Lagging vaccinations for kids between ages 5 and 11 prove daunting for California schools

Vaccination clinic on a recent Sunday at Coyote Hills Elementary School in Newark.

Credit: Louis Freedberg

Even as the nation gears up to offer vaccines to its youngest children, a more immediate battle is how to get the existing pediatric vaccine to more 5 to 11-year-olds.

Although rates vary wildly depending on the county and school district, as of last week only 1 in 4 of these elementary school-age children had been fully vaccinated in California. That compares with just under two-thirds of 12- to 17-year-olds who have been fully vaccinated.

This means that in most places in California, the majority of students at elementary schools are still not vaccinated, even with one shot, complicating the challenge of keeping schools open for in-person instruction and putting more children at risk of contracting the disease.

That’s despite what Dr. Mark Sawyer, a pediatric infectious disease specialist at University of California San Diego, and past president of the American Academy of Pediatrics’ San Diego chapter, says is an “open and shut case” for administering the vaccine from a health perspective.

Unless the pace picks up considerably, it could sink efforts by Gov. Gavin Newsom and in the state Legislature to require students to be vaccinated to attend school in the fall.

If large numbers of children are still not vaccinated by then, keeping so many of them out of school and in remote learning will be an educational and political impossibility.

That’s why there is some urgency for California to use the next few months to figure out what the principal barriers are to vaccinating 5 to 11-year-olds, and more importantly, how to overcome them.

“Now would be a really good time for the state to look at what is driving the great variation in vaccine uptakes among children,” said Dr. Jeanne Noble, director of Covid-19 Response at the UC San Francisco Parnassus emergency department, and a parent of school-age children.

If it doesn’t, she said, there could be a “terrible standoff” when schools reopen in the fall.

There were great expectations when the Pfizer vaccine for younger children became available last November that most parents would jump at the opportunity. But after three months, most are still holding off, despite aggressive efforts to overcome obstacles. That includes offering gifts to children who show for the vaccine, as well as $50 gift certificates to their parents for groceries in some counties.

The slow pace can’t be blamed simply on the fact that the pediatric vaccine is the most recent one to come on the market. After a similar amount of time, many more 12- to 15-year-olds had been vaccinated, indicating that the younger age group presents special challenges.

At least some of the lag is due to parents who are against vaccines, in general, or the Covid vaccine, in particular, like Kristy Llewellyn, a parent of a 4-, 10- and 13-year- old, in Temecula north of San Diego.

“I’m not an anti-vaxxer,” said Llewellyn, whose school-age children are in class in the Temecula Valley school district. “We just don’t have enough information for me to feel safe about it.”

Nobody in her family has been vaccinated, and none intend to, she says. Her entire family was stricken by the virus last summer. All recovered, with relatively mild symptoms, and she now feels her family is adequately protected — bolstered, she said, by getting regular exercise, eating healthily and following standard Covid-19 safety precautions.

Beyond vaccine resistance, there are multiple logistical barriers that have disproportionately affected 5- to 11-year-olds. One is that there are simply fewer places where young children can get the vaccine than there were last year for teenagers and adults.

Take the experience of Ilene Guerrero in San Bernardino, who also initially was against her 11-year-old daughter, Celeste, getting the shot. “We knew people who had bad reactions,” she said.  “We are worried about kids growing up without knowing exactly what the side effects will be.”

What settled the issue was her daughter, a middle school student, insisting on getting the vaccine.  “Her fears were out-of-control,” she said. “She was more scared about getting the virus than the shot.”

To get it, Guerrero had to spend an hour finding an appointment online for her daughter a week later and then had to drive 20 miles to get the vaccine, offered by the county public health department in a local park.

Amid these difficulties, there is at least one positive development: Pharmacy chains like CVS and Walgreens have begun to offer the Covid vaccine to children — the first time they have provided vaccines of any kind to young children.

But vaccines for young children are available at only a small percentage of pharmacies. Of 1,175 CVS locations in California, only about one-fourth offer them.

Alameda County is way ahead of most counties, with 53% of its 5- to 11-year-olds fully vaccinated, twice the state average. Part of its success is linked to working closely with schools to educate and inform parents. It has also offered a handful of vaccine clinics on weekends and evenings at some schools, like the one I observed at the Coyote Hills Elementary School on a recent Sunday in Newark. The goal: Make it easier for working parents to get the vaccine.

Another little-mentioned problem is that pediatric vaccines come in vials with 10 doses that have to be administered over a 12-hour period – compared to only six doses in vials for older children.

That makes it more difficult for some pediatricians to administer. It’s especially the case for those who are sole practitioners or have smaller practices because it is rare to have 10 children showing up to be vaccinated on a particular day. Pediatricians like UCSD’s Sawyer say it would help if Pfizer came up with vials with single doses.

The most immediate problem, says Jen Kates, director of global health and HIV policy at the Kaiser Family Foundation, is that “the very eager parents have already gotten their children vaccinated, and it has gone down since then.” Vaccination of 12- to 17-year-olds also dropped off after an initial spurt, but not as rapidly with the younger ones.

“The last mile with any vaccination is hard,” Kates said. “This is going to be really hard.”

To remove at least one obstacle, the FDA should move expeditiously and do what it needs to do to lift the emergency use label and provide full authorization for the vaccine, says Dr. Monica Gandhi, an infectious disease specialist at UCSF. That will alleviate at least some parents’ anxieties.

Parents must also be convinced that even though children are at low risk of becoming seriously ill from Covid, they can still die from it, said Gandhi. “Even though the rate of severe infection is very low in this community, if you have a safe and effective vaccine, why have any deaths at all?”

What’s daunting is that all these challenges will likely be multiplied when California begins administering vaccines to even younger children, which could happen within weeks.

The scale of the challenge is evident in Los Angeles County, where only 25% of 5- to 11-year-olds have been fully vaccinated. Some 575,000 children in this age group alone have yet to receive even one shot.

Dr. Nava Yeganeh, medical director for the county’s Vaccine Preventable Disease Control Program, is optimistic that with “a little more time and effort,” many more children will be vaccinated.  “It is early days,” she said.

Let’s hope she is right.

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Louis Freedberg is a past executive director of EdSource and a veteran education journalist.

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