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Twenty-eight million children are one step closer to receiving their COVID-19 vaccines. This week, the Federal Drug Administration (FDA) advisory committee voted to authorize the Pfizer vaccine for all kids ages 5-11 after reviewing clinical trial data. The vaccine is slightly different than the one for adults: 

“The main difference is they are getting a smaller dose, in a smaller volume,” said Kawsar Talaat, an infectious disease physician, pediatrician, associate professor at Johns Hopkins Bloomberg School of Public Health, and a principal investigator of the Pfizer vaccine trial.

Kids represent over 10% of newly diagnosed cases. At least 94 have died from the virus in the U.S. since the start of the pandemic, with a recent study finding it was in the top 10 leading causes of death through August and September for children under 15 years old. Children of color are more affected than white kids, being more susceptible to severe hospitalization and multisystem inflammatory syndrome, a serious condition that affects organ systems. Of all cases in kids, 50% of cases and 59% of deaths are children of color. In addition to BIPOC kids, children in foster care, those from low-income families, and those whose parents work inflexible jobs without paid time off for vaccination are also likely to face barriers to getting the shots.

With vaccine approval for young children on the horizon, a rollout centered on equity and access could close this gap. The Biden administration is gearing up, revealing their plan to get as many kids vaccinated as possible. The focus is on trusted sites and messengers: shots at pediatrician’s and doctor’s offices, hospitals, pharmacies, school and community-based clinics, health centers, while growing broader public education and trust in the effectiveness of the vaccine. 

But for families who don’t fit within the current system—working multiple jobs with no paid time off, lacking insurance or a primary doctor, or without transport—there are still obstacles. 

The Vaccine Equity Cooperative (VEC), a national collaboration of community health focused organizations and nonprofits, is leading the advisory group guiding the Biden administration’s youth vaccine rollout strategy. VEC brings together voices working directly in communities who “should be national experts and advisors themselves,” said Denise Octavia Smith, founding executive director of the National Association of Community Health Workers and co-lead of VEC. 

“We are not equipped as a country to handle something like this,” explained Alexandra Quinn, VEC’s co-lead and the CEO of Health Leads. But some communities are, she pointed out, noting how the Indian Health Service (IHS) has had incredible success in vaccine distribution, in part because many Native American communities have embraced public health—including vaccination—as a collective responsibility rather than a choice that only affects an individual. Quinn also noted that IHS “knows that it has to work deeply with community partners.” 

Learning from these effective systems and bright spots, VEC’s recommendations (which have been officially been published) highlight the importance of this ground game, working directly with groups that hold these relationships of trust: ensuring there’s someone who looks and talks like you, especially for those who don’t have a medical home like a doctor’s office, to ensure racial health equity

After all, parents and caregivers will need to consent to vaccines, putting responsibility for learning about it and finding time to get it in their hands. For those with questions, they may need more time at the doctor for counseling, meaning longer appointments. These services will need to be compensated to ensure doctors make time for it. 

Families without a doctor will need to find a trusted voice to talk to and get the shot. Additional federal funding will also be directed at community health clinics, where many low-income communities already receive medical care, to help address this gap. 

Some school and local districts are getting ready to hold vaccination drives and community fairs at times that work for busy families like the weekends, already sending out surveys and talking to families about the vaccine. Talaat explained that schools are key since they’re “places where families can go after school and on a weekend; a place they are normally going, and a trusted environment.” 

But there’s challenges: vaccines at school still leave out homeschooled students, kids who aren’t at school regularly, and some of those in the foster system. And some schools are contentious now, having turned masks and vaccine mandates into political issues instead of public health ones. 

One of the biggest hurdles is paid sick leave. There is a mandate for some employers to provide paid leave for employees to get vaccinated, which still leaves gaps for gig and other precarious workers, but currently no announcements have been made requiring this leave to extend to getting shots for kids. This leaves communities of color most at risk as women of color are already more likely to work in jobs without paid time off. These same caregivers will need to take time off to take their kids to the doctor and may need to take additional time to deal with any potential side effects, which are similar to side effects for older children but with lower fevers due to the lower doses.  

“When we come to the equity line, we can see where people don’t have sick time or they don’t get time off at all. Just like before the pandemic,” Smith said.

If states and communities learn from what’s worked before, like at-home vaccination programs, and are proactive in looking for missed groups as the funds and doses are being distributed, these obstacles could be addressed. 

The big question then becomes how the rollout will vary. With so much direction left to states, some may simply be slower in the uptake, making it harder for families. Effective monitoring and VEC believes democratization of data, resources, and information will be key.

“We need to make sure those who are on the ground doing the work are getting the resources they need,” Quinn said. “And to keep bringing them to those with power in a room to understand what needs to happen.”

Now that the advisory committee put their stamp of approval on the vaccine, it needs formal approval by the FDA. The Centers for Disease Control and Prevention will weigh in on the decision at their meeting next week If approved, the vaccine could be available as early as next month.

Umme Hoque

Umme Hoque is a writer, editor, and organizer. She's passionate about writing about and investigating issues for low-income workers and communities of color, lifting up the experiences of those who are...