Are We Really Still Doing This?
Covid Vaccine “Deserts” For Kids Under 5 Make It Almost Impossible For Parents To Find Shots
Vaccine hesitancy is not the only reason kids aren’t getting immunized.
“We almost made it,” I thought, as I sat with my 14-month-old son in the emergency room. He was stripped down to his diaper and sprawled against me, simultaneously shivering and sweating profusely. He was barely responsive, half asleep (it was after 11 p.m.) and half delirious (his fever was 104). I was fanning him with our check-in paperwork, silently begging the Motrin I’d given him to work its magic already. We had been fighting high fevers for over a week, and that night, we seemed to be losing.
My son tested positive for Covid on May 25, 2022. It was his first bout. His fever had come and gone a few times in the 10 days he’d been sick, which concerned the doctors. They ran labs for MIS-C, an inflammatory condition some children develop after Covid that affects major organs. While we waited for the results, we watched sensory videos on my phone and named the zoo animals on his tiny hospital gown. To our relief, his long-lasting symptoms were caused by ear infections, and not some nebulous, frightening illness we knew nothing about.
Less than a month later, in June of last year, the Pfizer vaccine was finally approved for infants as young as 6 months by the Centers for Disease Control and Prevention (CDC). It’s recommended by the American Academy of Pediatrics (AAP) and bivalent boosters became available in December 2022 to protect against newer variants. And despite my best efforts, I still can’t find anyone to give my son his first shot. He is nearly 2, and supposed to be protected from Covid-19 by now, but something about our system is failing him.
He’s not alone. The CDC’s Covid vaccine tracker reports that only 6.9% of kids 2 years or younger have received their first Covid shot, and only 9.8% of children between 2 and 4 years old have had theirs. The AAP estimates that’s about 15.2 million children who have not had their first dose yet. While there are, of course, families who have chosen to forgo vaccinating their children, there’s a sizable group of parents still searching for shots. Why can’t they find them?
Where we live, in Jacksonville, Florida, there are no nearby pediatricians carrying Covid vaccines in their offices. Ours referred us to our local pharmacies or health department. Vaccines.gov also directs us to nearby Walgreens locations and CVS locations. But when you actually try to book an appointment, the problems begin.
According to the Walgreens website, “Walgreens pharmacists are authorized to administer Covid-19 vaccinations to children ages 3 and older. … For parents or guardians seeking a Covid-19 vaccine for their child under the age of 3, we encourage reaching out to their pediatrician.” As for CVS, since the vaccine’s approval, their pharmacy has offered Covid vaccinations to children 5 and up, and those with MinuteClinics (staffed by family nurse practitioners, physician associates, and nurses) can give them to children as young as 18 months, a CVS representative tells Romper. There are more than 9,000 CVS pharmacies nationwide; only 1,100 have MinuteClinics.
So, if your pediatrician doesn’t offer Covid shots, and nearby pharmacies can’t administer them to your child, can you turn to nearby hospitals or health departments? That depends on where you live. Whether your local children’s hospital and health department administer vaccines varies by region (and in some states, local health departments have been barred from stocking vaccines at all, The Washington Post reports).
This is not the first time families have struggled to access vaccines recommended to them by health authorities — pregnant people were turned away from Covid vaccine sites at alarming rates, even after shots were approved for them in December 2020. Once again, parents are navigating a broken health system to find vaccines, all while the health system shouts back, “Get your children vaccinated! Prevent those illnesses! Don’t delay!”
What is a vaccine desert, and how do I know if I’m in one?
If you’ve tried your doctor’s office and local pharmacies and come up empty-handed, you might live in a vaccine desert. “There’s this false belief that vaccines are available everywhere for everyone, and that’s just not the case for children under 5,” says Dr. Michelle Fiscus, chief medical officer of the Association of Immunization Managers. “The problem is when you get into rural areas where you may not have a pediatric provider within a 30-minute drive, and maybe you’ve got a pharmacy, but they’re not trained to vaccinate kids that young. Deserts for kids at the really young ages are even larger.”
