Children Under 5 Receive Covid-19 Vaccines At University Of Washington Hospital

Rural parents are less likely to say their pediatrician recommended COVID shots. Here’s why that matters

The yearslong wait for a COVID vaccine for infants, toddlers and preschoolers is over – the first doses for America’s youngest children began last week. But depending on where a child lives, long-standing disparities in health care access and the influence of misinformation could shape whether they secure those shots.

According to a survey of parents released in March by the CDC, four out of 10 parents in rural communities said their pediatricians – who in general rank among the most trusted health care providers – did not recommend that their patients get COVID vaccines, far more than one out of 10 parents in urban communities who said the same.

What a pediatrician recommends serves as a strong predictor of whether or not a caregiver chooses to get their child vaccinated against COVID.

READ MORE: The COVID-19 vaccine and kids. Your questions answered

“This reported disparity between urban and rural pediatricians highlights the importance of partnering with health care providers and provider organizations to reduce vaccine hesitancy and increase vaccination coverage,” the study’s authors wrote.

These disparities – and vaccine hesitancy, particularly in rural communities – existed long before the pandemic began, said Lt. Commander Neil Murthy, a medical epidemiologist within the CDC’s Public Health Service who also helped author the study.

Rural residents, particularly across the South, are less likely to be fully vaccinated than those in more densely populated parts of the country, including the Northeast and Western U.S. The gaps in vaccine coverage between people in rural and urban areas more than doubled over a 10-month period, according to research from the Centers for Disease Control and Prevention.

Those attitudes and outcomes are influenced by systemic problems that rural residents disproportionately face, Murthy said.

covid vaccination coverage

Graphic by Megan McGrew/ PBS NewsHour

“Often, folks in rural communities may not have a health care home or a trusted medical provider,” Murthy said. If people don’t have a trusted provider urging them to get vaccinated against COVID, they are less likely to decide to do so, he said.

In Morgantown, West Virginia, Dr. Lisa Costello has treated children throughout the pandemic and frequently fields questions from fellow parents and pediatricians about COVID vaccines.

About 58 percent of West Virginians age 5 or older are up to date on their vaccines, according to the state’s Department of Health and Human Resources.

Approaching conversations from “a place of empathy and listening,” Costello said that she knows often “it takes more than one conversation to move someone,” including when politics or misinformation may have swayed people’s views about COVID vaccines.

READ MORE: How one city is reaching the unvaccinated

Nationwide, vaccination levels are lower among younger populations, particularly those under age 18. So far, fewer than two-thirds of kids aged 12 to 17, the first youth age group to be approved for COVID vaccines, have received their two-dose series, according to analysis of federal data by the American Academies of Pediatrics. Less than a third of kids ages 5 to 11 – who have been eligible since November – are protected fully. Overall, one out of five parents of children under age 5 said they want their kid to be vaccinated immediately, according to the Kaiser Family Foundation’s Vaccine Monitor survey in April, roughly on par with parent attitudes last summer. Another two out of five parents said they would wait awhile before getting their youngest children vaccinated against COVID.

An estimated 13.6 million children have been infected with the virus since the pandemic began, accounting for roughly one out of five cases in the United States, according to the academy, while a CDC study published in April found that about three out of four children and adolescents in the U.S. had been infected by February.

Until this month, children under age 5 have had to rely on other people’s choices to protect them. Advisers to the Food and Drug Administration on June 15 authorized the emergency use of two vaccines – Moderna’s dual-dose and Pfizer’s triple-dose – for kids under age 5 as being safe and effective. On June 18, the CDC’s own expert panel voted to recommend their use and CDC Director, Dr. Rochelle Walensky, made the final approval, clearing the way for shots to begin.

Months of work led up to that final decision. In June, the White House presented a rollout plan that included pediatrician and primary care clinics, children’s hospital networks and health care systems, state and local public health departments and pharmacies. An estimated 85 percent of children under 5 live within five miles of a “potential vaccination site,” White House COVID-19 Response Advisor Dr. Ashish Jha said during a briefing on June 9, during which he predicted that the milestone would offer “additional peace of mind to parents and guardians.”

The Biden administration’s plan to distribute 10 million vaccines for this age group included shipping out 100-dose packages with smaller needles to small pediatric practices and rural areas. Community health centers and rural health clinics, which serve more than 2 million children under age 5, were featured in these plans, and the Department of Health and Human Services’ COVID-19 Community Corps has played a role in launching these vaccines.

But in many parts of the country, on the first full day vaccines were available following the Juneteenth holiday weekend, shots were not as easy to find as they had been with earlier pediatric groups. In some communities, mass vaccination sites have been shuttered. At some pharmacies, people were able to make appointments for their children only to find out that the retailers did not yet have doses on hand. And some pediatricians were still waiting for shipments to arrive.

Pediatricians located in rural parts of the country, particularly those without connections to a research hospital or academic institution, may not always have ready access to the latest COVID guidelines, including those tied to vaccines, Costello said. Our understanding of the virus changes quickly, and “that’s part of the scientific process,” Costello said. Even for medical professionals, it can be a struggle to stay up to date on how to best protect oneself.

READ MORE: How ‘prebunking’ can fight fast-moving vaccine lies

To bridge those knowledge gaps quickly, Costello said trusted sources, including the American Academy of Pediatrics, share webinars to help overstretched providers. She also said West Virginia released a website to help families and providers track when someone is due for their next COVID dose. To use it, you plug in your age, if you’re immunocompromised, which vaccine you last received (if any) and the date. The website shares if or when you should make your next appointment.

“We’ve tried to make that easier because it can be really complicated,” Costello said.

The advantages to continually educating pediatricians about the virus are self-evident, said Dr. Paul Offit, who directs the Vaccine Education Center at Children’s Hospital of Philadelphia and serves on the FDA’s advisory committee on vaccines. But now that vaccines are available for these youngest children, he anticipates what has been observed when previous age cohorts became eligible: “Dramatic uptake, and then it came down and stayed down.”

Whenever people dismiss COVID as a serious disease for children, Offit said he wishes they could see what he has witnessed in the patients he has treated: Children rushed to the hospital, sick and struggling to breathe. Too often, he said that is followed by a mask placed over the child’s face to flow oxygen, a trip to the intensive care unit, and a tube attached to a ventilator going down the child’s windpipe. The virus, he added, has led to the hospitalization of 30,000 children under age 5 and premature deaths for more than 400 in that age group. “That is a significant burden.”

At times, he said, he wishes doctors could wear a bodycam so the public would know what virus can do to children.

“At some level, as awful as it sounds, you wish you could see those pictures to wake people up to how bad this is,” he said.