It is widely expected that children, ages 5-11, will soon become the latest group to be eligible for COVID-19 vaccination in the United States. The Food and Drug Administration (FDA)’s advisory committee is meeting on October 26 to vote on Pfizer’s request to authorize its vaccine for children, which would be followed by an FDA decision. The Centers for Disease Control and Prevention (CDC) Advisory Committee on Immunization Practices (ACIP) is meeting on November 2-3 to make its recommendation, which would be followed by a CDC Director recommendation. As such, children could become eligible as soon as November 3 or 4. In anticipation, the White House and CDC have engaged in operational planning with state and local jurisdictions. However, when the doses for children become available and how rapidly the rollout translates into shots getting into kids’ arms nationwide remain to be seen. At least in the near term, there could be some unique challenges to this new vaccination effort as well as a repeat of some of the difficulties faced during previous COVID-19 vaccination phases. This brief highlights key issues to consider for the vaccination rollout to younger children.

Scale-up and Supply

Access to vaccines for children will likely vary across the country in the short run. While the federal government has been working with state and local jurisdictions to prepare to administer vaccines, as in the early days of the vaccine effort, much of the rollout will depend on jurisdictional decisions, and implementation will likely vary across the country. Local vaccination efforts will reflect decisions about pre-ordering supplies, choosing vaccination sites and providers, the adequacy of provider networks, and communication and outreach plans. While this vaccination effort will rely on existing COVID-19 vaccination providers (pharmacies, Community Health Centers/Rural Health Clinics, hospitals), other providers will have an expanded role in the rollout to younger kids, including pediatricians, primary care providers, schools, and children’s hospitals. New providers will need to be registered, trained, and certified, a process which likely to occur at different speeds and with different levels of completeness across jurisdictions. As a result, vaccine availability for children will likely vary depending on where they live.

Demand for pediatric vaccinations could initially outstrip supply, as providers wait for delivery of children’s vaccines and update processes to administer them. Up until now, when a new group has been prioritized or authorized for COVID-19 vaccination, providers could simply use existing supply to administer the vaccine. However, Pfizer’s COVID-19 vaccines for children will have different dosing, formulation, and packaging requirements compared to vaccines for adults. The new product and packaging have advantages, including a smaller number of vials per carton (compared to the much large number of adult doses distributed) that may make it easier for physicians’ offices and other locations to store and manage; these differences will also keep pediatric vaccines easily distinct from adult vaccines. However, existing vaccination providers – including physicians’ offices, pharmacies, clinics, and other sites – will have to wait for delivery of these new vials to begin vaccinating this age group and may have to update processes to reflect these differences.

The speed of scale-up will likely vary across the country, partially dependent on state ordering and assessments. The White House has said that the federal government has enough vaccine supply for the estimated 28 million children ages 5-11, who will become eligible for vaccination. Initially, a large, one-time allotment of 15 million doses will be made available to jurisdictions for pre-order, on a pro-rata basis based on the distribution of the child population. This initial allotment will be distributed in three waves, and began October 20. States will be responsible for planning and ordering first and second doses and distributing doses to participating providers and sites (although pharmacies will also receive doses directly from the federal government as part of the federal pharmacy program). At least initially, unpredictable and shifting levels of demand could result in mismatches between demand and supply across and within states.