Dozens of South Florida pharmacies, community health centers, children’s hospitals and pediatricians received delivery this week of the first COVID-19 vaccines available for children as young as 6 months old — much earlier than anticipated after state officials missed a deadline for pre-ordering the shots.
But pediatricians and public health advocates working to vaccinate newly eligible children under 5 said they are throwing away the majority of the doses they have ordered because Gov. Ron DeSantis will not authorize state programs to administer the vaccines for infants and toddlers, effectively cutting off supply to many family doctors. The health department also will not promote the vaccines to parents, some of whom are hesitant to have their young children vaccinated.
Parents have mixed feelings about the vaccines. Some are actively seeking it for their children under 5, the last group to be authorized for the COVID vaccines. Others are holding back, concerned about whether there has been enough research on the vaccines and their impact on young children.
As a result, initial demand has been low, and doctors are throwing away vaccines. That’s because each vaccine vial contains 10 doses, and once a vial is opened, it has to be used within 12 hours.
Pediatricians say they can no longer turn to their county health department to supply them with smaller amounts of the vaccine, which is what many doctors have been doing to procure the vaccine for older kids and adults, said Dr. Lisa Gwynn, a University of Miami pediatrician and president of the Florida Chapter of American Academy of Pediatrics.
Gwynn said Florida’s county health departments have been involved in helping pediatricians and other doctors vaccinate older children and adults. But by denying Florida’s county health departments the authority to provide the vaccines to the newly eligible children, she said, the state has cut off access for some of its youngest and neediest children.
“That’s what we’re going through on the front lines,” Gwynn said. “Local health departments will not be offering the vaccine (for newly eligible children), nor will they participate in the distribution to pediatricians and local family doctors.”
The Florida health department and governor’s office did not respond to the Herald’s request for comment Friday.
‘Nobody to give it to’
Dr. Tina Carroll-Scott, a pediatrician who runs the South Miami Children’s Clinic, said she received 100 doses — the minimum amount per order — of the newly approved vaccine on Wednesday, two days after placing the request. Carroll-Scott ordered the vaccines through Florida Shots, a joint program between the Florida Department of Health and the CDC. With other COVID vaccines, a doctor could order vaccines in much smaller doses from the health department.
The vaccines arrived faster than she expected, given that Florida was the only state in the country to miss a CDC deadline for pre-ordering the vaccines and White House officials indicated that deliveries would take longer to reach the state as a result.
As of Friday, however, Carroll-Scott said she had administered the vaccine to one patient.
“Because we only used one dose,” she said, “we had to throw away the vial with nine doses left because [there was] nobody to give it to.”
Similar waste has occurred with vaccines for 5- to 11-year-olds, Carroll-Scott said. “We have wasted so many vaccines.”
South Florida pediatricians say part of the challenge in vaccinating their young patients is that they also must contend with guidance from a state surgeon general who advises against vaccinating healthy children, contrary to recommendations from the Centers for Disease Control and Prevention, the Food and Drug Administration and pediatric medical associations.
In predominantly Black and Hispanic communities that have been disproportionately affected by the pandemic, the words of Florida Surgeon General Dr. Joseph Ladapo carry much weight because Ladapo is Black, said Carroll-Scott, who also is Black and whose nearly 2,000 pediatric patients are predominantly Black and Hispanic.
Ladapo issued guidance in March stating that “healthy children” younger than 16 years old are at “little to no risk of severe illness,” and that for adolescents 16 to 17 years old the vaccine’s risks “may outweigh the benefits.” That guidance, Carroll-Scott said, has undermined pediatricians as trusted messengers in their communities.
“Having a surgeon general of color, a Black man, come out against what every other pediatrician or most pediatricians are advising to the parents of these kids regarding the vaccines has really made it difficult for those of us on the ground in communities of color,” she said.
Concern about Black and brown children
Ladapo’s guidance, Carroll-Scott said, causes confusion and can exacerbate the pandemic’s disproportionate impact on low-income and minority communities, who as a group experience relatively poorer health, shorter lifespans and less access to healthcare than whites.
“Here we were in a situation where there’s urgency because Black and brown communities are being disproportionately affected by the virus,” she said, “and we have little information and we’re trying to roll out the vaccine and educate at the same time.”
