The pediatric COVID-19 vaccine for 5- to 11-year-old children is being rolled out — a monumental milestone nearly two years into the pandemic. Early data relating to the rollout for 12- to 18-year-old children, however, indicate vaccination gaps — in distribution, access, and uptake — between white children and children of color, particularly Black children. Little data are available yet for the roll-out for 5- to 11-year-old children, but there are persistent disparities in immunization rates for other preventable childhood diseases. How can the child health field ensure this disparity isn’t perpetuated in rolling out the COVID-19 vaccine to younger children?
COVID-19 has disproportionately affected the health of Black, Latino, and American Indian and Alaska Native (AIAN) children, resulting in higher infection and hospitalization rates as well as increased death rates when compared with white children. While the Biden Administration has secured enough vaccines to supply all 28 million children in the U.S. who are now eligible, Black, Latino, and AIAN children may still experience delays and other obstacles in receiving the vaccine in the absence of careful planning and coordination.
This blog post offers considerations for pediatric medical care teams and community partners to ensure more equitable COVID-19 vaccine distribution among children. These recommendations fall under four broad categories and draw from conversations with pediatric practices, family advisors, and core partners engaged in Accelerating Child Health Transformation, a national initiative led by the Center for Health Care Strategies with support from the Robert Wood Johnson Foundation.
1. Leverage Existing Assets to Reduce Hurdles to Vaccination Access
- Listen to families and communities. Through trusted and authentic partnerships with families and communities of color, pediatric medical care teams can co-identify barriers to equitable vaccination rollouts and innovative solutions alongside families. For example, community partners and leaders can co-design modes of engagement, as well as non-coercive and empowering incentives tailored to families in specific communities.
- Review current practices through an equity lens to help alleviate unintended consequences. Pediatric medical care teams can use a strengths-based approach to assess the existing resources to which they have access. Practices can also lean on relationships with families and community partners to co-create family-driven solutions aimed at reducing barriers, such as flexible scheduling practices. For example, families may have an easier time getting their child vaccinated if the office offers appointments during non-business hours with no penalties for tardiness or no-shows.
- Leverage community partnerships with schools, school-based health centers, community social workers, and faith-based organizations to connect with children and families who may have reduced access to the vaccine. Other community partners can also serve as a resource to offer additional convenient locations and times, mobile or pop-up clinics that are staffed by trusted community partners and in under-resourced communities, no-cost transportation to and from vaccination sites, and support navigating online appointment portals.
2. Share Information Effectively to Build Vaccine Confidence
- Use clear, concise, and accessible messaging to discuss vaccine efficacy with families and counteract persistent misinformation campaigns. One way to quickly incorporate effective communication is to adapt language that has already been crafted to address families concerns about the COVID-19 vaccine and other recommended immunizations.
- Ensure ample time for parents to ask questions. The medical care team can bring up the importance of vaccination for the entire family and make sure that family concerns are addressed and that they have the information needed to make their decision. In addition, care teams can provide vaccine counseling to foster supportive conversations around the COVID-19 vaccine.
- Use culturally sensitive language and tailor existing community engagement resources (including core messaging, infographics, social media posts, and campaign tools) to reach specific communities, including Black and Latino communities, as well as refugee, immigrant, and migrant communities.
3. Focus on the Medical Care Team
- Ensure that the medical care team is comfortable addressing vaccine hesitancy and other family concerns to foster an environment where all families feel supported during a stressful time. Practices can offer trainings such as the teach-back method, which assists with clear communication, or show their commitment by crafting a statement or joining local initiatives like the Power of Providers initiative in Washington State.
- Help staff vaccinate their own families by offering vaccine drives or additional paid time off. Offering opportunities for the medical team to vaccinate their own families provides a space for staff to talk about the experience of vaccinating their families with the community they serve and signals the practice’s commitment to vaccination.
4. Measure Equity Progress and Advocate for Equity
- Track vaccination data in real time and collect disaggregated data by race and ethnicity, as well as by language spoken and geographies, whenever possible. There are various tools available to assist health care systems and practices think through metrics, including this toolkit, which offers a framework for tracking vaccine equity metrics.
- Advocate for anti-racist practices and policies that drive vaccine equity and benefit all families. Joint efforts with families and community leaders can be used to inform policymakers and advocate for local, state, and federal policies to help dismantle racist systems that impede equitable preventable care, including immunizations.
An estimated 25,000 pediatric and other primary care sites are involved in the roll-out of the COVID-19 vaccines for 5- to 11-year-old children. As a main provider of care for children and trusted messengers with policymakers, pediatricians have a key role to play with ensuring vaccine equity both in this phase and the future roll-out of a vaccine for children under 5 years old. Pediatric medical care teams can meaningfully engage with families and communities of color and can use existing resources and expertise to co-create solutions to ensure vaccine access for all families. Vaccination efforts have direct impacts on the health outcomes for all children and their families, especially for those who have already been disproportionately affected by the pandemic. Ensuring that all children have equitable access is essential.