Immunization Update
Loren Bonner
1. What COVID-19 vaccines are currently available to babies, toddlers, and children?
On June 17, 2022, FDA authorized emergency use of the Moderna COVID-19 vaccine and the Pfizer–BioNTech COVID-19 vaccine to include use in children as young as 6 months old.
For the Moderna COVID-19 vaccine, FDA amended the EUA to include use of the vaccine in individuals 6 months through 17 years. The vaccine had previously been authorized for use in adults 18 years and older.
For the Pfizer–BioNTech COVID-19 vaccine, FDA amended the EUA to include use of the vaccine in individuals 6 months through 4 years. The vaccine had been authorized for use in individuals 5 years and older.
In May 2022, FDA amended the EUA for the Pfizer–BioNTech COVID-19 vaccine to authorize the use of a single booster dose for administration to individuals 5–11 years at least 5 months after completion of a primary series with the Pfizer–BioNTech COVID-19 vaccine.
The recently FDA-authorized Novavax COVID-19 vaccine, the first protein-based formula, is indicated for adults only at this time. The manufacturer, however, intends to seek authorization for a booster and for administration to younger populations.
2. Do pharmacists want to vaccinate children?
Under federal PREP Act authority, pharmacists and other pharmacy team members in every state can vaccinate children 3 years and older with FDA-authorized COVID-19 vaccines and with FDA-approved routine vaccines, subject to certain requirements. This authority overrides any state practice authority. However, some states allow pharmacists to vaccinate children younger than 3 years and those laws still stand in those respective states.
According to a pulse survey conducted by APhA in the spring of 2022, over half of pharmacists surveyed said they were willing and ready to administer COVID-19 vaccines to children under 5 years old. Even more were willing to vaccinate children 5 years and older.
3. Should pharmacists who don’t want to vaccinate very young children turn away those patients? What’s the best way to handle that?
Through the pandemic, patients have been accustomed to conveniently getting their vaccine at a local pharmacy. If unable to vaccinate younger children, pharmacists should refer patients to an appropriate vaccinator. Some pharmacies may not provide these vaccines to all children due to practice-specific factors; however, pharmacists and their teams can be important disseminators of information, guidance, and referrals in their community when appropriate. Pharmacy teams should determine the scope and age group(s) for vaccine administration within their practice.
4. What tips are there for pharmacists who are beginning to vaccinate younger kids for the first time?
During a June 28, 2022, APhA webinar, Beverly Schaefer, RPh, from Katterman’s Sand Point Pharmacy in Seattle said she always talks right to the child and makes a connection with them.
“I ask them what sports they do, their favorite color, or what grade they are in,” she said. Making a good connection with the parent is important as well—since they are normally just as anxious.
Some helpful tips for kids that may also apply to younger children include
Keep a bag of candy in the vaccination room and offer it after the vaccine with the parent’s permission. Stickers are an alternative.
- Make sure the child’s parent or caregiver is in the room. Have them hold the child’s hand, or have the child sit on their lap.
- Use kid-friendly adhesive bandages (e.g., those with a character design).
- Prepare everything before entering the immunization room. Few things can be scarier to a child than seeing a vaccine drawn into a syringe or a needle put into a syringe.
- Try to distract the patient right as the needle goes in by asking them what music they like listening to, for example.
- Use the ShotBlocker.
5. What resources are available?
Latest recommendations from CDC
CDC now recommends infants and children 6 months through 5 years complete a COVID-19 vaccination series. The options available for this age group include
- A three-dose primary series of Pfizer–BioNTech COVID-19 vaccine authorized for infants and children 6 months through 4 years (this product has a maroon vial cap)
• Each dose is 0.2 mL (3 mcg); separate dose 1 and dose 2 by 3–8 weeks, followed by dose 3 at least 8 weeks after dose 2
- A two-dose primary series of Moderna COVID-19 vaccine authorized for infants and children 6 months through 5 years (this product has a dark blue vial cap and a label with a magenta border)
• Each dose is 0.25 mL (25 mcg); separate dose 1 and dose 2 by 4–8 weeks