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The <a href="https://www.washingtonpost.com/health/2023/09/22/covid-vaccine-insurance-coverage-denials/" target=_blank>troubled rollout of updated coronavirus vaccines</a> is proving especially challenging for physicians and parents seeking to <a href="https://www.washingtonpost.com/health/2023/09/29/flu-covid-rsv-vaccines-kids-fall/" target=_blank>immunize children</a> — a reflection of distribution delays, shortages at pharmacies and financial obstacles confronting pediatric practices.

The federal government is no longer buying and distributing all vaccines, unleashing a host of complications as the new shots, recommended for everyone older than 6 months, hit the private market in mid-September. The <a href="https://www.washingtonpost.com/nation/2023/08/17/vaccine-flu-season-covid-rsv/" target=_blank>updated vaccines are tailored to provide a shield of protection</a> against <a href="https://www.washingtonpost.com/coronavirus/" target="_blank" class="contextual_link">coronavirus</a> variants in circulation and arrive as the fall respiratory illness season dawns and an expected winter covid-19 uptick looms.

The issues have been pronounced for pediatric vaccines, which come in a different dose size and packaging.

Elias Kass, a Seattle-area provider, said he sees a disconnect between federal officials stressing the importance of getting vaccinated and the experiences of his patients, who must reschedule appointments because the practice doesn’t have enough information about when vaccine doses will arrive.

Annabel Clark

“Nobody is acknowledging the delay in pediatric vaccines, nobody is explaining it, nobody is giving updated timelines,” he wrote in an email last week. “The number of babies and kids who have tested positive in the last week or two is incredibly depressing. This rollout should have happened months ago.”

Mandy Cohen, director of the Centers for Disease Control and Prevention, urged patience.

“Manufacturers and distributors were getting out the adult vaccines first. So that was what was shipping in the first number of days,” Cohen told reporters Thursday. “The supply is filling out, and make sure that you’re calling ahead to your pediatrician or your pharmacy to see if the vaccine is available, and if not, check back again.”

The difficulties in shoring up defenses for the youngest Americans against the coronavirus are the latest illustration of the nation’s byzantine, decentralized health-care system.

When <a href="https://www.washingtonpost.com/health/2023/09/12/covid-booster-shots-2023-cdc/" target=_blank>federal health officials recommended the updated coronavirus vaccines</a> for everyone 6 months and older, officials <a href="https://www.cdc.gov/vaccines/acip/meetings/downloads/slides-2023-09-12/03-COVID-Havers-508.pdf" target=_blank>cited data</a> showing that infants, along with older adults, have the highest rates of covid-associated hospitalizations. In addition, most children younger than 5 hospitalized for the disease had no underlying medical conditions. Even though children have a low risk of severe outcomes from covid-19, public health officials say it remains imperative to use vaccines to save lives from preventable diseases.

Uptake of previous coronavirus shots was low for eligible children, with fewer than 1 in 10 receiving one of the most recent boosters, <a href="https://covid.cdc.gov/covid-data-tracker/#vaccinations_vacc-people-booster-percent-pop5" target=_blank>according to the CDC</a>. Experts worry the rate for the updated vaccines will plunge further if families continue having troubles with access.

Doctors say they generally prefer Moderna’s single-dose vial because it reduces potential for waste. But some parents and doctors said Moderna’s vaccine for children younger than 5 has been especially hard to find.

The CDC recommends that <a href="https://www.aap.org/en/pages/2019-novel-coronavirus-covid-19-infections/covid-19-vaccine-for-children/about-the-covid-19-vaccine-frequently-asked-questions/" target=_blank>children younger than 5 </a>previously vaccinated against the coronavirus should receive one or two doses of the updated vaccines from Moderna or from Pfizer and its German partner, BioNTech, and that doses from the same manufacturer be used.

Jamie Leonardi, a mother of two in the Pittsburgh area, has hit repeated road blocks trying to get her 4-year-old daughter, Juliet, her second Moderna dose.

Leonardi called her pediatric practice, which has more than 250 providers. It lacked vaccine doses and offered no information about when it might be available. She had no luck with her county health department, which holds regular vaccination clinics, or with pharmacies and a supermarket.

She is worried because there have already been classroom exposures for Juliet, who is in all-day pre-K, and her older daughter, Juno, 7.

She spotted on social media that Walgreens had the Moderna pediatric doses, but her insurance plan told her the pharmacy chain was not in-network and shots would not be covered.

Quinn Glabicki

“CDC is messaging everybody to go get your vaccine, no problem,” Leonardi said. “But, no, vaccines are not there.”

