An Update on Vaccine Roll-Out for 5-11 Year-olds in the U.S.

Introduction

On November 2, the Centers for Disease Control and Prevention (CDC) recommended Pfizer’s COVID-19 vaccine for children, ages 5-11, in the United States, making the U.S. one of the first countries to do so. We previously discussed many of the issues to consider in rolling out pediatric COVID-19 vaccines to the 28 million 5-11 year-olds living in the U.S., including that a new formulation of the vaccine needed to be shipped for this purpose, different vaccine providers would need to be engaged, and parents and caregivers would play the determinate role in the effort, all factors suggesting that rollout might face unique issues. Now, a little more than one month since vaccines were first recommended for kids, we examine progress to date nationally and by state.

Our analysis is based on data obtained from the CDC’s Data Tracker, which itself is based on data reported by jurisdictions to CDC; however, there may be differences between the CDC Tracker and data provided on individual state websites due to reporting timeframe and other factors. To calculate the number of 5-11 year-olds who had received at least one vaccine dose by state, we calculated the difference between the number of those aged 5+ with at least one dose and the number of those aged 12+ with one dose. We included data from federal entities, territories and associated jurisdictions in our national totals, but only the 50 states and DC in our state analysis. Data from Idaho were not available for this age group. Data are as of December 5, 2021.

Overall, we find that after an initial period of high demand, vaccination progress among those ages 5-11 has slowed significantly. The increase in new doses administered began slowing leading up to the Thanksgiving holiday and has continued since. In addition, like vaccination rates for adults, we find wide variation in coverage across the country. Specific findings are as follows:

Findings

Nationally, an estimated 16.7% of 5-11 year-olds had received at least one COVID-19 vaccine dose as of December 5, 2021 (Figure 1). This represents almost 4.8 million of the approximately 28 million children in this age group in the United States. Given the two dose Pfizer regimen, administered three weeks apart, and the need for a two-week period afterward to be considered fully vaccinated, just 4.3% of children have reached this point.

The rate of vaccination among 5-11 year-olds has slowed considerably, a drop that preceded the Thanksgiving holiday and has continued since. Vaccination rates among 5-11 year-olds, as measured by first doses administered daily, rose sharply after the recommendation was first made on November 2. One week later, on November 9, the rate had risen to 4% and on November 16, it was 9.8%. Since then, however, and leading into the Thanksgiving holiday, the rate of first dose administration began to slow and has continued to decline since (Figure 2).

At the state level, as with the rest of the COVID-19 vaccination effort, there is significant variation across the country, with a more than 40 percentage point difference between the top and bottom ranking states. The share of children having received at least one COVID-19 vaccine dose ranged from 45.6% in Vermont to just 3.6% in West Virginia (Table 1). Eight states have vaccinated a quarter or more of 5-11 year-olds; ten states have vaccinated fewer than 10%.

There are some regional differences, with states in the Northeast more likely to have achieved higher coverage rates, while those in the South more likely to rank towards the bottom. The four states with highest vaccination rates, all in New England (Vermont, Massachusetts, Maine, and Rhode Island), have vaccinated at least 30% of children while the four states with the lowest vaccination rates (West Virginia, Mississippi, Louisiana, and Alabama) have vaccinated 6% or less (Table 1). Eight of the ten states with the lowest vaccine coverage among 5-11 year-olds are in the South.

Across most (34) states, rankings on vaccination rates for children ages 5-11 are similar (within 10 points) of their adult, 18+ rankings. Among the ten states with the highest vaccination rates for children, six (Vermont, Massachusetts, Maine, Rhode Island, DC, and Connecticut) also rank in the top ten states for adult vaccinations (Table 1). At the other end of the spectrum, of the ten states that rank lowest in vaccination rates for children, six (Mississippi, Louisiana, Alabama, Wyoming, Tennessee, and Georgia) are also in the bottom ten rankings for vaccinations for adults.

Discussion

While approximately 4.8 million children, ages 5-11, have received at least one COVID-19 vaccine dose, we find that just over one month into the pediatric vaccination effort, the rate of increase appears to already be leveling off. This drop-off began before the Thanksgiving holiday and has continued since, suggesting that eager parents and caregivers, who make vaccination decisions for children, have already come forward. Indeed, our polling has found that two thirds of parents say they will wait and see or won’t get their child vaccinated against COVID-19 at all, and this next phase of the vaccination effort will likely be much harder.

As with vaccination rates for adults, the share of children ages 5-11 having received at least one COVID-19 vaccine dose varies quite significantly across states. Given the role parents play in vaccination decisions for their children, it is perhaps not surprising that many of the states with among the lowest vaccination rates for adults also have the lowest vaccine coverage for children. At the same time, while state rankings on vaccination rates for children ages 5-11 generally mirror those for adults, a handful of states appear to be doing a better job of vaccinating children compared to adults. Understanding the factors contributing to the higher rankings for these states could help identify strategies for reducing barriers and vaccine hesitancy among parents in states with lower rankings.

Finally, at least as important as tracking overall vaccination rates for children is understanding who those children are, in order to be able to assess access and equity. However, there are limited data available to do so. Nationally, data on vaccination status by age and race/ethnicity are not available and only a handful of states report data disaggregated at this level.