“Parents should not be driving 45 minutes to get a dose of a vaccine, a free vaccine that the federal government provides you,” adds Dr. Rebecca Weintraub, director of Better Evidence at Ariadne Labs and founding director of the Global Health Delivery Project at Harvard University. “Like any other vaccine, you should be able to get this in your doctor’s office near your home or workplace. That means you’re dealing with a regional vaccine desert.”
The CDC reports that only 6.9% of kids 2 years or younger have received their first Covid shot, and only 9.8% of children between 2 and 4 years old have had theirs.
To help address the issue, Weintraub created Vaccineplanner.org with Boston Children’s Hospital and Google Health. The online tool allows you to enter your zip code, whether you drive or use public transportation, and the age of the person who needs to be vaccinated. It will shade the map in areas where you have to travel more than 30 minutes to find a shot, and identify possible sites within the desert for you to contact and maybe, just maybe, find your child a vaccine.
Why do vaccine deserts for young children exist?
It wasn’t supposed to be like this. On June 9, 2022, the White House issued a statement detailing their vaccine rollout plan for children 5 and younger. Their goal, they said, was to make “vaccinations available in convenient places parents and families know and trust.” The announcement promised that vaccinations would be available at pediatricians’ and other doctors’ offices, community health centers, rural health clinics, children’s hospitals, public health clinics, local pharmacies, and other community-based organizations. Eighty-five percent of children under the age of 5 lived within 5 miles of a potential vaccination site, it said, and “every child—including those who may not have a pediatrician or primary care provider—[would have] access to the vaccine.”
The network of different providers was the key to this plan. “At the beginning of the under-5 rollout in June, the Biden administration called on pediatricians and other health care providers to offer vaccines for kids, as these are the places kids are most familiar with receiving vaccines,” Weintraub says.
There are a number of reasons this didn’t work. First, pediatricians’ offices are already short-staffed and overburdened. “It’s a time scarcity issue. The staff at these clinics, their schedules are jam-packed and there’s not sufficient staffing to help,” Weintraub says. “We have to train more people to vaccinate young children if we want to close this gap.”
Additionally, the way vaccines are packaged means many offices struggle with how to administer them efficiently. Pediatric Covid vaccines, like the adult versions, are packaged in vials that hold multiple doses. Once you open a vial, all the doses must be used the same day or they expire. “With decreasing enthusiasm among parents, you have concern about popping open a vial of a vaccine for one dose when the second might not be used, at a cost of $110 to $120 per dose,” Fiscus says. “They also have to carry vaccines for every age group in their practice, including boosters. They’re all just sitting in your fridge and you’re hoping you have enough demand.”
Then there’s the pharmacies, which aren’t allowed or equipped to vaccinate children under 3. “It’s not ideal for a pharmacist to wrangle a 3-year-old in the store, and most pharmacies don’t have a space for them. We also have to vaccinate a child in the thighs instead of the arm,” Fiscus says. At the time of this reporting, Weintraub’s team believes there are around 39,000 vaccination sites nationwide for kids under 5; most of these are pharmacies, many of which can’t vaccinate kids 3 and younger, and only around 11,000 currently have the vaccine in stock.
To make matters worse, certain states are actively making it harder to administer vaccines. “You can live not just in a desert, you can live in a bad state,” says Dr. Tommy Schechtman, president and CEO of Pediatric Partners in West Palm Beach, Florida. According to the AAP, “child vaccination rates vary widely across states, ranging from 2% to 39% receiving their first dose.” Weintraub seconded this, noting 29% of kids in Washington, D.C. have received their first dose compared to 1.7% in Mississippi.
Florida Governor Ron DeSantis, for example, refused to preorder the vaccines, before prohibiting county health departments from administering shots or distributing them to pediatricians near the end of 2022. This has a profound effect, says Schechtman. “When you’re a small office ordering small amounts of vaccines, it’s difficult to order what you need through the state. If I needed 10 vaccines for my office, I could go pick it up at the warehouse of the local health department. But the governor stopped that months ago, so now access to the vaccines has been made much more difficult. Instead of making it easier, which is the purpose of a federal program, our state has made it harder. Certainly who’s being impacted the most are minority groups.”
