Nurse checking childs heartbeat 500x333

Highlighting Key Data to Support COVID-19 Pediatric Vaccinations

Nov 04, 2021 | Adelaide Appiah

On Tuesday, November 2, the Centers for Disease Control and Prevention’s (CDC) Advisory Committee on Immunization Practices (ACIP) unanimously recommended the Pfizer-BioNTech Covid-19 vaccine for children ages 5–11 under the Federal Drug Administration’s (FDA) emergency use authorization (EUA). With a committee vote of 14–0, CDC Director Rochelle P. Walensky, MD, MPH, endorsed the CDC ACIP recommendation, expanding vaccine recommendations to approximately 28 million children in this age group and allowing providers to begin vaccinating them as soon as possible.

“We have watched as the education gaps that exist in this country have widened, as this virus has disproportionately impacted racial and ethnic minority communities,” Walensky said. “Pediatric vaccination has the power to help us change all of that.”

While children of this age group are less likely to experience severe COVID-19 infections and deaths than adolescents and adults, there have been recent increases in infections and hospitalizations due to the Delta variant. In addition, children can spread COVID-19 to other vulnerable groups of individuals. Critically, vaccination is one of the most effective ways to ensure children can continue in-person learning and participation in extra-curricular activities. Thus, NACCHO applauds the EUA, the ACIP recommendation, and the diligent scientific review by the FDA for the use of the Pfizer vaccine for children 5–11 years old. In addition, NACCHO appreciates the operational guidance and vaccination resources put forth by the Biden Administration and the CDC.

While the EUA crosses a significant hurdle, vaccine hesitancy among parents presents another challenge in vaccine uptake among this age group. With support from the Centers for Disease Control and Prevention (CDC), NACCHO recently collaborated with the What to Expect Project to survey parents with children 0–11 years-old (n=735). A majority of this sample was White (69%), had college-level education or above (69%), and an annual income of $75,000 or above (62%). About half of this sample (51%) lived in suburban areas with the other half living in urban or rural areas. Our sample demographics combined with the results of our data shows that regardless of education, income, or race, many parents of children 0–11 years-old are unsure whether they would vaccinate their child if the vaccine became available (See A1).

Figure A1

Figure A1: Likelihood of vaccinating children <12

Furthermore, recent National Immunization Survey (NIS) - Child findings indicate a disparity in race and ethnicity for vaccination coverage among children in 2018–2020. Vaccine coverage for Black and Hispanic children was lower compared with White children.1
Additionally, vaccine hesitancy is further exacerbated for parents who live in rural areas who were more likely to indicate that they would not vaccinate their children. When asked about their deciding factors to vaccinate their children, parents stated that the availability of data and information on COVID-19 vaccines for children is one of their primary concerns (See A2).

Figure A2

A2: Factors that affect parental decisions to vaccinate their children

Additionally, parents in this sample indicated receiving their information on vaccination from doctors/providers, federal agencies, and local public health officials (See A3).

Figure A3

A3: Parents’ trusted source for receiving COVID-19 information

Local Health departments continue to play a pivotal role in addressing vaccination hesitancy among families in their communities. Given these findings, we strongly encourage local health officials to:

  • Collaborate with pediatricians, community partners, news media outlets, and other trusted messengers to share available data on this age group and the COVID-19 vaccine and provide messaging related to the effectiveness and safety of the vaccines for children 5–11 years old.
  • Identify strategies to ensure that vaccination communication is tailored to support decision making and includes information regarding where to access COVID-19 vaccination and how to reach all communities. Clearly communicate with the community that COVID-19 vaccines are available at no cost for all people living in the United States regardless of their immigration or health insurance status.
  • Prioritize children who belong to Black, indigenous, people of color (BIPOC) communities, non-English speaking communities, and rural communities.
  • Implement strategies to increase vaccine access and uptake particularly among children who are not privately insured, and children covered through the Vaccines for Children Program.
  • Promote vaccination to all people, especially those ages 5–11, in addition to the co-administration of the COVID-19 vaccine, influenza, and other childhood vaccines, when appropriate.
  • Use CDC’s Pediatric COVID-19 Operational Guide and CDC resources on vaccinating children 5-11 to help plan and promote the COVID-19 vaccine in your community.
  • Continue to follow NACCHO resources to receive updates on federal guidance and messaging for promoting the vaccine, including our upcoming webinar (November 9 at 3:00 PM EST) on the COVID-19 Pediatric Vaccine Guidance.


  1. Hill HA, Yankey D, Elam-Evans LD, Singleton JA, Sterrett N. Vaccination Coverage by Age 24 Months Among Children Born in 2017 and 2018 — National Immunization Survey-Child, United States, 2018–2020. MMWR Morb Mortal Wkly Rep 2021;70:1435–1440. DOI: icon

About Adelaide Appiah

Sr. Program Analyst, Community Health

More posts by Adelaide Appiah

Related Posts

  • Webinar COVID-19

Webinar: COVID-19 Pediatric Vaccine Guidance

Join this webinar on Tuesday, November 9, 3:00-4:15 PM ET.

Nov 01, 2021 | Beth Hess

Webinar: COVID-19 Pediatric Vaccine Guidance

  • Webinar COVID-19

Webinar: COVID-19 Booster Vaccines

Join this webinar on Thursday, November 4, 3:00-4:15 PM ET.

Nov 01, 2021 | Beth Hess

Webinar: COVID-19 Booster Vaccines

Vaccines and kids 2
  • COVID-19 Immunization

COVID-19 Vaccine Requirements: Considerations for U.S....

As the COVID-19 response evolves, vaccine requirements, sometimes referred to...

Nov 03, 2021 | Katherine Waters, Victoria Thompson

COVID-19 Vaccine Requirements: Considerations for U.S....

Back to Top