Advancing Children’s Health: Promoting COVID-19 Vaccination and Mitigation Measures

Vaccine Distribution
Most children across racial and ethnic populations, income levels, and payer types receive their routine vaccinations at one of three sites: Medical homes (pediatricians, family med or med peds clinics, FQHCs), schools and school-based clinics, or public health departments. As a result, the community-based vaccination sites that were critical to advancing racial equity among the adult population, may not be as integral to equitably vaccinate 5-11 and 12-17 year olds.

Critical Role for Schools and School Based Clinics
The robustness of the national school health infrastructure (school based clinics, school nurses etc.) varies by district and state. But given the core role schools play in the lives of families and communities, they are a crucial site to partner with in the vaccination effort – for disseminating information about vaccines and delivering vaccines. Schools are also important to bridge access gaps for underserved communities who lack a medical home.

Increased Support for Public Health Departments at All Levels
Public health departments, at the local and state level, are the backbone of targeted public health responses and in many jurisdictions the main site of vaccination for children and families who lack medical homes, are recent immigrants, or lack insurance coverage. Ensuring health departments are equipped and resourced to: support linkages between schools and medical homes, coordinate local efforts to proactively provide patients with information about vaccination, and offer vaccination, will be a necessary complement to the broader effort to vaccinate families.

Maximizing the Use of VFC
The backbone of the national effort to provide routine immunizations to the pediatric population is the Vaccines for Children program (VFC), which since its inception has helped narrow and sometimes even close gaps in routine vaccination by racial and ethnic group and across income levels. Maximizing and optimizing use of the VFC program will be critical to equitably and effectively vaccinating 5-11 and 12-17 year olds.

Reimburse and Incentivize Vaccine Counseling
Families will likely have questions for their pediatrician/primary care provider regarding vaccines even when they are not a vaccination site. There is no current mechanism to pay for this counseling in current billing and coding systems. In addition, some families will require several rounds of counseling before they are ready to receive a vaccine even from their primary care provider, but the primary care provider can only receive payment when the actual administration happens. Payment systems must encourage appropriate vaccine counseling. This is an urgent problem for CMS, state Medicaid programs, and private insurance to address. A couple of places have added reimbursement for counseling, including North Carolina Medicaid and New York City.

Enable a “No Wrong Door” Approach to Ensure Whole Families Are Vaccinated
The 5-11 roll out is an important opportunity to vaccinate families and communities and bolster community-level protection. This is an especially important approach for communities with low vaccination rates among adult caregivers, who then may be less likely to vaccinate their children. Family vaccination strategies capture the essence of the “no wrong door approach” and ensure caregivers and siblings are also protected when they accompany children who are 5-11 to their medical visits. But equipping vaccination sites to administer doses to clients or patients of varying ages raises important safety concerns that need to be proactively addressed.

Integrate and Equip Local Health Departments
Integrate local health departments (LHDs) and other key vaccine providers and community stakeholders into local planning to address operational challenges, effective coordination, consistent communication, and messaging, and ensure an approach to rollout with health equity at the center of the approach.

Clear, Consistent Communication Centered in Racial Health Equity
Clear, proactive, and unified communication across government agencies and all participants in the roll out for 5-11 will be critical to success. Such coordination requires planning and information dissemination strategies that are language appropriate, culturally appropriate, scientifically accurate, simple to digest, and timely.

Ensure Local Trusted Messengers Are Equipped With Clear Consistent Communication
Ensure that community based organizations, community health worker and promotora networks are adequately resourced and equipped with culturally appropriate and scientifically accurate information to do outreach to children, families, and communities, especially those who have experienced a disproportionate burden of COVID illness and other impacts, before and during the vaccine rollout.

Build on Bright Spots and Learnings From Local Communities
Build on learning, infrastructure, best practices and research from adult COVID vaccinations and routine childhood immunizations where public health, health care, community based organizations and community based workforce worked in concert to educate, combat misinformation and increase vaccination rates.