Gwynn emphasized that children 5 and older can still get vaccinated against COVID-19 through county health departments in Florida. Only children younger than 5 are excluded.
As a public health advocate and a physician, Gwynn said she is concerned with providing access to as many people as possible, particularly children who are low-income and uninsured.
“This is about equity and access,” she said. “Now poor kids [younger than 5], who normally get their vaccines from places out in the community, such as the local health departments, will no longer have access that way.”
Those families will have to search for a different provider, Gwynn said, and many low-income families do not have reliable internet access and may have trouble speaking English or finding transportation to take them to an appointment.
And though many parents can also turn to community health centers and pharmacies that carry the vaccines, most pharmacies will not vaccinate children younger than 3 years old due to a federal law that shields medical providers from liability only in cases of children 3 and older.
One of the largest retail providers in Florida — Publix supermarkets — said its stores will not offer the newly approved vaccine for young children “at this time.”
Parents have mixed feelings
The Biden administration has said 10 million doses are available for distribution to states and healthcare providers, but only 2.5 million doses of the Pfizer-BioNTech vaccine and 1.3 million doses of the Moderna vaccine have been ordered to date.
On Thursday, the White House’s COVID-19 Response Coordinator, Dr. Ashish Jha, said more than 4 million doses have been delivered to about 13,000 sites across the country.
While some parents have been eagerly awaiting the vaccines’ availability, it’s not clear how many will vaccinate their infants and toddlers.
About 1 in 5 parents of children under 5 said they wanted to vaccinate their child “right away” once federal regulators authorized the shots, according to an April 2022 survey by the Kaiser Family Foundation, a nonprofit group that analyzes national health issues.
More than a third of parents said they would wait and see how the vaccine works in other children, and about 1 in 4 reported they would “definitely not” have their children vaccinated. Another 11% said they would vaccinate their kids “only if required.”
“Probably part of the reason parents are hesitant is that many kids have had COVID, but we know that people can get it again,” Dr. Thresia Gambon, a pediatrician with Citrus Health Network, a community health center with clinics in Miami-Dade, said in an email. “The vaccine may have side effects in some children, but we need to weigh that with the illness itself, or the potential for long COVID.”
Children and COVID
About 1,500 children younger than 18 have died from COVID-19, according to CDC data. And children also run a risk of long COVID, or symptoms that last for months or more after the initial infection has passed. A recent study, which has to be peer reviewed, indicates that repeated re-infection raises the risk of an adverse outcome.
Though children as a group have not experienced the same degree of serious illness, hospitalization and death from COVID-19 as adults and the elderly, Gwynn said they remain at risk for long-term health effects from infection.
In February, the CDC found that 75% of all children and adolescents in the United States had evidence of a previous infection, with about one third becoming newly infected since December 2021 during the omicron wave.
Florida’s health department reports that about 193,000 or nearly 17% of the more than 1.1 million children younger than 5 in Florida, have tested positive for COVID-19 during the pandemic, including an estimated 2,800 cases confirmed the week ended June 16.
Possibly the best barometer for forecasting demand will be the rollout of vaccines for 5- to 11-year-olds in November 2021, when demand initially rose but then dropped two weeks later.
More than seven months after the authorization for 5- to 11-year-olds to be vaccinated, about 24%, or 1 in 4 of the nearly 1.7 million Florida kids in that age group, have received at least one dose of vaccine, according to the health department.
Among Florida’s nearly 2 million adolescents and young adults ages 12- to 19-years-old, about 56% have received at least one dose.
Nationally, nearly 30% of children ages 5 to 11 years old, and nearly 60% of adolescents ages 12 to 17 years old, are fully vaccinated as of June 22, according vaccination demographics data from the CDC.
What parents are saying
In South Florida, some parents jumped at the chance to vaccinate their young children. For them, the newly approved vaccines are the beginning of the end of more than two years of precautions and concern about their babies, toddlers and preschool children who were the last Americans to be afforded effective protection against serious illness, hospitalization and death.
Dan Goodfriend of North Miami Beach said he was prepared to drive out of state to get his 15-month-old daughter, Ava, vaccinated if he couldn’t find a place closer to home. But Goodfriend was able to get his daughter vaccinated through a local clinical trial with vaccine manufacturer Moderna on June 10, about one week before the CDC and Food and Drug Administration authorized the vaccines for children as young as 6 months old.
