ACIP Backs Free COVID Shot for Certain Kids Under Federal Program

The CDC’s vaccine advisors voted unanimously on Wednesday to recommend that COVID-19 shots be added to the list of immunizations covered by the Vaccines for Children (VFC) program.

By a vote of 15-0, the Advisory Committee on Immunization Practices (ACIP) said the COVID vaccines should be covered under the federal program, which buys vaccines at a discounted rate, then distributes them to contracted vaccine providers, allowing free access to children 6 months and up who might not otherwise be vaccinated because of an inability to pay.

“The point of the VFC vote is to allow for un- or underinsured children to have access to COVID-19 vaccines at a time in the future for when the vaccine transitions to a commercial market,” explained CDC’s Sara Oliver, MD, MPH, lead of ACIP’s COVID vaccine working group.

The vaccines won’t be available immediately under the program, but the resolution allows the CDC to take steps toward awarding contracts to VFC providers for when the vaccines are no longer available under the national COVID-19 response, explained Jeanne Santoli, MD, MPH, also of CDC’s National Center for Immunization and Respiratory Diseases.

Then designated “providers will be able to order vaccines through the VFC program,” said Santoli.

To date, uptake of the COVID-19 vaccine in the youngest kids has been low, with only 6.9% of children ages 6 months to 4 years having receiving an initial dose, according to Oliver.

For kids ages 5 to 11 years, 38.6% have received at least a first dose of their primary series, while 71.1% of adolescents ages 12 to 17 years have received at least a first dose. In addition, 1.4 million children ages 5 to 11 years and 4.5 million adolescents have received a booster shot as well, she added.

ACIP has reviewed the risk-benefit calculus at six separate meetings, said Oliver, and each time determined that the benefits outweigh the risks.

She noted that the the risk of myocarditis and pericarditis after administration of mRNA COVID-19 vaccines is “rare” and has mainly been seen in adolescent and young adult males within the first week of receiving the second dose or booster dose. Most are fully recovered at follow-up. Spacing the primary series doses 8 weeks apart may reduce the risk for myocarditis, she said.

For boys ages 12 to 17, Oliver added that the risk of adverse cardiac events with COVID-19 itself is 2 to 6 times higher than after receiving the vaccine.

ACIP member Sarah Long, MD, of Drexel University College of Medicine in Philadelphia, argued that the harms of COVID-19 in children are underappreciated, and said that safety concerns for very young children were fueled by misinformation.

“Omicron has changed the landscape,” she said, driving up both pediatric hospitalizations and deaths from COVID-19.

Oliver noted in her presentation that the youngest children, those 6 months to 4 years, have the highest COVID-19 hospitalization rates.

“We have to get the message out that it is not,” Long noted, “just the saving of a couple of days of a cold, but that this is a serious illness in children and that there’s a vaccine. It’s available, and they should have it.”

Long also asked what the timeline was for a pediatric bivalent primary vaccine series.

Oliver explained that while “studies are ongoing,” there isn’t a timeline yet, but that the CDC plans to bring forward any data to discuss with ACIP once available.

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Jeffrey Duchin, MD, an alternate liaison representative for the National Association of County and City Health Officials, highlighted findings of a 2021 report from the National Vaccine Advisory Committee (NVAC), which found that “immunization is a long-standing and persistent barrier.”

Black, Hispanic, and Asian adults still have lower vaccination rates than white adults for all recommended adult vaccines, he said.

“We really need a ‘vaccines-for-all’ program — children and adults,” Duchin said, highlighting a key recommendation from the NVAC report.

Michael Hogue, PharmD, of the American Pharmacists Association, pointed out that many of the COVID-19 vaccine doses for individuals 12 and older were given in pharmacies, but in most states pharmacies aren’t approved VFC providers.

Less than 150 pharmacies are VFC providers, he noted, urging the CDC to address that problem.