Answers to readers’ questions about the new coronavirus vaccine, flu and RSV vaccines

Moderna began shipping pediatric doses last week, according to one industry official and one federal health official familiar with distribution, speaking on the condition of anonymity to discuss private conversations. Moderna did not respond to questions about distribution of its pediatric doses.

Pediatricians said Pfizer had burdensome requirements for the youngest age group — 6 months to 4 years — with larger minimum orders than Moderna required and three-dose vials that must be used the same day. And, at first, it appeared that pediatricians giving shots to the youngest group would not get refunds from Pfizer for unused doses until May.

“Pediatricians can’t afford to be a bank and loan Pfizer money so that we can stock the vaccine and ask for a credit later,” said Sandy Chung, president of the American Academy of Pediatrics. The academy and the CDC are hosting a town hall Wednesday for members to address coronavirus vaccine recommendations and distribution issues.

Hearing the demands for greater flexibility, Pfizer recently changed its refund policies, said company spokesman Kit Longley. Offices can now return unused doses of the vaccine for the youngest age group, including partially used vials, at any time and receive credit within 60 days.

“We recognize both the importance and the complexity of pediatric vaccination and wanted to ensure that pediatric offices did not have hurdles to providing vaccine to their patients,” Longley said in an email.

A bigger problem for pediatricians is trying to estimate how many doses to buy upfront while waiting to learn how much insurance companies will reimburse.

Covid is here to stay. How will we know when it stops being special?

Several major health insurance providers that together cover hundreds of millions of Americans told Health and Human Services Secretary Xavier Becerra in a meeting on Wednesday and in a letter that lingering coverage and cost issues in the initial days of the rollout of adult vaccines are largely resolved.

While that may address issues for adults seeking vaccine at pharmacies, pediatricians say they aren’t getting needed payment information from insurance plans.

Alyssa Pointer

Atlanta pediatrician Reshma Chugani, part of a two-doctor practice, said she cannot stock Pfizer vaccine doses because insurance plans’ online systems do not indicate what insurance will pay. On Friday, she received an updated fee schedule through Oct. 14 from one major insurance plan that does not even list the coronavirus vaccine, she said.

Coronavirus vaccine uptake among children has been <a href="https://www.washingtonpost.com/health/2022/09/18/kids-coronavirus-vaccine/" target=_blank>abysmal</a>, Chugani said, “but if we have to fight for payment from insurance companies, it’s going to be even worse.”

Chugani and other pediatricians are concerned because parts of the country, especially the South, are experiencing increasing coronavirus cases. Chugani said some children’s hospitals are seeing high volumes of patients in emergency departments because of another respiratory virus, RSV, or <a href="https://www.cdc.gov/surveillance/nrevss/rsv/hhsregion.html" target=_blank>respiratory syncytial virus</a>.

Free covid tests by mail are available for order again

Some critics said public health officials should have made updated coronavirus vaccines available for children before the start of the <a href="https://www.washingtonpost.com/education/2023/09/06/school-mask-mandate-politics/" target=_blank>school year</a>, which began as cases and hospitalizations were rising nationwide.

In Seattle, Kass said he was able to order Moderna pediatric doses a week ago for his two-provider practice but couldn’t schedule appointments because he could not find out when doses were arriving. Late Thursday night, he received notification that vaccine doses were arriving the next day.

“We ordered 500 doses, and the UPS truck pulled up with 100 doses,” Kass said Friday. But the practice had already paused scheduling shots for 300 children, he said. About 30 to 40 children who happened to be getting flu shots Friday were able to get coronavirus vaccines at the same time, he said.

“Patience doesn’t help us with our planning for patients,” he said. “We need information.”

A previous version of this article incorrectly said that fewer than 1 in 5 U.S. children received one of the most recent coronavirus booster shots. Fewer than 1 in 10 children received the booster. The article has been corrected.

Pulitzer Prize for National Reporting for coverage of the war on terrorism, part of national reporting team, 2002

 Robert F. Kennedy journalism award, international print, 1994 

Cornell University, BS in communication

Columbia University, MA in journalism

Lena H. Sun is a national reporter for The Washington Post covering health with a special focus on public health and infectious disease. A longtime reporter at The Post, she has covered the Metro transit system, immigration, education and was a Beijing bureau chief. 

Lena H. Sun

Northwestern University, BS in journalism and political science. 

American University, MSJ in journalism. 

Fenit Nirappil is a reporter for the Health & Science team who covers public health, infectious diseases and LGBTQ issues. He previously covered local politics. 

Fenit Nirappil

Covid vaccines for children have been hard to find

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