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With COVID-19 vaccine for younger children, a chance to promote health equity across all ages

It’s a shot to get this right for family members across age groups, particularly those with higher risk of disease vulnerability and greater barriers to health care access.

Naomi Macklom, 5, whose parents enrolled her and another daughter in a Pfizer-BioNTech COVID-19 vaccine trial, shows the "I was vaccinated" patch on her Girl Scout Brownie vest, in Cedar Park, Texas, on Sept. 6.ILANA PANICH-LINSMAN/NYT

The text from our pediatrician’s office popped up on my phone a few weeks ago. “We are getting ready to order the COVID-19 vaccines for the age group of 5-11. Would you like to give your child the vaccine? Please respond 1 YES or 2 NO.” I immediately texted back “YES.” Like millions of other parents and caregivers, and alongside our public health and health care colleagues (I am a public health professor; my husband is a primary care physician), we have been anxiously awaiting the availability of this vaccine for months.

With last week’s Food and Drug Administration approval of the Pfizer vaccine for younger children — 28 million children in the United States are ages 5 to 11 — we are probably days away from scheduling our 6-year-old’s first dose. And yet, being eligible does not equate to having access, and having access does not equate to uptake, as we have seen from past vaccine rollouts. The relief that the older of my two children would soon be able to get the vaccine was clouded with my anxiety of when it would be approved for the youngest member of our family (our 4-year-old) and my concern that government and health leaders may repeat mistakes, such as relying primarily on overburdened health care systems for distribution, requiring Internet and digital platforms for vaccine registration, and lack of prioritization for communities at greatest risk. My husband and I are able to be flexible in terms of scheduling and distance to make a vaccination appointment for our daughter as soon as possible, but what about other families with less capacity and higher risk of COVID-19 complications?


Across the country, Black and Latinx children experience disproportionately higher rates of COVID-19 hospitalizations and deaths. Racial inequities in vaccination access and uptake also persist, even in Massachusetts, which has one of the highest adult vaccination rates nationwide. Among families with children ages 12 to 17 in the state, less than 50 percent of Black parents reported that their teenagers were vaccinated, compared to 70 percent of white parents, according to a recent Household Pulse Survey. Among adults, 81 and 84 percent of those who identify as Latinx or Black, respectively, reported receiving a COVID-19 vaccine, compared to 90 percent of white adults and 98 percent of Asian adults. To prevent similar trends of inequities among younger children, leaders in government and health care can design a pediatric vaccine rollout with equity and caregiver support at the forefront.

In October, the Biden administration released a plan to ensure that child vaccination will be convenient, accessible, and free at pediatricians’ offices, pharmacies, and some schools. This plan can be strengthened by tailoring and adding strategies based on community, caregiver, and child needs. Recommendations for such efforts can include:


Building upon and supporting existing efforts established by trusted community partners. The state can ensure local organizations that have led adult vaccination efforts are well funded and actively involved in pediatric vaccine outreach and distribution planning. La Colaborativa and East Boston Neighborhood Health Center launched a vaccination site in Chelsea that brought vaccines to a central community location. These efforts helped many lower-income workers in Chelsea to overcome structural barriers (e.g., transportation, workplace flexibility) to vaccination. Similarly, the organization 1DaySooner delivered vaccines in Roxbury on Boston Vaccine Day.


Meeting children where they are. In addition to pediatrician offices, schools and youth-based community settings such as Boys and Girls Clubs and YMCAs are prime locations that facilitate delivery of vaccines directly to children; minimization of transportation and scheduling barriers for caregivers; and community awareness and trust in the vaccine. Approximately half of low-income parents report concerns with being able to take time off work and the ability to get the vaccine from a trusted place for their younger children.

Engaging children and caregivers in family-based vaccination efforts. The availability of vaccines for younger children offers an invaluable time to reengage adults who are now or soon will be eligible for boosters, as well as to conduct outreach with adults and older children who have yet to be vaccinated. The Montgomery County Public School system in Maryland, for example, plans to host free vaccination clinics for young children and their parents and guardians who would like shots or boosters. Vaccination sites that offer vaccine doses for a variety of age groups, cater to a range of work schedules, and have availability on the weekends timed with community events can maximize uptake of the vaccine and minimize scheduling and transportation barriers for the whole family.

Implementing inclusive strategies to address vaccine concerns and misinformation. The vaccine rollout for young children offers a critical opportunity to communicate accurate, evidence-based information about the vaccine and its risks and benefits to children and adults, with particular attention paid to families of color and non-English-speaking families who have experienced racism or inadequate health care. The distribution of informational materials in multiple languages across different modalities and the presence of bilingual personnel (based on each community’s needs) and trusted, trained community members ready to answer questions at vaccination sites can promote equitable vaccine uptake.


Maintaining data-driven school mask policies. Until community transmission is lower or until far more people have been vaccinated across racial, ethnic, and income groups, universal school masking should be kept in place. Even with high child vaccination rates, removing mask policies in crowded indoor settings like schools could allow for rapid spread of COVID. Linking 80 percent child vaccination rates to the removal of school mask policies, as Massachusetts has done, may perpetuate inequities given that large disparities in vaccination by race, ethnicity, and income compound existing disparities in COVID-19 among children and their caregivers.

Record numbers of young people below the age of 21 died during the Delta surge. Rapid, equitable vaccine delivery can help prevent further cases, hospitalizations, and deaths as we enter the winter months. The availability of the COVID-19 vaccine for younger children is a shot to get this right for family members across age groups, particularly those with higher risk of disease vulnerability and greater barriers to health care access. And I am still waiting for the day my 4-year-old can get her shot too.


Monica L. Wang is an associate professor of community health sciences at the Boston University School of Public Health, an associate director of narrative at the Boston University Center for Antiracist Research, and an adjunct associate professor of health policy and management at the Harvard T.H. Chan School of Public Health.