On November 3, 2021, the day after the Food and Drug Administration (FDA) approved Pfizer-BioNTech’s COVID-19 vaccine for emergency use in children ages 5 to 11, health officials in Los Angeles County were already offering the vaccines at Eugene A. Obregon Park in East Los Angeles as part of the county’s year-long vaccination initiative, vaccinatelacounty.com.
In East LA, more than 19% of the population falls at or below the poverty level and poverty has been identified by the Centers for Disease Control and Prevention (CDC) as a risk factor that may “weaken a community’s ability to prevent suffering and financial loss in a disaster” like the current COVID-19 pandemic. With these events, county officials are hoping to reach families where they are and get more shots in the arms of 5- to 11-year-olds who live in communities with increased risk.
“The quality of accurate information and the amount of disinformation varies in each community. As a result, vaccine rollouts that are offered on a 'first come, first serve’ basis often lead to equity issues,” says Nava Yeganeh, MD, a pediatric infectious disease physician who works with COVID-19 school vaccine efforts through the Los Angeles County Department of Public Health. “Some people don’t have internet access. Others face transportation barriers. So, the people who access vaccination sites first often aren’t the ones living in communities that have the highest rates of COVID-19.”
The challenge? Just 28% of kids ages 5-11 have received at least one dose of the COVID-19 vaccine as of January 19; that number jumps to 65% for kids ages 12-17, the American Academy of Pediatrics reports.
To reach kids in under-resourced communities, health departments and community leaders are developing creative strategies to get shots in the arms of children who face the greatest access barriers. From vaccinating children in schools and providing weekend and evening clinics that parents can attend to traveling door-to-door and hosting town hall meetings, health officials are working hard to protect the nation's youngest and most vulnerable children against COVID-19.
Meeting families where they are
To ensure easy access to COVID-19 vaccines for adults and children alike, some health departments have been offering pop-up clinics in parks, community spaces, and places of worship. But with this next wave of vaccinations for 5- to 11-year-olds, many of the youngest and most vulnerable kids are getting their vaccines at school.
This is what’s happening in Travis County, Texas. By the time the FDA approved the Pfizer-BioNTech vaccine for emergency use in kids 5-11, the Del Valle Independent School District (DVISD), for example, had already sent consent forms home in both English and Spanish for parents to sign.
“We were ready to roll,” says Christopher Weddle, DVISD executive director. More than 88% of school children in the district qualify for free school lunch.
“A lot of these kids speak English as their second language and their parents don’t have access to transportation,” says Emily Bickle, RN, who served as clinic lead for nine school events in Travis County in November and December 2021. “With this community, it was really important for us to be on the ground delivering vaccines while kids were in school.”
With masterful coordination and collaboration, Travis County Health & Human Services, school officials, and nurses from the University of Texas at Austin School of Nursing were able to provide and administer two doses of the vaccine before winter break in December 2021.
“Our goal was to make sure parents don’t have to deal with the stress of booking an appointment or trying to figure out which private provider is offering vaccines,” says Weddle.
Their efforts paid off. With this in-school effort, which included two doses of vaccine, DVISD vaccinated 15% of district kids, or more than 800 students.
Other counties are vaccinating kids outside of school hours. Public health officials in Los Angeles County (which is home to 80 school districts and 3,000 schools) and Anne Arundel County (which has 125 schools) outside of Baltimore, have set up weekend and evening clinics to accommodate parents who want to be with their kids when they get their shots, and after-hours clinics that are open to all children, whether they attend a district school or not.
In these areas, community data is an important component in identifying under-resourced populations. In Los Angeles County, coordinators use the California Healthy Places Index Plus COVID-19 (HPI) case rate, a platform that showcases community characteristics that affect health outcomes.
“We reviewed the HPI data and reached out directly to the districts that had schools located in the hardest-hit communities,” says Yeganeh. “There were 43 districts with schools located in those zip codes comprising more than half of Los Angeles County school districts.”
In Anne Arundel County, health officials scheduled two evening clinics a week for families in areas that are under-resourced and/or have the lowest vaccination rates.
