Experts worry a lack of data may be obscuring where to target strategies for vaccinating kids of color, who disproportionately suffer severe illness from COVID-19 but may lack access to the shot.
Just shy of a third of children ages 5 to 11 nationwide have received at least one dose of COVID-19 vaccine and a quarter are fully vaccinated, Centers for Disease Control and Prevention data shows. About 67% of kids 12 and older have received one dose, and only 57% are fully vaccinated.
But the CDC does not report children’s COVID-19 vaccination rates by race, and inconsistencies and variations remain in the ways figures are broken down and reported from state to state.
The Kaiser Family Foundation reports only seven states are releasing kids’ vaccination data by race in a way that allows for statistical comparison. Among those states, Black children generally trailed behind white children, with rates of kids from other racial groups varying.
But overall, “it remains challenging to draw strong conclusions about racial equity in COVID-19 vaccinations among children due to the dearth of comprehensive data, inconsistency in reporting, and the lack of disaggregated data for smaller racial/ethnic groups,” the authors wrote.
More data is needed to keep a pulse on which communities need more outreach, said Dr. Rebekah Fenton, a pediatrician and adolescent medicine fellow at Lurie Children’s Hospital of Chicago.
“Without that information, we would potentially get to this place where if COVID was doing well in the larger communities, that smaller communities such as Black and brown individuals will just get looked over,” she said.
A lack of kids’ vaccination data also can hinder districts from informed decisions on when it’s safe for in-person learning, Fenton said.
“We’re making sweeping decisions across these very diverse school districts about policies,” she said. “Assuming that it’s safe to determine because of high vaccination rates among parents or children themselves, without recognizing the unique needs of certain communities in particular schools.”
Kids of color have been more likely to be hospitalized with more severe COVID-19.
Of more than 10,000 children hospitalized with COVID-19, those who were Black and those with obesity, which disproportionally occurs in children of color, were more likely to experience “higher severity disease” and the rare complication MIS-C or multisystem inflammatory syndrome, found a recent study published in the Journal of the American Medical Association.
Without vaccination data, it’s difficult for experts to see which high-risk teens aren’t getting the shot and to target outreach. While parents can be hesitant to vaccinate their children, teens encountering misinformation online can also be wary, and age-appropriate outreach to engage them is essential, said Dr. Kara Odom Walker, chief population health officer at Nemours Children’s Health.
“We have to think about all of the partners who can come together to decrease barriers, and meet adolescents where they are,” she said. “Reaching them through innovative and creative ways that are age appropriate, culturally tailored is critically important. Having messengers and influencers who can speak to them directly will be part of how we overcome this.”
Walker, former Delaware Department of Health and Social Services secretary, pointed to disparities that persist between Black and white adult vaccination rates, as well as other minorities, according to the latest CDC data.
Although vaccination rates have closed between white adults and those who are Hispanic, Native Hawaiian or Pacific Islander, Asian and American Indian/Alaska Native, according to the CDC, Black adults are still being vaccinated at lower rates. Just 46.6% of Black adults have received at least one dose, compared with 52.6% of white adults. Only 40% of Blacks are fully vaccinated, compared with 47% of whites.
Between white children and kids of color, she fears the disparities “may be even wider” than those seen in adults.
Logistical barriers to vaccination that disproportionately impact families of color and were barriers for parents may also be barriers for kids. They include transportation to a clinic offering the shot, a lack of neighborhood pharmacies, an inability to take off work or too few government-issued at-home tests for a multigenerational household.
Public health strategies to close the gap in flu vaccinations among kids, such as school mandates, would help with the COVID-19 vaccine, Walker said. A Nemours research team recently published findings that suggested increased COVID-19 vaccine uptake following a flu shot.
“We have found and studied certain ways to overcome those persistent disparities in flu vaccination that we’re going to have to use and leverage to make sure that there’s equitable uptake of COVID-19 vaccine,” she said. Those include continued partnerships with faith-based organizations and trusted community messengers.
While disparities exist and are concerning, vaccination rates among all children are lagging, said Dr. Yvonne Maldonado, a pediatric infectious disease specialist at Stanford University.
“There’s still a lot of misinformation among our communities. But honestly, we’re not doing a good job in any age group over 5,” she said.
Continued community-level messaging that emphasizes the safety of the vaccine and correcting misconceptions that children can’t get seriously sick from the virus is critical, she said.
“I don’t think people take the disease seriously in kids,” she said. “We just need to keep getting that message out that children should be safe. And if we can keep them safe, why not keep them safe?”