Whether children receive a dose of a Covid-19 vaccine often depends on where they call home.
About 81 percent of children ages 12 to 17 in Vermont have had at least one dose of a vaccine to protect against Covid-19, according to data from the Centers for Disease Control and Prevention analyzed by NBC News. Puerto Rico leads the U.S. with a vaccination rate of 91 percent.
But in West Virginia, the rate is just 35 percent — a marker of stark regional disparities that are deepening across the country.
The analysis, which tracks closely with a separate review of vaccination data by the American Academy of Pediatrics, suggests that children are subject to some of the same geographic inequities as adults.
About 58 percent of eligible children nationwide have had at least one shot, but the rollout has stalled. Just 137,000 children got a first shot last week — the second fewest in a week since April, according to data from the pediatrics academy.
Children 16 and up became eligible for the Pfizer vaccine in December. Access was expanded to children ages 12 to 15 in May. The number of children receiving first shots has been on a downward trend since mid-August, the pediatrics academy data show.
As the pace of vaccination slows among young people, doctors say they’re battling deeply ingrained misconceptions that could leave many children unvaccinated and at heightened risk. Some parents internalized reassuring messages about children’s risk early in the pandemic that aren’t true. Vaccination access and parents’ vaccine hesitancy are also issues.
Children represent about a quarter of all new Covid cases in the U.S. Polling suggests that doctors and health officials could face an uphill battle to persuade parents of children ages 5 to 11 to pursue the vaccines, which could be crucial to easing the pandemic.
The majority of children in 17 states who are eligible for a vaccine remain unvaccinated, NBC News’ analysis shows. Southeastern states like Mississippi, Tennessee and Alabama are among those at the bottom of the list, with vaccination rates that have yet to top 40 percent.
Northeastern states like Vermont, Massachusetts and Connecticut report some of the highest rates in the country.
The root of why some communities have fallen behind on children’s Covid vaccinations harks back to the pandemic’s earliest days, when scientists were making educated guesses about the coronavirus’s behavior, news flowed in a deluge, and concerned parents couldn’t stop clicking on news stories.
In the first months of the pandemic in the U.S., few children were testing positive, becoming hospitalized or dying from Covid.
Testing was also in its infancy, and supply shortages often meant only the sickest were tested. Then, many communities tumbled into lockdown, keeping children out of school, in their houses and, for many, away from the virus.
Researchers weren’t sure whether children weren’t getting the virus or just didn’t experience, on the whole, the illness’ most acute and attention-drawing effects. Children weren’t showing up in the data, giving some parents a sense that they weren’t at risk.
“In the beginning of the pandemic, there was a lot of misinformation. How kids are just immune. Adults will get it, but their kids are just fine,” said Dr. Anisa Ibrahim, a pediatrician at Harborview Medical Center in Seattle and an associate professor of pediatrics at the University of Washington. Now, she said, “that’s the kind of messaging we’re trying to combat.”
While Covid isn’t hospitalizing or killing children at the same rate as adults, they can contract the disease, spread it and suffer grave consequences, including death. Doctors say it’s hard to know how a child’s infection will play out.
“It’s difficult to predict who will get incredibly sick and who will not among young, healthy people,” Ibrahim said.
Nearly 6.3 million children in the U.S. have tested positive for Covid-19, and at least 584 of them have died, according to data from the American Academy of Pediatrics.
But doctors and researchers have said the idea that children are less susceptible to the virus and therefore don’t need the vaccines has persisted among some parents.
“Those early messages were sticky,” said Jessica Calarco, a researcher and associate professor of sociology at Indiana University who has periodically interviewed 80 mothers since 2018 and evaluated their decisions about vaccination.
In an academic paper awaiting peer review, Calarco argues that reassuring messages from the CDC, other public health officials and the news media created a “sense of moral calm” about the risks of Covid, sapping some parents’ urgency today.
Now, researchers have a more accurate understanding of the risks of Covid, and they’re sharing the message. But many parents told Calarco that they’ve tuned out Covid news since the initial flood of information.
“They’ve come to feel very fatigued,” Calarco said. “One mom I talked to said she stuck her head in the sand and she’s not paying attention to Covid anymore.”
That opens the door to misinformation and vaccine hesitancy, Calarco said.
Other factors are at work, too, said Dr. Melissa Stockwell, who heads the division of child and adolescent health at Columbia University’s Irving Medical Center. Some states have problems with access that can make it difficult for families to get their children to vaccination clinics at convenient times.
Disinformation on social media also helps spur vaccine hesitancy. Some people have seen or experienced medical racism that leads to distrust of the medical community. Language can be an information barrier, and it’s important to meet people where they are.
“We take for granted that we can turn on NPR and NBC and watch something in English and know,” said Ibrahim, who conducts events in the Somali language in Seattle to reach members of the Somali community.
Polling in August by the Kaiser Family Foundation found that Hispanic and Black parents were more likely to have concerns about barriers to access.
Unvaccinated children are at risk in several ways, Stockwell said.
“When the coverage is 35 percent, the children in that community don’t have the same level of protection as at 80 percent,” she said. “It matters for their own health, but it also matters for getting back to normal as we can get at this point. It’s really hard for kids to be out of school for so long.”
Doctors said no single approach will work to boost vaccinations in the age group.
“There’s no blanket statement,” Ibrahim said.
The doctors said every office visit is a chance to bring up vaccinations, connect with parents and assuage fears.
“The tide is going to be turned one by one, family by family,” Stockwell said.
The next wave of new vaccinations could prove to be challenging, however.
The White House told governors this month to expect vaccinations for children ages 5 to 11 to begin early next month. A federal advisory committee was scheduled to review data from Pfizer clinical trials in younger children Tuesday.
A Food and Drug Administration review of Pfizer’s data said the vaccine’s benefits “would clearly outweigh” its risks, with no unexpected side effects. The FDA did model the impact of an extremely rare side effect, heart inflammation, in several scenarios. Only if cases fell to their lowest point since the pandemic began would there be any question of whether the benefits of vaccinating this group outweigh the risks, the agency found.
But only a third of parents said they would immediately seek vaccinations for children 5 to 11, according to Kaiser Family Foundation polling. Ibrahim expects some parents of younger children to take a bit more time and proceed warily.
“I can anticipate these decisions being slower because we are asking parents to make decisions for their prized possession — their children,” she said.