Equitable access to the childhood COVID-19 vaccines is essential, especially in light of the fact that COVID-19 has disproportionately affected the health of children from communities of color.1 Although, overall, children have not been as severely affected as adults by infection with COVID-19, a certain subset, including those of racial and ethnicity minority groups and vulnerable populations, have been hospitalized and shown to experience long-term consequences and death from the disease.2 Data, though limited, have also shown that children of color may be less likely to receive a COVID-19 vaccine.1
So, how can the different stakeholders, including health care providers, researchers, policymakers, and caregivers, ensure parity and smoother vaccine rollout among younger children?
To give us further insight into the various aspects of childhood COVID-19 vaccinations, we spoke with Suzette Oyeku, MD, MPH, chief of the Division of Academic General Pediatrics at the Children’s Hospital at Montefiore in New York and professor of pediatrics at the Albert Einstein College of Medicine.
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Transcript
Research has shown that COVID-19 has disproportionately affected the health of children of color, especially those who are Black, Hispanic, and Asian. Would you be able to provide an overview of the available data on the disparities seen in COVID-19-related infection and death among the pediatric population?
Dr Oyeku: So, if we start first in terms of globally looking at COVID-19 infections in the general population, we see that COVID-19 has disproportionately [affected Black and communities of color].3 So then, by extension, we’re seeing that same pattern play out with our children, and specifically, communities of color. But we’re also seeing individuals who are living in poverty, [those] living in rural settings, also being disproportionately [affected].2
Thankfully, COVID-19, though it’s causing a significant amount of cases in children, it has not led to a lot of deaths in the pediatric population.2 So, overall, children have not died [at the same rates as] that of adults, but we know that any child’s life that’s lost [is devastating and] we don’t want that to happen. So, I think we are all working together collectively to try to ensure that no child [dies] from this infection.
It has been reported that vaccination against COVID-19 was approximately 90% effective in preventing SARS-CoV-2 infection in children aged between 5 and 11 years.4 However, although there are limited available data, children of color were found to have a lack of access to the pediatric COVID-19 vaccines. Could you explain the different factors contributing to this?
Dr Oyeku: So, we know that we have enough supply of vaccinations; so, we don’t have a supply issue. Part of it is getting the vaccine to where children seek care. Most parents are going to want their child to be vaccinated in their medical home – so either in their pediatrician’s office or their family medicine doctor’s office. It’s unlikely that most parents are not going to get their kids vaccinated at the local pharmacy. We have seen that, but by and large, most families are more comfortable in places that they know. So, in terms of their doctor’s offices and school settings, those are definitely areas where our children are going to get vaccinated.
But I think prior to the [COVID-19 vaccine] approval for children [aged] 5 to 11 years, parents still had a lot of questions about the safety of the vaccine in this age group, and they still have questions. So, I think, part of the reason that we’ve seen disparities or gaps in vaccinations in this age range, and particularly in communities of color, is that parents still have questions that are unanswered.
So, I think for us, as health care providers, we have to do the work in terms of engaging our families in ongoing conversation, and addressing their questions, and meeting them where they are. For some families that might be conversation; for some families, it may be them reading some of the data and the studies; and for some families, it may be talking to other parents who have had their children vaccinated. We need a multimodal approach to address some of our parents’ concerns about the vaccine. But I realize that once we have the conversation, many of us, and you included, probably have been successful in terms of getting your children who are [aged] 5 to 11 [years] vaccinated.
But I think the reasons for the gap in pediatric vaccinations are, 1, availability in places that families are comfortable; 2, unanswered questions they have about the vaccine, and particularly, the safety. Then, also, in terms of timing – for many families, it’s also being able to coordinate getting their child vaccinated at a time that works for the family because we’re trying to ensure their children still go to school and the parents continue to go to work. So, for many families, you’re trying to make sure that they can get vaccinated at times that are convenient for them.
What are the existing barriers and how can equity be achieved in childhood COVID-19 vaccination?
Dr Oyeku: That’s going to be a multimodal approach, and there are several ways that that can be accomplished.
One, I think, is making sure that our families have access to getting vaccines at times that are convenient to them. Also, removing any barriers to getting vaccinated – so, transportation barriers and being able to get vaccinated at times that work for them.
The other is, really, a knowledge gap for some of our families. Despite how much information that is out on the media and on the TV, there’s a lot of misinformation that’s out there, and I think for families, they need to be able to disaggregate the truth from what is not factual. And that’s where we come into play. As health care workers, our job is to really help families disaggregate the information and be able to get their questions answered. So, that takes time; it takes time to have the questions and going over all of their concerns.
I think the other barrier that we’re seeing is that we still have gaps in adult vaccinations; and children, they’re generally part of families, so the family context, and we need to think about what is the vaccination status of the entire family. We know that if there [are] parents and grandparents, and other family members [who] are vaccinated, then we anticipate that the children are likely going to be vaccinated in the household. So, the conversation doesn’t only focus on children. The pathway to childhood vaccination equity is really also ensuring that the family is vaccinated, as well.
How can health care providers play a role in encouraging the uptake of vaccines among these individuals, but especially among children of minority groups and those with chronic conditions?
Dr Oyeku: Several ways that we have been working to encourage vaccine uptake amongst our pediatric population is hosting vaccine popups in our children’s hospital [of Montefiore], but also providing vaccinations in our primary care practices to make it accessible for our families. We’ve also engaged in community education events, so we’ve done town halls; we’ve also done community vaccine events; and we’ve also talked to local and national media to be able to address people’s concerns. I think that multimodal approach has definitely helped to increase the uptake of vaccines in our patient population that we see here at Montefiore.
