Following the May 10, 2021 approval from the Food and Drug Administration (FDA) authorizing the Pfizer COVID-19 vaccine for adolescents aged 12-15, approximately 17 million adolescents are now able to get vaccinated, about half of whom are adolescents of color. States are using lessons learned from earlier vaccination efforts and adapting the planning and implementation process of vaccinating individuals aged 16 and older against COVID-19 to inform the process for those 12 and older and ensure an equitable and efficient approach.
This authorization raises new considerations for states as they work to increase vaccination rates among their populations, including where children and adolescents will get vaccinated, how to build vaccine confidence among parents and adolescents, what the consent process looks like, and appropriate messaging strategies.
To reach adolescents ages 12-15, states are both drawing on existing vaccination locations, from mass vaccination clinics and pharmacies to medical offices, as well as setting up new vaccine sites in a variety of settings. For example, Alaska changed its vaccine allocation for evening drive-thru sites to Pfizer to increase access for adolescents after school and work hours. Some states are also newly engaging pediatricians. Washington State is working to get the Pfizer vaccine into pediatricians’ and primary care providers’ offices so trusted and familiar providers can educate children and their parents about the vaccine together, and family members can receive their vaccinations at the same time.
Many states are also leveraging schools as a critical vaccination setting and are developing plans for pop-up vaccination sites at summer camps and other recreational programs. In Virginia, the Department of Health began reaching out to school systems and meeting with superintendents prior to the FDA’s authorization. The state was able to help educate and prepare the schools to hit the ground running so that they could immediately schedule vaccine clinics upon FDA approval. This process was especially important given the short window of time before the school year ends. Earlier in May, South Carolina announced plans to hold vaccination events at schools intended for both students and their parents, with an added incentive of school supply giveaways for those who receive the vaccine. Additionally, some high schools in Maine are hosting vaccine clinics at the end of May, which provides just enough time to administer second doses before the school year ends. Oregon state officials are encouraging schools to provide the venue and help with outreach and scheduling, while facilitating partnerships with federally qualified health centers, pharmacies, and local public health authorities to provide the vaccination services on campus.
As states roll out the vaccine to new providers and locations, providers are also identifying a need for smaller vaccine packaging to avoid any potential vaccine waste. Vaccine waste has varied among states. Some state officials noted that they removed previous requirements for providers to use a certain percentage of doses within a given timeframe to ensure all opportunities to administer the vaccine are taken and to reduce barriers to vaccination, especially in areas with lower vaccination rates.
Requirements for parental consent to vaccinate minors vary among states, and even across vaccination sites. In Maine, parents or guardians do not have to be on site to provide consent. Rather, Maine allows parents to sign a form and either mail or email the form to the provider in advance, or have the child bring a hard copy to the vaccine site. Maine parents can also provide verbal consent over the phone. A small number of youth in Maine may provide their own consent for the vaccine, including those who are living separately from their parent/legal guardian, are legally married, are a member of the armed forces, or have been emancipated by the court. The state has already used this process for 16- and 17-year-olds.
In Alabama, adolescents aged 14 and older can consent for themselves in clinics, like mass vaccination sites or provider offices, but require parental consent for vaccinations in school. The state has existing processes in place to obtain consent for children to receive other routine childhood immunizations through the school; it is using the same process for the COVID-19 vaccine. Other states, like Kentucky, are also using existing processes for obtaining consent for routine immunizations and adapting them for the COVID-19 vaccine.
Vaccine Outreach and Messaging
Because studies have shown children have a lower risk of serious illness and death from COVID-19, polling has indicated that parents are confused about the benefits and risks of vaccination and hesitant to vaccinate themselves and their children. However, over the first two weeks of May, there was a 3 percent increase in the total number of COVID-19 cases in children, and a jump of over 20 percent of new cases in children under 19. The CDC is emphasizing that vaccinating eligible children is of the utmost importance to help protect both children and families, and move towards the goal of herd immunity to protect vulnerable community members who cannot get vaccinated.
Vaccinating children and adolescents brings an additional challenge for states and providers, who are tasked with building vaccine confidence among both parents/guardians and their children. State officials note that one important strategy is providing the vaccine in familiar settings with trusted providers, who can engage in conversations with families to understand their concerns and educate about the vaccine’s safety and efficacy. State officials also note the importance of messaging to both youth and adults, because children can be effective health advocates for their parents as well.
States are using trusted messengers and venues to communicate with adolescents. For example, the Louisiana Department of Health circulated flyers to the Department of Education encouraging vaccinations for adolescents 12 and above and providing relevant information. Some health departments are capitalizing on parents’ motivation to ensure their children can continue to play sports by messaging through sports teams that getting vaccinated eliminates the need for students to quarantine (thereby missing practices and games) if there is a school exposure. Other states are using football games that draw large crowds of teens as an opportunity to educate about the benefits of vaccination.
The Oregon Youth Authority (OYA) created resources in different languages tailored to adolescents from different populations and those in OYA custody. The flyers include first-hand accounts of COVID-19 vaccination experiences from individuals who identify as Latino, Black, and Native American, and information about the Indian Health Services’ involvement in the vaccine planning and development process. The Michigan Department of Health & Human Services is using social media advertising designed for parents and children, including Snapchat, Instagram, and TikTok. The Alaska Department of Health and Human Services has created opportunities to ensure adolescents can communicate with each other using peer-to-peer platforms to give unvaccinated teens the opportunity to ask questions of vaccinated teens and share why they chose to get vaccinated.
As states vaccinate more adolescents and adults against COVID-19, they continue to use multi-pronged strategies in order to reach the greatest number of people in the most efficient and equitable way. With more populations now eligible, states are figuring out how to tailor vaccination strategies developed for adults to younger children and adolescents. As the vaccine distribution progresses, NASHP will continue to share promising strategies and support states in these efforts.