What to expect from the youth vaccine rollout in Vermont

  • A youth vaccination clinic at Spaulding High School in Barre on May 19. State health officials say school-based clinics will be a key part of the vaccine rollout for 5- to 11-year-olds. Photo by Mike Dougherty/VTDigger VTDigger file photograph — Mike Dougherty

Published: 10/29/2021 9:30:33 PM
Modified: 10/29/2021 9:31:03 PM

Vermont health leaders will begin vaccinating children ages 5 to 11 against COVID-19 as soon as federal authorities give the go-ahead.

The state is well-positioned for success, according to medical experts and health officials — but the pediatric effort still faces both logistical hurdles and apprehension from some parents.

An advisory panel of the U.S. Food and Drug Administration recommended Tuesday that the agency authorize the Pfizer vaccine for children ages 5 to 11. If the FDA does so, a committee of the Centers for Disease Control and Prevention will take up the recommendation at a meeting on Nov. 2.

Assuming the CDC concurs, Vermont children in that age group could become eligible for shots as early as Nov. 5, said Kelly Dougherty, deputy commissioner of the Vermont Department of Health. Nov. 8 is the state’s target date to begin vaccinating large groups of children through clinics in schools.

About 44,000 Vermont children would be eligible. According to Dougherty, the health department hopes to vaccinate 60% of them within the first eight weeks of the campaign, with a long-term goal of 80%.

The medical community is confident that parents will step up, and for good reason: Vermont has led the nation in COVID-19 vaccine uptake throughout the year.

That enthusiasm is likely to drive high youth vaccination rates, said Rebecca Bell, president of the Vermont chapter of the American Academy of Pediatrics: “The biggest predictor of whether or not a child’s going to get vaccinated is if their parents are vaccinated.”

But vaccinating younger children comes with unique challenges, Bell said. Parents tend to be more nervous about medications for their children than for themselves, and some degree of general vaccine hesitancy has become entrenched during the roughly 10 months since the adult COVID-19 vaccines launched.

Plus, the youth vaccine would be distributed separately from the adult supply. Ensuring equity in allocating doses to different communities will be front of mind for pediatric providers and health officials.

Experts say a potentially major public health benefit is at stake: High uptake among the 5-to-11 age group would boost the state’s overall vaccination rate and help protect a population that’s been highly vulnerable to infection during the Delta wave.

According to health department data, children ages 11 and under have had by far the highest rate of COVID-19 infection of any age group since the Delta variant became dominant in July. The persistent rate of pediatric cases has led to frequent disruption in schools and strain on health care providers.

“It’s hard to imagine a way out of this until our kids are vaccinated …” Dougherty said. “Hopefully, that’s what’s going to help bring it to an end and make it more an endemic disease that we just manage, like we do other infectious diseases.”

Getting doses out the door

The logistics of vaccinating 44,000 additional Vermonters would be daunting even if the vaccine were the same for adults and children. It is not.

Pfizer’s pediatric vaccine comes in smaller vials and requires smaller needles to administer. Both the adult and youth versions have the same active ingredients, but the pediatric dose is lower — 10 micrograms, compared to 30 for adults.

Unlike the adult doses, which require deep freezing, the pediatric shots can be stored at normal refrigeration temperatures for up to 10 weeks, according to a White House fact sheet. That’s likely to enable more doctor’s offices to store and administer shots.

The state will have to decide how many doses go to which locations. But that planning is well underway, Dougherty said. Doses will be stored at health department district offices in each of Vermont’s 14 counties, and shipments from the federal government will begin as soon as the FDA authorization becomes official.

Vermont would receive 15,900 children’s doses in the first three weeks of the vaccination campaign, Mike Smith, secretary of the Agency of Human Services, said at a press conference earlier this month.

“We’ve had a lot of practice over the last almost-year of getting vaccine where it needs to go. I think we’ve become pretty proficient at that,” Dougherty said. “We’re feeling good that we’re going to have it where we need to have it.”

Youth vaccines will be available at pharmacies and state-run mass vaccination sites, as well as doctor’s offices, she said. Pharmacies will receive their own supplies from the federal government.

The state plans to hold two types of mass vaccination clinics: school-based clinics specifically for the 5-to-11 age group, plus community-based clinics like those the state has operated throughout the year. While school clinics will be the focus in the first weeks of the youth vaccination effort, community clinics will eventually become one-stop shops, where families of mixed age groups can get their first, second or third shots all together.

Dougherty expects mass vaccination sites will accommodate the parents who are most enthusiastic to have their children vaccinated in the opening weeks of the campaign. What happens after that could depend on the buy-in of the state’s pediatricians.

Helping the hesitant

Parents of 5- to 11-year-olds in the U.S. are split roughly into thirds, according to a national survey by the Kaiser Family Foundation. Some plan to get their young children vaccinated right away, others plan to “wait and see,” and others say no way.

That’s one indication that the youth effort may face more vaccine hesitancy than earlier groups, Dougherty said. One-on-one conversations with pediatricians will be key for families who don’t participate in the first round of mass vaccination clinics, she said — and the goal is for pediatricians to have the supplies on hand to administer shots as soon as parents come around.

Because doctors must enroll with the health department to receive doses of the vaccine, the state can track interest from providers in real time. So far, roughly 90% of pediatric practices have signed on.

The challenge will be reaching large groups of families quickly, said Rebecca Bell, from the pediatrics academy. Many families with children ages 5 to 11 see their pediatrician only once a year.

