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Connecticut preparing strategies to roll out COVID vaccines to children

Federal regulators are considering a COVID-19 vaccine for 5- to 11-year-olds. A decision could be imminent.
Federal regulators are considering a COVID-19 vaccine for children 5 to 11 years old. A decision could be imminent.

Anticipating that federal officials will soon grant emergency authorization to a coronavirus vaccine for children ages 5 to 11, Connecticut’s Department of Public Health has reached out to 1,100 providers across the state to begin developing a network for administering the shots.

As of last week, at least 200 pediatricians had responded and said they would administer the vaccine, Dr. Manisha Juthani, Connecticut’s public health commissioner, said in an interview.

The state will pre-order 39,000 doses of the vaccine for children in that age group by the end of the week, health officials said, and it is expected to have about 150,000 doses available across pediatric offices, pharmacies and other locations by the time the rollout begins.

In Connecticut, about 277,630 children fall into the 5- to 11-year-old age bracket.

“We have pediatrician practices that have signed up to be able to give the vaccine; we have anticipated pharmacies that will be available also to give vaccines to kids,” Juthani said. “And we have the DPH vans that have been going around the state, so setting up vans in different places to have outreach would be another potential option.”

The mass vaccination sites that played an important role in getting adolescents and adults inoculated this year will not be part of the state’s strategy for young children, she said. Instead, pediatric offices that are comfortable and familiar to families will be a key area for vaccine administration.

“There are going to be multiple places where people can go for children – their familiar places, and then maybe their neighborhood places,” Juthani said. “I don’t think the large mass-vax sites are going to happen like they did for adults.”

School-based health centers could also play a crucial part in helping administer the vaccine. For children who don’t have good access to the health care system or who want the convenience of being immunized at school, Juthani said the state is considering partnering with those centers.

Melanie Bonjour, who served as president of the Connecticut Association of School-Based Health Centers for more than a decade until this month, said the health centers have provided numerous services in response to the pandemic, including rapid and PCR testing and screening for COVID-19, along with continuing to offer primary care.

Some facilities have also vaccinated teachers and students against the coronavirus. The Pfizer vaccine is approved for emergency use in 12- to 17-year-olds.

Bonjour envisions the health centers providing critical support as the shot is expanded to include 5- to 11-year-olds.

“Because we’ve been demonstrating our support in assisting with COVID testing and COVID vaccines, both in school and in the community, I think they’ll play a fairly vital role,” she said. “It may not necessarily be that there are mass vaccine clinics in the elementary schools, but certainly they will be instrumental and part of the vaccine administrative process.”

School leaders are also in discussions with the state about administration of vaccines in school buildings. They have not yet revealed how the clinics would work.

At the Hartford Public School District, spokesman John Fergus said officials believe parents will primarily turn to family doctors once the shot is approved for 5- to 11-year-olds. “However,” he said, “HPS has ongoing discussions with the Hartford Health Department and our other local health partners about opportunities for vaccination access to all our students and families. We expect to know more in the near future.”

Earlier this month, Pfizer and BioNTech sought emergency use approval from the U.S. Food and Drug Administration to open their coronavirus vaccine to children ages 5 to 11. A meeting to review the request has been scheduled for Tuesday, and a decision could quickly follow.

Connecticut’s plan to roll out the shots mirrors the national strategy laid out by the Biden administration Wednesday. Federal officials are leaning away from mass vaccination sites and engaging pediatricians and school clinics to help in the effort.

The Biden administration is seeking the aid of more than 25,000 pediatric or primary care offices, more than 100 children’s hospitals and health systems, tens of thousands of pharmacies, hundreds of school and community-based health centers and hundreds of community health clinics and rural health clinics, it said in a statement.

“The Administration’s plan will mobilize a comprehensive effort across the public and private sectors to ensure that we have the supply, the sites, and the support needed to get our nation’s children vaccinated and protected against the virus,” it said.

Encouraging participation

In Connecticut, state leaders and medical personnel are preparing to listen to parents’ concerns, dispel myths about the vaccine and encourage participation.

For Dr. Scott Schoem, president of the Connecticut chapter of the American Academy of Pediatrics and head of pediatric otolaryngology at Connecticut Children’s Medical Center, those conversations have already begun.

While many parents are eager to vaccinate their children, he said, others have concerns about possible side effects.

“There are those who tell me they got vaccinated themselves, but they’re still reticent about the safety issues in younger children because they don’t feel there was enough of a robust, big study with a long-term look at potential side effects,” he said. “Well, of course no one’s going to have five-year data on long-term, potential side effects. But one of the reasons why it took the FDA longer to approve [the vaccine] for the 12- to 17-year-old group is that they really wanted to look at the side effects. And the reason why it’s taking longer now for the 5- to 11-year-old group is that they made Pfizer and Moderna go back and look at lower doses.”

The children’s vaccine made by Pfizer and BioNTech is expected to be a third of the dose – 10 micrograms – of the immunization given to adults and teenagers. The adult dose is 30 micrograms.

“They were able to show that it has the same efficacy, but fewer side effects,” Schoem said.

For parents, he said, “I think a lot of it is fear of the unknown, where they say, ‘I’m willing to do it for myself, but I’m not so sure, for my younger child, whether I’m ready for this.’ I think many parents will come around to it once they see enough data, once it’s been FDA-approved, and there are thousands and thousands of children around the country who have been vaccinated and they’re not showing some kind of different or unusual adverse effect.”

Another concern physicians have heard is that parents feel the vaccine is not needed because their child has lived through the pandemic so far without catching the virus.

“What I tell parents is that there are still fewer risks in getting the vaccine and having some measure of protection than in getting COVID and potentially getting very sick,” Schoem said. “I try to frame the discussion in a risk assessment – you can’t protect your child from getting COVID, they’re out there in the world; they’re mixing with all these other kids. And their chances of eventually getting it are pretty high.”

“Of course, the vaccine doesn’t prevent you from getting it 100%,” he added. “But your chances of getting really sick will be much less if you get the vaccine.”

Some parents have expressed fears about incidences of myocarditis and pericarditis that were reported following the vaccine, mostly in adolescent boys and young men. As of July, 1,226 cases of myocarditis or pericarditis had been reported to the Vaccine Adverse Event Reporting System (VAERS), after administration of about 300 million doses of the Pfizer and Moderna shots. Not all had been verified.

Myocarditis is inflammation of the heart muscle. Pericarditis is inflammation of the outer lining of the heart. In both cases, the body’s immune system causes inflammation in response to an infection or some other trigger, according to the Centers for Disease Control and Prevention.

Juthani, who is also an infectious disease physician, said the risk for myocarditis is higher when someone gets COVID-19 than when they receive the vaccine.

“Children, adolescents and adults who get COVID get myocarditis at a higher rate than people who have gotten myocarditis from the vaccine,” she said. “If you look at myocarditis from COVID or from the vaccine, and your risk of getting it is higher with COVID, I always go with the vaccine.”

Juthani said she will also promote the vaccine as a vehicle for families to return to a sense of normalcy. The sooner children get vaccinated, she said, the more quickly restrictions like masks in schools will be lifted.

“What are we all trying to do for our children? We want them to be able to live their lives as normally as possible,” Juthani said. “I can’t give you a date on when masks are going to come off. But I can tell you that vaccines are our road to that for sure.

“As more people get vaccinated and the safer it is in school, the more likely we will be to return to normalcy in the school system.”

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