U.S. health officials are setting the stage for a national campaign to vaccinate young children against COVID-19 by inviting state officials to order doses before vaccinations are allowed.
The Pfizer coronavirus vaccine is currently being administered in the United States to people as young as 12 years old. Over the next three weeks, federal officials plan to discuss making lower-dose vaccines available to the country’s 28 million children aged 5 to 11.
To help states and cities prepare, the Centers for Disease Control and Prevention sent out a seven-page document this week with instructions on how to create expanded vaccination programs.
For example, it notes that pharmacies in every state can vaccinate children against COVID-19, but clarifies that for children under 12, only doses prepared and packaged specifically for children should be used.
However, this does not answer some of the more pressing questions, such as how much to rely on in school clinics or whether children should be required to be vaccinated as a condition of school attendance.
These issues will need to be addressed in every state and city.
The guide comes as communities prepare for a new phase in a 10-month effort to vaccinate as many people as possible against the virus that has killed more than 720,000 people in the United States.
The disease is most dangerous for the elderly, whose mortality and hospitalization rates are higher than those of children. But some children are at risk of serious illness, and more than 540 children in the United States have died from COVID-19, according to the American Academy of Pediatrics.
Equally important, health officials believe that vaccinating children will reduce the spread of the virus among vulnerable adults.
Pfizer and its German partner BioNTech have gone the furthest in research on the use of their vaccine in young children. They say the two-dose series of vaccines – one-third more effective than the vaccine given to people over 12 years of age – is safe and effective for children 5 to 11 years old.
An independent panel of experts that advises the FDA is scheduled to publicly discuss the evidence at a meeting in late October. If the FDA approves doses for children, another panel of experts advising the CDC will review the matter in early November and then offer CDC recommendations.
It is unclear how many people will immediately vaccinate their young children, said Dr. Markus Plescia, chief physician of the Association of State and Territorial Health Authorities.
“We’re going to have a potentially very stressful and possibly moderately chaotic time,” he said at the beginning.
But there probably won’t be as much demand as when shots were first made available to adults, he added.
New CDC guidelines call for vaccinations in pediatric and family doctor’s offices, as well as in pharmacies, rural clinics and federal health centers.
The CDC discussed the option of vaccination in schools, but did not endorse it as the main way to vaccinate children. School clinics are attractive in terms of logistics, but many parents may not like the idea, Pleshcha said.
Plescia noted that the guideline also warns health care providers to only use doses that have been specially formulated for children and not try to split doses for adults.
The CDC guidance says immunization program managers can start ordering doses on Wednesday, although the vials won’t be shipped until the FDA and CDC sign.
When coronavirus vaccines were first authorized in December, the US government prioritized their introduction in hospitals and pharmacies. Some doctors in the office felt left out.
Dr. Jesse Hackell registered early in New York State to be able to vaccinate adolescents. He said his office, located 25 miles north of New York, did not receive doses for this until May.
But Hackell said the CDC has assured pediatricians that once authorization occurs for children ages 5 to 11, the process will go smoother and pediatric surgeries can receive supplies quickly.
Dr. Richard Besser urged the government to do more to address racial and economic inequalities that can arise in the course of vaccination of young children.
For example, children may not be vaccinated if parents are unable to get away from work to bring them to their home.
“It is very important that we understand the barriers to vaccination,” said Besser, executive director of the Robert Wood Johnson Foundation and former acting director of the CDC.