Goodfriend said he and his wife, whose name he asked to keep private, spent years trying to have a baby, going through in vitro fertilization or IVF treatments and, when those failed, choosing to adopt. But the pandemic struck while the Goodfriends were in the adoption process, forcing them to pause, he said. Then, to their surprise, Goodfriend said, his wife became pregnant in summer 2020.
The family has not eaten indoors at a restaurant, or gone to an indoor movie theater, or attended a concert during the pandemic. Goodfriend said he and his family also wear face masks whenever they’re in a public place. They take great precautions, Dan Goodfriend said, because he has asthma and the couple aren’t willing to risk the health of a child they tried for so long and so hard to conceive.
“We’ve been leading a very cloistered life, going to what I think the majority of people would think are extreme lengths to keep her from getting infected,” Goodfriend said. “I know I’m in the minority, but frankly I think I’m right about this. I think the rest of the world has become far too cavalier about it.”
Goodfriend said he feels frustrated still taking precautions. “It feels like the world has moved on and left us behind, like we don’t matter,” he said. But, he added, “I don’t think anybody else should be in a position to decide what level of risk is appropriate for my daughter.“
Other parents, like Paul Behar of Pembroke Pines, said they want to wait for more research and experience with the newly approved vaccines. Even then, Behar said, he may not vaccinate his daughter, Rose, who just turned 5.
“I’m in the wait-and-see approach, if you want to describe it as that, or maybe even a don’t-do-it approach,” he said.
Behar said he wants to see if there are long-term effects from the vaccines, but he’s also doubtful that the shots will prevent her from getting COVID-19. And if she does, Behar said, he thinks she’ll beat it on her own.
“My daughter has great health and is a very active child, lots of extracurricular activities, lots of outdoors time, healthy diet, nutrition,” Behar said, echoing the Florida health department’s COVID-19 prevention guidance. “It’s important that we’re prioritizing healthy lifestyle, and that is almost always the best prevention for disease.”
Vaccine drives planned
South Florida hospitals and county governments are planning public vaccination campaigns for newly eligible children. Miami-Dade vendor Nomi Health, a private company that provides COVID-19 vaccines and testing at public sites throughout the county, will hold vaccine drives for children 6 months and older on Saturday and June 27 at Miami-Dade’s Tropical Park, Dolphin Mall, Zoo Miami and other locations.
Vaccines are free for most, regardless of insurance status. But Nomi said it will charge those without a valid U.S. address and no health insurance $40 for the vaccine.
Through the University of Miami Health System, Gwynn also conducts outreach with mobile clinics that bring vaccines to schools, community centers and other public areas free of charge and without an appointment. UHealth provides a monthly schedule for the mobile clinics online at pediatricmobileclinic.com and by phone at 305-243-6407.
At Citrus Health, Gambon said, “We have some parents asking for the vaccine, but not the majority.” She added that most of the parents asking about the vaccines have family members who work in healthcare or who have children considered at high risk for serious illness from COVID-19.
Citrus Health is still gathering information from parents to gauge demand, Gambon said, because once a vial of 10 doses is opened, doctors only have a few hours to use them.
Jackson to administer pediatric vaccine
At Jackson Health System’s Holtz Children’s Hospital in Miami, pharmacists have about 100 doses of the vaccine in cold storage, and they plan to order more if there’s demand, said Venessa Goodnow, chief pharmacy officer.
Goodnow said the vaccines arrived this week, and they’ll will be distributed at Holtz and through Jackson Health’s primary care clinics in Miami-Dade.
Jackson Health, Miami-Dade’s taxpayer-owned hospital system, will host educational webinars and public events to make sure parents know the vaccines are available and hear more about the science behind them.
Public vaccination events also are planned, including a partnership with the University of Miami Health System’s pediatric mobile clinic that will offer the vaccine to walk-up patients without an appointment from 8:30 a.m. to 3 p.m. on June 29 at Jackson Memorial Hospital.
Goodnow said she expects that infants in the first year of life may be more likely to get vaccinated because they have more frequent doctor visits, giving pediatricians more chances to talk to their parents, than older children who may only receive annual visits.
But she doesn’t know how many parents will want to vaccinate their young children.
“It will be interesting to see what the interest is for this age group,” Goodnow said. “We’re not sure what it will look like.”