“We used the data to drive us to specific locations,” says Tonii Gedin, RN, DNP, Deputy Health Officer of Public Health in Anne Arundel County.
Getting parental buy-in
Unfortunately, sending consent forms home and offering vaccinations in schools isn’t enough to reach every eligible child. Like any vaccination effort aimed at children, success depends largely on parental buy-in. That’s especially true for the younger subset, since parental consent is required in all states for children under 12, though Washington, D.C., and Philadelphia allow 11-year-olds to self-consent for the COVID-19 vaccines.
That means getting parents on board is key. According to Kaiser Family Foundation polling, 31% of parents who have kids in the 5-11 age group say they will not get their children vaccinated — or will only do so if required. Another 32% report that they’re taking the “wait and see” approach. In total, more than half of kids’ parents aren’t convinced that vaccinating their children is the right move.
To help inform parents of the benefits of the vaccine, the U.S. Department of Health and Human Services launched "We Can Do This," an aggressive national public education campaign that relies heavily on trusted messengers and community leaders.
“Partnering with community-based and faith-based organizations has been a key element of our efforts,” Yeganeh says. “We can bring vaccines, and the medical expertise, but our community partners bring joy and reassurance to the events, and they’re trusted by community members.”
In Los Angeles County, for example, the California Association of African-American Superintendents and Administrators (CAAASA) has been instrumental in reaching youth from under-resourced communities. With funding from various grants, CAAASA officials have been walking door-to-door to notify families of upcoming vaccination clinics.
This month, they’re launching a series of six events in one of the communities most impacted by COVID-19 in Los Angeles County’s Antelope Valley. The events are aimed at vaccinating entire families against both COVID-19 and the flu, while also providing free food and gift cards to those who receive shots.
In Anne Arundel County, health officers are relying on their community partners to host vaccine clinics and help register people for vaccination clinics in under-resourced communities who may be more apt to listen to their pastor or community-based leaders.
“A lot of these partners are churches and community organizations who are working with individuals from communities with recent immigrants, some of whom may be undocumented,” says Gedin. “We found that giving those folks advanced access was successful with adults, so we’re repeating it with kids.”
In an ideal world, children would get COVID-19 vaccines from their pediatricians. That way, trained physicians would be available on the spot to respond to parental concerns. But because of the urgency of COVID-19 and the unpredictability of new variants, many counties are focusing on vaccinating as many children as possible as quickly as possible at larger vaccination sites — and that requires listening to community members ahead of time to determine the real barriers to accessing and accepting vaccines.
“We’re realizing that sometimes our perception of the barriers is not the same as what people in the community are facing,” says Gedin. “So we’re meeting with community members and asking: What are the barriers for you? What do you need us to be responsive to? And what’s happening in the community?”
What they’ve learned: People want to talk to someone in their own language. They don’t want translation software. And they want to discuss their concerns with a pediatrician. To address that need, Anne Arundel County will be hosting several Facebook Live sessions where parents can ask their questions directly to pediatricians who represent the community, including physicians of color and those who speak two languages, Spanish and English.
“Our goal is always to be responsive and show that this is what we did as a result of what you said,” Gedin says.
In addition, since some parents don’t feel comfortable voicing their concerns in large open forums or during online town hall meetings, Los Angeles County has partnered with the Los Angeles Office of Education to do six small focus group sessions in areas with the lowest vaccination rates.
“We’re trying to pivot more toward a model that engages community-based organizations, faith-based organizations, and trusted pediatricians who look like our community members to talk to families on the ground,” says Yeganeh.
The evidence is clear: The more people who are vaccinated, the closer we will come to ending this pandemic. Vaccinating children means safer experiences for in-person school, sports, and gatherings with friends and family. With any luck, these vaccination efforts may even produce a welcome byproduct, greater trust between public health organizations and their communities over the long haul.
“The one thing we’ve learned is that it’s all about relationship building,” says Yeganeh. “After COVID passes, we’ll be able to use these relationships to remove access barriers for other vaccines and even address public health crises like mental health and obesity.