“I think folks want to sometimes talk to their own pediatrician, which we certainly recommend,” she said. “But do you set up an appointment? Do you wait until the next time you see your pediatrician?”

One strategy that worked this spring with parents of adolescents was local information sessions. The Vermont chapter of the American Academy of Pediatrics organized virtual forums to coincide with school-based vaccine clinics. At each event, local pediatricians and school nurses joined AAP leaders to answer questions from parents. Similar events are already in the works for the next age group, Bell said.

The state also is working on targeted outreach to communities that may have more barriers to obtaining information about the vaccine.

Many of Vermont’s immigrant communities have been particularly susceptible to anti-vaccine messaging this year, said Andrea Green, a pediatrician at the University of Vermont Children’s Hospital and director of the hospital’s Pediatric New American Clinic. The clinic serves families who came to the Burlington area through refugee resettlement programs and who face language, cultural and logistical barriers to obtaining health care.

Older parents in those communities often had personal experience with serious diseases like tetanus and generally support vaccines, Green said. Younger parents who have immigrated more recently appear to be less certain.

“The conversation in the United States around vaccines has now made them sort of say, ‘Well, maybe I need to worry about vaccines. It seems people are worried about vaccines. I think I need to ask more questions,’ ” she said.

“People are not in the clinic refusing vaccines for the kids. I’m not having that happen. But you can tell that there’s this sense of, like, ‘Americans think vaccines might be a bad idea. Why is that?’ ”

Green and her colleagues are now “priming”: signaling to patients that vaccines for 5- to 11-year-olds are on the way and trying to answer their questions ahead of time.

As a familiar face to many parents in the Burlington-area New American community, Green is working with the Vermont Multilingual Coronavirus Taskforce to prepare educational videos about the youth vaccine in multiple languages. The group also plans to work with school liaisons to ensure information and forms are available before school clinics take place.

Efforts also are underway to address the dramatic gap in vaccination rates in Vermont’s Native American community ahead of the youth rollout. According to health department data, as of Oct. 28, people in the Native American, Indigenous or First Nation communities had a 29.6% rate of starting vaccination compared with the statewide rate of 89.8%.

Abenaki people in Vermont have historical reasons to distrust the state’s health care system, said Joanne Crawford, a state employee who is on the board of directors of the Missisquoi Abenaki. “The people who’ve lived through or experienced eugenics are still with us, and that type of thing gets passed down generation to generation,” she said.

The gap in vaccination rates could very likely persist when youth vaccinations become available, Crawford said. She is now working with the health department on a separate round of educational sessions for Vermont’s Native American community in November and December, with a focus on the importance of vaccinating children.

“I think once they can build up the trust, I think you will see the numbers change. At least, I hope,” Crawford said.

Questions and concerns

Parents are overwhelmingly excited about the youth vaccine, said Amy Pfenning, a pediatric nurse practitioner at Community Health in Rutland. “They are asking repeatedly when they come in with their littles. ... ‘When can we get them vaccinated? When is it coming in?’ ”

That said, many express concerns. “They’re very worried about, you know, ‘This is the new mRNA vaccine. Have we ever used this before?’ ” While mRNA technology has existed for decades, it hadn’t been used in a vaccine until COVID-19. But federal authorities have reviewed testing data carefully to ensure the vaccine is safe and effective for younger age groups.

Parents are concerned that there’s no longer-term data, Rebecca Bell said. “That’s always the question: ‘Will this affect my child five or 10 or 15 years down the line?’ ”

Bell tells parents the vaccine is temporary. Like a recipe, it teaches your body to make a certain protein, then disappears. “You don’t put the actual piece of paper in your food as you’re making it, you know?” she said. “It’s an instruction, and then it goes away.”

Vaccine side effects almost always show up within hours or days of a shot, Bell said. “There’s never been a vaccine where we’ve vaccinated folks, and then something comes up one year, five years, 10 years down the road.”

Taking an empathetic approach is key, said Joseph Pelletier, a pediatrician at Gifford Health Care in Randolph.

“We start from the baseline that we realize that all parents are trying to do what they think is best for their kids,” Pelletier said. “Even if they feel like vaccines are not the best thing for their kids, we respect that they’re trying to make the right decision.”

Pelletier said some parents have already brought up heart inflammation, called myocarditis, which has been linked to the Pfizer and Moderna shots in a small number of teenagers and young adults, as a particular concern around vaccinating their children. He tells parents these cases have been exceedingly rare, and COVID-19 itself presents a higher risk of similar conditions.

“When they hear that, they sort of think about, ‘Well, the vaccine potentially could have some side effects, but the side effects from having COVID could be much worse,’ ” Pelletier said.

Bell said another frequent question is more philosophical: ” ‘If all the adults just get vaccinated, do we even need to vaccinate kids?’ ”

When the vaccine was authorized for adolescents in May, cases were rapidly declining, and children appeared to be at low risk. Many parents were skeptical that getting their kids vaccinated would have any effect.

The delta variant may have answered that question for us, Bell said. The surge in infections this fall has brought renewed attention to the effects of community spread — and it’s had an outsized effect on parents facing repeated disruptions to their children’s education.

“When the disease is out there and affecting both your community and you personally, it becomes more pressing,” Bell said.

Pfenning, the Rutland nurse practitioner, said she and her colleagues are preparing to do whatever it takes to get as many children vaccinated as possible. “We’ll make this happen, because there’s no other way,” she said. “It’s necessary for the health of our community and the health of these children.”

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