The White House on Thursday outlined the early stages of its plan for making coronavirus vaccines available this month to roughly 18 million children younger than 5, should the doses be cleared by federal regulators for the last group of Americans yet to be eligible.
The Biden administration has made 10 million doses available to states and health providers, with roughly 85% of children in the age group living within 5 miles of possible vaccination sites, according to a White House fact sheet.
Half of the 10 million doses were made available for order last week, the other half this week, with equal numbers of Pfizer-BioNTech and Moderna vaccines, the two that federal regulators are reviewing and could authorize as soon as next week.
"Let's actually take a moment to understand what a historic moment this is," said Dr. Ashish Jha, President Joe Biden's coronavirus response coordinator. "It would mean that for the first time, essentially every American from our oldest to our youngest would be eligible for the protection that vaccines provide."
More than 30,000 U.S. children younger than 5 have been hospitalized with covid-19 and nearly 500 coronavirus deaths have been reported in that age group, said Dr. Vivek Murthy, the U.S. surgeon general.
Orders from states have been somewhat tepid so far, according to data that senior administration officials provided to reporters in a briefing Wednesday evening. Of the 5 million doses offered last week, 58% of those made by Pfizer-BioNTech have been ordered, as have roughly a third of those made by Moderna.
The officials, who spoke on the condition of anonymity to preview the formal announcement Thursday, said the initial orders were typical of covid-19 vaccination campaigns thus far, as states usually increase their orders over time.
Still, uptake of the vaccine among children ages 5 to 11 has been plodding, a trend that health experts have worried could continue with the youngest group.
Public health officials have been disappointed at how many older U.S. children, who have been eligible for shots for months, have yet to be vaccinated: Less than one-third of kids ages 5 to 11 have gotten the two recommended doses, according to government figures.
"As we go down in the age groups, we see lower and lower uptake" of vaccines, said Dr. Lucia Abascal of the California Department of Public Health.
A Kaiser Family Foundation survey conducted in April found that just 18% of parents with children younger than 5 said they would get them vaccinated right away, while 38% said they would wait and see. Their hesitation could be at least partly because the virus is typically less risky for young children.
Jha on Thursday said health officials expected many children younger than 5 to be vaccinated by pediatricians and primary care physicians, a contrast to other age groups.
But he and other officials Thursday said they had organized a network of other locations that would work to get shots to families, including pharmacies and children's hospitals.
To reach smaller pediatric offices and rural providers, the White House said Thursday, doses are being packaged by the hundred.
Delivery of the vaccines is contingent on the Food and Drug Administration authorizing pediatric doses -- a step that could take place as soon as next week -- and the Centers for Disease Control and Prevention recommending them, which would formally initiate the campaign. The FDA and its outside panel of vaccine advisers are set to meet Wednesday to discuss the shots for young children; the CDC's expert committee is scheduled to meet days later.
CDC Director Dr. Rochelle Walensky would be the last to sign off.
Jha said he expected vaccinations to begin in earnest the next week, perhaps starting June 21, but he suggested it could take time for some families to gain access.
"Realistically, it means we could see shots in arms of kids under 5 as early as the week of June 20," he said of the federal review timeline, adding that the federal Juneteenth holiday on that day -- a Monday -- would mean many offices would begin administering the shots June 21.
"The vaccination program is going to ramp up in the days and weeks that follow with more and more doses and more and more appointments becoming available," he said.
Moderna is seeking authorization of its two-dose shot for children younger than 6, while Pfizer is asking regulators to clear its three-dose vaccine for those younger than 5.
Federal officials have said that they are not preempting regulatory actions by announcing distribution plans for the vaccine before it is authorized. Instead, they have said, they are working to prepare families and physicians for the possible rollout. Last year, the White House was criticized for subverting the regulatory review that usually precedes vaccination campaigns when it announced a broad booster shot campaign before FDA officials or their outside advisers had weighed in, a decision that proved divisive.
The deliberations over the vaccine for the youngest children are not expected to provoke the same kind of dissent. Parents have long clamored for the option and were briefly given hope over the winter when FDA officials worked to make an initial two doses of Pfizer-BioNTech's shot available to children as they studied a third dose. That plan backfired when data showed that two doses did not provide significant protection against the omicron variant.
Moderna is proposing a two-dose regimen for children ages 6 months through 5 years old, using one-fourth the strength of an adult dose. Pfizer and BioNTech are working on a three-dose regimen for children ages 6 months through 4 years old, at one-tenth the strength of the adult dose.
STATE DOSES
As reported previously by the Democrat-Gazette, on Monday, state health department Director Jennifer Dillaha said Arkansas is set to receive an initial allocation of 35,800 doses of covid-19 vaccines for children as young as 6 months old if the shots are authorized for that age group next week.
Half of the doses would be the Pfizer vaccine for children from 6 months to 4 years of age and the other half would be the Moderna vaccine for children ages 6 months to 5 years.
Both vaccines are low-dose versions of the companies' shots that are available to adults.
On June 15, an advisory committee to the U.S. Food and Drug Administration will discuss authorizing the shots for the new age groups.
If the federal officials sign off, Arkansas could receive its first doses as soon as June 20, Dillaha said.
She said most will likely to go Health Department local health units, pediatricians, family medicine clinics and other providers that participate in a federal program that distributes free vaccines for children.
"That's where families are accustomed to getting their vaccines for their young children," Dillaha said.
"Most of them have a relationship where they can get the information they need and make an informed decision about vaccinating their children."
Currently the Pfizer vaccine is available to ages 5 and up, and Moderna's is allowed for people 18 and older. No covid-19 vaccine has yet been authorized for children under 5.
According to the CDC, 23.7% of Arkansas children age 5-11 had received at least one vaccine dose as of Monday, and 17.2% were fully vaccinated.
As of Saturday, just 791 children in that age group had received booster doses, which were authorized less than a month ago for children who received their initial two-dose series at least five months earlier.
"I would like to see the uptake increase," Dillaha said of covid-19 vaccines for children generally.
"Hopefully it will toward the end of summer as parents get their kids ready for school because the kind of immunity provided by vaccines when kids receive the recommended doses will go a long way toward decreasing the spread of covid in schools."
While children are less likely than adults to develop severe illness from covid-19, Dillaha noted they can develop long-term symptoms as well as a rare condition involving inflammation of organs such as the heart and lungs.
"I am concerned about long covid in children and the fact that so many of the children who end up in the hospital don't have risk factors," Dillaha said.
"It's really hard to predict which of the children will have severe illness, and it's hard to know which will have the multi-inflammatory syndrome in children as a result, and that can be very severe."
Information for this article was contributed by Noah Weiland of The New York Times, Mike Stobbe of The Associated Press and Hunter Field of The Arkansas-Democrat Gazette.