I have had countless conversations about vaccines with families, usually surrounding the COVID or flu vaccines. Parents sometimes will decline when I offer it, either backed by a specific reason or, more often, a vague “I don’t think they really need it.” In both cases, it provides an opportunity to engage in a meaningful discussion around immunizations.
A few months ago, I had a discussion with a mother who I’ve known since I first started caring for her son more than a year ago, when he was born. This time, I was now seeing her second child, a 6-month old. During most visits, she would say no to the flu or COVID vaccine, so when I brought it up again, I was prepared for her to say no. To my surprise, she first hesitated and then agreed to the COVID vaccine. It felt like a moment to celebrate. When I asked what was different this time, she said I knew her and her children — and she trusted my advice.
Five years have passed since the beginning of the COVID-19 pandemic in the United States. It would be understandable to think the disease is somehow less severe and less relevant today but, as a pediatrician, I still see the ramifications of this virus — particularly in young infants like my patient.
In fact, from October 2022 to April 2024, there were 1,470 hospitalizations related to COVID-19 for infants younger than 6 months old, according to data from the CDC. This number is only surpassed by COVID-19 associated hospitalization in adults older than 75 years old.
Recently, the U.S. Secretary of Health and Human Services (HHS), Robert F. Kennedy Jr., posted a video on social media announcing that the COVID-19 vaccine would no longer be recommended for healthy children and pregnant individuals. This decision is concerning on multiple levels.
Emphasizing that healthy children do not need the vaccine is misleading: 56% of children less than 6 months old who were hospitalized in the intensive care unit (ICU) for COVID-19 between October 2022 and April 2024 did not have any underlying health conditions. Second, it is unclear how this determination was made — health experts and scientists were not consulted prior to this announcement. Typically, the Advisory Committee on Immunization Practices (ACIP) meets to discuss recommendations for the upcoming season, but this was not done. The American Academy of Pediatrics (AAP) and American College of Obstetricians and Gynecologists (ACOG) quickly came out with statements against this decision.
Additionally, insurance companies could use this recommendation to justify limiting coverage for the vaccine, creating more inequity and access issues.
Not only are increased rates of hospitalizations a cost burden to the healthcare system, young infants can have severe outcomes related to COVID-19 including admission to the ICU, the need for mechanical ventilation and, in rarer cases, death. We also know young infants are at increased risk for a myriad of infections given their relative decreased immunity and inability to receive certain immunizations such as the COVID-19 and flu vaccine until they are 6 months or older. In fact, COVID-19 vaccination rates are low in children with less than 20% receiving the vaccine between 2024 and 2025, and only about 5% receiving the vaccine in children 6 months to 5 years old.
How do we help protect this vulnerable population? Prevention.
One key method of prevention is to provide the COVID-19 vaccine to people who are pregnant, a recommendation endorsed by the ACOG. Maternal antibodies transfer to the fetus and help protect infants in the early part of their life. However, despite the evidence that supports the safety of the vaccine in this population, COVID-19 vaccination rates are low among pregnant individuals. This further exacerbates the risk for young infants as nearly 90% of infants hospitalized due to COVID-19 from October 2022 to April 2024 were born to mothers who had no record of receiving the COVID-19 vaccination during pregnancy.
The decision by the HHS will likely not change how often I have vaccine discussions with families. I will continue to establish trust and build rapport with parents and provide them with the most current evidence available to make decisions.
Pediatricians also may have to brace for yet another significant respiratory season that could have been prevented. But we will be fine; we do our jobs everyday with commitment and dedication to our patients and families. However, the next time I care for a family that is finally ready to provide the COVID-19 vaccine to their child, I am not sure if they will have reliable access to it, increasing the risk of a serious infection among our most vulnerable.
(Meera Nagarajan) Dr. Meera Nagarajan is a pediatrician in Salt Lake City.
Dr. Meera Nagarajan is a pediatrician in Salt Lake City. She has a particular interest in community advocacy, increasing healthy food access and environmental health.
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