CDC inaction delays COVID shots for low-income children

Bobby Jr. and Trump withhold vaccine from poor children

Liz Szabo, MA

Satire from The Onion, but not far from the truth

Although hospitalizations due to COVID-19 are climbing, the Centers for Disease Control and Prevention (CDC) has not yet announced when COVID shots for the most vulnerable children in the country—those eligible for the Vaccines for Children (VFC) program—will be available.

The VFC program offers free immunizations to more than half of US children, including those who are uninsured, underinsured, eligible for Medicaid, or American Indians or Alaska Natives.

The CDC approved updated COVID shots on August 27, and manufacturers have been shipping the vaccines to medical offices since at least September 7. 

While doctors and pharmacists have been able to buy COVID shots for children with private insurance, public health officials who administer state VFC programs say they have not yet received the free vaccines, a problem originally reported by The Wall Street Journal.

States waiting for CDC go-ahead

Bobby Junior has his priorities

Public health officials in California, Georgia, New York, Pennsylvania, and South Carolina confirmed that COVID vaccines are not yet available for their states’ VFC programs.

“Provider offices in California have begun receiving privately purchased doses of COVID-19 vaccine, but COVID-19 vaccine is not yet available for children who are eligible for VFC,” Beth Deines, a spokeswoman for the California Department of Public Health, told CIDRAP News.

States also have not been able to order COVID vaccines through the federal 317 program, a CDC initiative that provides grants to states to immunize underinsured adults, Deines said.

“What makes it so important that the vaccine be available in VFC as soon as it available in the private sector is that we want all parents and children to have access to the vaccine at the same time––as soon as it is approved and available,” said Claire Hannan, MPH, executive director of the Association of Immunization Managers (AIM), a nonprofit group that represents directors of state, local, and territorial vaccination programs. 

“All parents who choose vaccination as protection for their children need to be able to find a healthcare provider offering the vaccine,” Hannan said.

Emily Hilliard, a spokeswoman for the Department of Health and Human Services (HHS), said people should not expect COVID vaccines to be available at the same time as influenza shots, which are typically available in the fall.

“COVID-19 does not follow the same predictable seasonal pattern as influenza and other respiratory viruses,” Hilliard said. “SARS-CoV-2 circulates throughout the year, with activity varying by region and with increases occurring at different points during the year, including during the summer and winter months. Accordingly, an arbitrary September date should not be treated as a public-health deadline for COVID-19 vaccine procurement.”

A ‘2-tiered’ system

The CDC has not even opened up the process that states use to order vaccines for the VFC program.

“There’s a lot of anxiety this time of year, because we don't have a date from CDC about when we might expect to see the vaccines,” said Michelle Fiscus, MD, AIM’s chief medical officer.

States encountered similar delays last year, Fiscus said. COVID shots for the VFC program were not available last year until October 6, or 40 days after they were approved.

That creates a two-tiered system that leaves low-income children vulnerable to disease for a longer time than wealthier kids, Fiscus said.

“We have a lot of angst about not having vaccines available for everyone all at once,” Fiscus said.

Babies and children under age 5 years are especially vulnerable to diseases such as COVID, Fiscus said. Although the overall hospitalization rate for COVID-19 remains low, the CDC notes that rates are highest for adults over 65 and babies under 1 year old.

Doctors face a difficult choice

Pediatricians receive vaccines in two ways.

They can buy vaccines themselves for children with private insurance plans, which then pay clinicians for their services. They can also opt to participate in the VFC program and receive doses of vaccination for eligible children that are ordered through the state.

The inability to vaccinate all children at the same time “puts doctors in a really difficult position,” Fiscus said.

Healthcare providers can respond in different ways.

“They can provide vaccines to their commercially insured patients and tell their patients who are covered under the VFC program that their vaccines aren't in yet, which feels terrible ethically and morally,” Fiscus said. 

Or, to be fair to everyone, providers “can choose not to vaccinate anyone, even though they have commercially purchased vaccines available,” Fiscus said.

Doctors in some states are allowed a third option.

The New York State Department of Health has told healthcare providers that they don’t have to wait to vaccinate children in the VFC program. Instead, clinicians are allowed to immunize kids in the VFC program with vaccines purchased for privately insured children, said Marissa Crary, a spokesman for New York’ s health department. Healthcare providers can replace these vaccine doses with free shots from the state once they become available.

With ACIP in limbo, uncertainty remains

State public health officials told CIDRAP News that they hope they will be able to order vaccines for the VFC program soon.

The California health department “is in ongoing communication with CDC … which has indicated that VFC approval is anticipated soon,” Deines said.

In the past, a CDC advisory panel would vote whether to recommend seasonal vaccines, such as flu and COVID shots, as well as whether the immunizations should be included in the VFC program. 

We are in uncharted waters here.

HHS Secretary Robert F. Kennedy Jr., however, has upended that system. Last year, he announced that the federal government no longer recommended COVID vaccines for healthy children and pregnant women.

A federal judge in March found that Kennedy likely violated a federal law when selecting members of the CDC panel, called the Advisory Committee on Immunization Practices (ACIP). As a result, ACIP has not met this year.

“There is no ACIP recommendation” for updated COVID shots this year, Hannan said. “We are in uncharted waters here.”

Hilliard, the HHS spokeswoman, said the CDC “is finalizing decisions regarding COVID-19 vaccine procurement through the Vaccines for Children and Section 317 programs, and additional information will be available soon.”

She added that, “HHS and CDC have a responsibility to ensure responsible stewardship of taxpayer resources and that vaccines procured through federally funded programs are appropriate for the populations those programs serve.”

The American Academy of Pediatrics (AAP) recommends ​COVID vaccines for all infants and children age 6 months through 23 months, as well as children and teens with increased risk factors for severe COVID. The AAP also recommends that COVID shots be available for children ages 2 to18 years whose parents wants them to have COVID vaccine protection.

“Respiratory virus season is right around the corner,” Crary said. “Vaccines prepare our immune systems to recognize and resist diseases. Getting a seasonal flu and COVID vaccine is the best way to reduce infection or serious illness.”