Vaccine access for kids may get worse before it gets better. In the coming months, government vaccination programs will end and Covid vaccines will become commercially available. “When these vaccines become commercialized, we throw a lot of other challenges into the mix in terms of equity and access,” Fiscus says. “Right now if you’re uninsured, underinsured, or on Medicaid, you can get a vaccine. When they become commercial, the way the system exists right now, if you’re a child covered under Medicaid, or under- or uninsured, you get vaccines through the CDC’s Vaccines for Children program, but not all VFC providers are offering Covid vaccines. You end up with this venn diagram where only a portion of access points remain once the vaccines become commercialized.”
Now that my son is 18 months old, he finally has an appointment for his first dose. When all families with young children will feel that sense of relief, no one can really say.
Experts are trying to eliminate vaccine deserts, but it’s going to take time. The Association of Immunization Managers, led by Fiscus, have funding from the CDC to gather data over the next nine months about how vaccine deserts form. This spring, they’re hosting meetings across the country with representatives from the AAP, Medicaid, pharmacy associations, and more to find solutions. “We need to really get teams to sit down and troubleshoot what their barriers are to vaccinating kids against Covid. There are so many layers to getting kids vaccinated. Lots of this crosstalk has to happen between organizations,” Fiscus says.
For example, in most states, Medicaid doesn’t pay pharmacists for administering vaccines like they would any other medical provider, Fiscus explains. “So, if we can get pharmacies and Medicaid to sit down and figure out how to get states to recognize pharmacists as vaccinating providers — they’ve vaccinated more than half the people in the country against Covid — there should be some way to make it worthwhile to engage pharmacists in those efforts.”
Schectman tells Romper he feels pediatricians should be the ones vaccinating children; they have the training to work with young children, and can take their entire medical history into account during the visit. Fiscus points out, though, that American children are roughly 37 million doses behind on their vaccines, and even pediatricians who want to administer the shots may need pharmacists’ support to catch up.
Where can I find pediatric Covid vaccines for kids under 5?
While systemic change lumbers along, if you’re having difficulty locating a Covid vaccine for your infant or toddler, Schectman encourages parents to call their local children’s hospital to ask about nearby vaccine sites. Weintraub recommends checking Vaccineplanner.org and calling local health departments. Even if they aren’t administering vaccines, they may be able to connect you with someone who does.
“You could be vaccinated by a family medicine doctor, for example,” she says. “There may be doctors in your area other than your pediatrician. It may also come down to asking a different pediatrician in the practice. Also, it matters for parents to call their representatives and say, ‘I cannot access a vaccine close to my home or work.’ We are not at the end of this, and I feel for working parents.”
Ultimately, it’s hard to know who to blame. Which is exactly what you want to do when every time your child comes home with another daycare virus, you wait to see if it’s the virus. The health care system is overwhelmed and burned out. Politicians are complicating vaccine access in an already fraught health care system. And as usual, America’s parents are left without adequate support, hoping that maybe one day, years after it was promised, the bare minimum of protection will be available to our children. All of them.
Now that my son is over 18 months old, he finally has a MinuteClinic appointment for his first dose. When all families with young children will feel that sense of relief, well, it seems no one can really say. So, parents will do what we do. We’ll be here, refreshing websites, calling around, looking for a vial in a haystack.
Dr. Rebecca Weintraub, director of Better Evidence at Ariadne Labs and founding director of the Global Health Delivery Project at Harvard University, assistant professor in the Department of Global Health and Social Medicine at Harvard Medical School, and an associate physician at Brigham and Women’s Hospital
Dr. Michelle Fiscus, board-certified pediatrician and chief medical officer of the Association of Immunization Managers
Dr. Tommy Schechtman, MSPH, FAAP, president and CEO of Pediatric Partners in West Palm Beach, Florida, and former president of the Florida Chapter of the AAP