I also think one of the other things that we’ve learned is that it’s everyone’s job to have a conversation, so it’s not only the physicians but also our nurses; every team member has a story. I think it’s important for every team member to share their why, and why did they get vaccinated? Because you never know what’s going to resonate with the family and is going to be the difference for them changing their mind and making a decision to get vaccinated.
The other strategy, I think, is using every health care encounter – sick visit, well visit, and inpatient visits – to actually have a conversation about vaccination, and not just COVID-19 but other childhood vaccinations, [too]. If we normalize the conversations, that also helps with this.
I recently worked at the inpatient unit and had a conversation with a mom in terms of what the family’s vaccination status was and just began to brainstorm ideas in terms of how she would be able to go about to get the rest of their family vaccinated. She was able to make a decision that she wanted to move forward and [I] provided her the information on how she could get vaccinated in addition to the rest of the family. So, I think it doesn’t have to just be during a regular doctor’s visit, it can be during any kind of encounter. It’s just being able to make the time to have the conversation.
This is an unprecedented time that we’re in and we need to use different strategies than we normally used to be able to increase [vaccine] uptake in our communities.
The recent news is that Pfizer has asked the [US Food and Drug Administration] FDA to authorize the COVID-19 vaccine for children younger than 5 years. Can you share your thoughts on this, and when this vaccine becomes available,* what approaches can be taken to ensure vaccine equity among the racial and ethnic minority groups in the US so that the current situation is not repeated?
Dr Oyeku: This is something that we actually are thinking about here at the Children’s Hospital at Montefiore, in anticipation for this authorization.
We recognize that this is going to be a different situation because we’re talking about our youngest children – so, our children who are [younger] than 5 [years]. For our families, they need to feel confident in the recommendation that their doctors are giving. We know the data show that if families receive a strong recommendation from their trusted health care provider, they’re more apt to move forward with getting vaccinated.
So I think it’s, 1, for us, as pediatricians and family medicine doctors, for us to make sure that we review the science and that we’re well-versed in the science, so that we’re then able to convey a strong recommendation to our families.
Two is using every opportunity to be able to have a conversation with our families, particularly children [younger] than 5 [years]. We see them very regularly in primary care, so I think every conversation is an opportunity now to begin to explore people’s views about vaccinating their younger children around COVID-19.
Three is also sharing the experience in terms of what COVID-19 infection looks like in younger children, and particularly with this most recent surge with the Omicron variant, we saw our youngest children affected. So, we saw children with bronchiolitis, we saw them with fever, and we saw some children with seizures. Having those conversations with our parents, to let them know what are the complications that children [younger than] 5 [years] can potentially get if they get infected. That, also, can be compelling for some families to make the decision to get their child vaccinated.
Then, 4, I think, is just also asking families what questions they have, what are their hesitations, and to then be able to begin to address those questions and hesitations.
I’d say, lastly, is continuing to assure that everyone has access to vaccination in locations, as well as times, [which] are convenient for the families because many of our families are working different hours and they won’t be able to come to get vaccinated during the traditional workday. They may need to get vaccinated in the evening or on the weekend. So, [it may be useful] beginning to be able to provide opportunities for our families to get vaccinated in locations, as well as times, [which] work best for them.
So, those would be the strategies that I think will help us to be able to ensure that our children younger than 5 [years] are able to get access to the [COVID-19] vaccine.
Any final thoughts you’d like to share on this topic before we conclude our conversation today?
Dr Oyeku: So, I would say, as rheumatologists, you have an important role to play in trying to ensure vaccine access for all of our patients. You take care of some of our most vulnerable patients, those with medical complexity. So, continuing to have those conversations and also reaching out to your primary care or family medicine partners to see how you might be able to collaborate to ensure that your shared patients are able to get vaccinated. We’re not going to be able to test our way out of this pandemic. The only way, really, is going to be for us to vaccinate our communities, and so, you play an integral part in making sure that that happens.
Dr Oyeku also added, “We need to continue to advocate for global COVID-19 vaccine access to ensure everyone is afforded the opportunity to get protected.”
*Editor’s Note: This interview was conducted before the FDA’s decision to delay the authorization of the Pfizer COVID-19 vaccine for children aged younger than 5 years until data on all 3 doses were available.
References
1. Kaiser Family Foundation. Racial disparities in COVID-19 impacts and vaccinations for children. Published September 16, 2021. Accessed March 1, 2022. https://www.kff.org/racial-equity-and-health-policy/issue-brief/racial-disparities-in-covid-19-impacts-and-vaccinations-for-children/
2. Centers for Disease Control and Prevention. Barriers to equity in childhood COVID-19 vaccination. Updated January 20, 2022. Accessed March 1, 2022. https://www.cdc.gov/vaccines/covid-19/planning/children/equity-barriers.html
3. Kaiser Family Foundation. COVID-19 cases and deaths by race/ethnicity: current data and changes over time. Published February 22, 2022. Accessed March 2, 2022. https://www.kff.org/coronavirus-covid-19/issue-brief/covid-19-cases-and-deaths-by-race-ethnicity-current-data-and-changes-over-time/
4. Woodworth KR, Moulia D, Collins J, et al. The Advisory Committee on Immunization Practices’ interim recommendation for use of Pfizer-BioNTech COVID-19 vaccine in children aged 5–11 years — United States, November 2021. MMWR Morb Mortal Wkly Rep. 2021;70(45):1579:1583. doi:10.15585/mmwr.mm7045e1
This article originally appeared on Rheumatology Advisor
