts can be initiated. Not only is access to the vaccine inadequate for young children, but some medical providers passively discourage parents from vaccinating their children by not stocking the vaccines or actively discourage them through messaging. The team from Georgia plans to use the Georgia Chapter of the American Academy of Pediatrics’ existing Educating Physicians/Practices in their Communities (EPIC) training program to help improve pediatrician participation in COVID-19 vaccination efforts for children and “normalize” COVID-19 vaccines as part of the routine childhood immunization schedule. The Ohio team plans to maximize educational opportunities for providers through joint communications from the state’s AAP and AAFP chapters, webinars, and targeted outreach, especially to provider sites that are located in vaccine deserts and not currently providing vaccinations to children.
Raise Parental Awareness and Vaccine Confidence
Raising parental awareness of the threat of COVID-19 to children and strengthening parental confidence in COVID-19 (and all) vaccines is a priority of many teams. The Illinois/Chicago team plans to train and position ambassadors and health navigators in churches, schools, and other places where parents are present to engage in conversations about the importance of COVID-19 vaccination for children. The Texas team plans to create a flyer for providers to give to parents at the 4-month well-child visit that explains the importance of starting the COVID-19 vaccination series at 6 months. Teams from Mississippi and Alaska plan to reach out to school nurses, asking them to be a resource for parents by providing information about COVID-19 vaccine and other childhood vaccinations. Some state teams are sharing lessons from “Vaccine Fears Overturned by Facts,” a booklet developed by two former anti-vaccine parents who aim to address common misconceptions around vaccines.
Partner with Pharmacists to Expand COVID-19 Vaccine Access, Especially for Young Children
With the extension of provisions of the Public Readiness and Emergency Preparedness (PREP) Act that allow pharmacists to vaccinate children ages 3 years and older against COVID-19 and seasonal influenza through 2024, states have opportunities to strengthen their relationships with pharmacists, especially those located in vaccine deserts where a pharmacist may be the only possible provider of COVID-19 vaccines for children. Many teams expressed interest in enrolling pharmacists in the Vaccines for Children (VFC) program, a federal entitlement program that provides routine childhood vaccines to children who are uninsured, underinsured, or insured by Medicaid programs, or who are Alaska Native or American Indian. States like Pennsylvania and Indiana, as well as Washington, D.C., have pharmacists enrolled in their VFC programs and hope to increase those enrollment numbers, while other states must first address common barriers, including state laws that limit pharmacists’ ability to vaccinate children below a certain age or that prohibit pharmacist participation in the VFC program.
Next Steps
The work plans generated by the 63 teams participating in regional VAC meetings highlight the importance of improving access to COVID-19 vaccines (especially for young children), improving provider and parental awareness of the need for children to be protected against COVID-19, and building parental vaccine confidence. While the challenges for improving pediatric COVID-19 vaccination rates are significant, so are the opportunities — particularly when critical partners in pediatric health and well-being can come together to maximize the impact of their efforts. Through the VAC meetings, NASHP, AcademyHealth, and AIM have built a coalition of over 300 state, local, and community leaders that are continuing the work of improving childhood vaccination coverage beyond COVID-19. To build on this momentum, NASHP, AcademyHealth, and AIM will be partnering in a new CDC-funded three-year project that includes an ongoing learning network to support these partners in addressing vaccine-preventable respiratory diseases, and AIM will continue to engage VAC attendees to provide resources and ensure that VAC partners remain connected and informed.
Acknowledgements
This brief is supported by the Centers for Disease Control and Prevention (CDC) of the U.S. Department of Health and Human Services (HHS). The contents are those of the author and do not necessarily represent the official views of, nor an endorsement, by CDC/HHS or the U.S. government.
