Hospitals Begin Giving COVID-19 Vaccines to Younger Kids, but the Effort Has its Challenges

Hospital systems are gearing up for another round of clinics and outreach efforts to get COVID-19 vaccines to younger children.

Federal regulators gave the final approval Nov. 2 to offer the Pfizer-BioNTech vaccine to kids 5-11, and shots started going into the arms of kids almost immediately. About 28 million children are now eligible for a COVID-19 vaccine for the first time.

Hospitals are putting together broad vaccination plans. It’s an enormous effort that involves no shortage of challenges.

Healthcare systems are offering appointments in their facilities, including pediatric practices, but that’s only one step. They’re also setting up clinics and other efforts to reach kids and families, including those who don’t see a doctor regularly.

Hospitals are undertaking these plans even as they contend with serious staffing challenges. They need to plan vaccine clinics with staff that are already taxed to the limit.

Like many others, Nemours Children’s Health is ramping up its vaccination plans. Kara Odom Walker, executive vice president and chief population health officer at Nemours, said the staffing crunch has added to the challenge. Nemours is considering staffing as it moves forward with its plans.

“The health care environment is under such constraint and pressure,” Walker said. “We have definitely felt it.”

Late in the week, Nemours was preparing to open clinics in Delaware and hoped to have clinics operating in Florida soon. Despite the challenges, Walker and others said doctors and nurses are stepping forward to get the clinics up and running.

Rebecca Carter, a pediatrician at the University of Maryland Medical Center in Baltimore, is director of community outreach and engagement for the pediatrics department. She acknowledged staffing is an issue.

“Staffing is a national challenge, but importantly in pediatrics, we do see a huge commitment towards getting children vaccinated against a range of illnesses, including COVID,” Carter said via email.

“Pediatric physicians, practitioners, and nursing staff are rising to the challenge, and seeking opportunities to reach as many kids and families as possible to help get us through this phase of the pandemic.”

‘Hospitals are very full’

In addition to the staffing shortage bedeviling many hospitals, healthcare systems face another challenge in deploying staff to vaccine clinics. Many hospitals are jammed with patients, said Nancy Foster, vice president of quality and patient safety policy at the American Hospital Association. Hospitals are packed with COVID-19 patients and those with other conditions who had been putting off medical care in the pandemic and now require treatment.

“Some may be thinking of setting up clinics for kids at the hospital, maybe a school or a church,” Foster said. “As they do that, one of the key questions they have to ask is, where do you get the staff to do that?”

“Our hospitals are very full,” Foster said, adding, “We don’t have a lot of staff to spare.”

Susan E. Coffin, attending physician in Children’s Hospital of Philadelphia’s Division of Infectious Diseases, said staffing is only one challenge in the effort to distribute vaccines.

“The task of vaccinating 28 million children all at once is a fundamental mismatch to the way we deliver healthcare normally,” she said in a call with reporters.

Children’s Hospital of Philadelphia is setting up “vaccine hubs” where patients can go simply to get the shots without a doctor’s appointment.

“We’re not as familiar with using vaccine only visits for this age group but I think this will be something really exciting for families, much more quick and convenient,” she said. Those hubs are designed for primary care patients, but the hospital system is planning other community vaccination programs to reach those who aren’t patients.

The University of Maryland Medical Center is drawing up its strategy to vaccinate younger kids. Carter offered advice to healthcare systems making their plans.

“One recommendation to any organization planning vaccination events for the 5-to-11-year-old cohort: providing access to pediatricians at these events will prove crucial to addressing questions and concerns about the vaccine,” Carter said.

Nemours is preparing to handle the first wave of parents clamoring to get their kids vaccinated, Walker said. She said the previous rounds of vaccinating teens followed a familiar pattern.

“There's this initial phase of very motivated parents … then there’s a little bit of a pause. And then it kind of trickles off,” Walker said.

With this new group of kids, she said she’s not sure how long that initial wave will last.

Clinics offer opportunity

Hospital systems are aiming to set up clinics that are easily accessible, including those in communities with a high minority population and less access to medical care. Walker said that’s an opportunity to address equity gaps in healthcare.

“Some of our outreach is to address that gap. We’re focused on underserved, minority communities,” Walker said.

“It’s not a magic wand,” she said. “We have a direct strategy. Text messaging and phone calls for contact.

“We’re working with community partners to get the word out,” Walker said.

The University of Maryland Medical Center has found COVID-19 has required new strategies, and those lessons can go beyond the pandemic.

“Communities that have historically been excluded from direct access need a different approach during this pandemic, as well as moving forward into the future of healthcare,” Carter said.

“Our model with the adult and 12+ age groups has been to bring vaccinations to the community instead of just waiting for the community to come to us,” she explained.

Nemours and other hospital systems are working to get shots to kids who don’t have a pediatrician and those families without doctors.

“We are always looking for ways to catch those developmental milestones and other healthcare needs,” Walker said. “Vaccination clinics provide an opportunity to get to know them, and for them to get to know us.”

“Because of COVID, we have seen many families who are behind on other healthcare needs,” Walker said.

The priority is getting kids vaccinated, said Carter. But community-based vaccination clinics also give hospital systems a chance to connect with people, possibly getting them into a doctor’s office on a more regular basis. It’s better to get patients going to a doctor’s office than emergency departments.

“Although we feel the primary goal is to help facilitate getting children vaccinated, we also want kids and families to understand that we are accessible and available to address other health needs,” she said.

“There is such a value in knowing and trusting a medical home to be a resource for any ailment that arises over the course of the year; to monitor overall growth and development and assist in preventive health maintenance,” Carter said. “We hope to provide an access point to build on these relationships with families we meet through the vaccination process.”