When COVID-19 vaccines for children under 5 finally rolled out in June, doctors expected to face hesitant parents. Surveys had predicted that only one in five would jump at the chance to vaccinate their littlest children right away.
But in the six weeks since, the uptake has proven even weaker than feared.
Nationally, as of figures reported on Aug. 3, 3.83 percent of children age 6 months until 5 years had received at least one dose of vaccine. In Massachusetts, which provided more current data, the number was 11 percent, one of the highest rates in the nation but still lower than any other age group in the state.
Seizing every opportunity to vaccinate, doctors are opening 10-dose vials during regular office visits, knowing they probably won’t use all the vaccine and will have to throw some out. Once a vial has been punctured, its contents must be used or discarded within 12 hours.
“It feels yucky. I hate waste,” said Dr. Wayne Altman, a family physician in Arlington. His practice has had a comparatively high uptake of vaccine, with about one-quarter of eligible patients getting it. Still, he has not once used up every dose in a vial.
Dr. Lloyd D. Fisher, a Worcester pediatrician, said he has also opened vials knowing he might have to discard as many as nine of the 10 doses.
“There is plenty of supply at this point, so it is not a huge problem, but we never want to waste any vaccine,” he wrote in an e-mail. “Parents have lots of questions and we can often allay their fears about side effects from the vaccine. They also wonder why, when the disease itself is generally not as severe in children, is it necessary.” Fisher explains that the safe vaccine “can make that low risk even lower.”
Dr. Alexy Arauz Boudreau, who oversees the primary care practices of the Massachusetts General Hospital for Children, said it’s crucial to have such conversations and offer the vaccine “then and there.”
Boudreau said she assures parents that the vaccines have been thoroughly studied in clinical trials and in the real world. “We have more knowledge about how this vaccine behaves in children than just about any other vaccine that we roll out,” she said.
National survey data show why these conversations are so important. In July, the Kaiser Family Foundation found that more than four in 10 parents of children under 5 would “definitely not” get their child vaccinated for COVID-19. Just over half considered the vaccine a bigger risk to their child’s health than getting infected with COVID-19.
Even those who appreciate the value of vaccination sometimes hold back. Shannon Cronin, whose daughter is 22 months old, feels “just a little bit nervous doing it right away without a ton of data.”
Cronin and her husband, who live in Hingham, are both fully vaccinated. But she had an unusually bad reaction to her booster shot, which left her feeling ill for two months.
“We know that was totally rare, and we’re very pro-vaccine,” Cronin said. She plans to discuss vaccination with her daughter’s pediatrician the next well visit in October.
“I just feel more comfortable having a conversation with her doctor, just to make sure,” Cronin said.
Doctors say that hesitance to take the vaccine is especially strong when it comes to the littlest children.
“People get more nervous about trying something new for little children than they would for themselves,” Altman, the Arlington doctor, said. But, he said, “The risk of COVID for young children is greater than the very small risks of what seems to be a very safe vaccine for children.”
COVID-19 infects even the youngest children. A recent study of blood samples found that two-thirds of children ages 1 to 4 have been infected with the coronavirus, and the number more than doubled between December 2021 and February 2022.
And a few suffer more than just sniffles. Multisystem inflammatory syndrome in children, or MIS-C, is a rare but severe outcome of COVID-19, and no one knows why some children get it and not others. That means every child can be considered at risk.
Long COVID — the syndrome of persistent symptoms that last months or years after infection — can also affect children, and vaccines make it less likely, Altman said.
A recent CDC study found that certain conditions that are very rare in children — including inflammation or weakening of the heart muscle, blood clots, kidney failure, and type 1 diabetes — were more common in those who had had COVID-19, although still rare. The conditions appeared anywhere from one month to a year after infection.
And children do die of COVID-19. As of July 27, the CDC tallied 471 deaths among children under age 5. That’s a tiny fraction of the deaths among the elderly but still a big number for young people who are expected to be healthy, making COVID-19 a leading cause of death among children.
Logistics may present challenges unique to families with younger children. Pharmacies, a common place for other age groups to get their shots, are not allowed to vaccinate children younger than 3, and parents may prefer to take their little ones to the pediatrician anyway.
Some parents only want one of the two vaccines available for this age group and will wait until they can get that one. The sought-after Moderna vaccine requires only two doses 28 days apart. The Pfizer version requires three shots, the first two 21 days apart, with at least eight weeks required between the second and third doses. With Pfizer, it will take longer for children to become fully protected.
In Massachusetts, the state’s vaccine finder lists dozens of sites offering Moderna, but roughly four times more offering Pfizer. (Many offer both.)
But Boudreau expects that eventually, the Moderna vaccine will also require a third dose.
It’s not possible to make direct comparisons between the two vaccines, but there’s no reason to think one is more effective, Boudreau said. “It is not worth hunting one over the other,” she said.
Another factor is simply the time of year — summer.
“People are off, families go away — that’s probably playing a role,” said Dr. Lael Yonker, a pediatric lung specialist at Massachusetts General Hospital. “When kids go back to school, or start up preschool or day care, they might think about the vaccine.”
But that’s a little late, because both vaccines require more than one dose to be fully protective.
And children do spread COVID-19. Yonker led a study published last fall that showed infected children carry just as much virus as adults.
The shots won’t totally stop the spread, because the virus has learned to evade vaccine immunity. But, Yonker said, vaccination can still help limit spread because vaccinated people tend to be infectious for a shorter period of time.
And the vaccines protect well against severe illness.
As the months go by, the safety of the vaccines for young children will likely be confirmed, Altman said. But he’s not optimistic that more parents will seek the shots. “People have come to their conclusions, and I don’t think that’s going to change,” he said.