The Washington PostDemocracy Dies in Darkness

Southern states fall behind in vaccinating kids as pediatric infections climb

Slow uptake heightens fears that another coronavirus wave could hit hard as families gather for the holidays.

A medical staffer moves a patient who died of covid-19 onto a gurney to hand off to a funeral home, at the Willis-Knighton Medical Center in Shreveport, La., last August. (Gerald Herbert/AP)
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Many Southern states, especially Louisiana, Alabama and Mississippi, have fallen behind the rest of the nation in vaccinating children as the threat of a winter surge casts a pall over the holiday season.

Those states also rank near the bottom for vaccinating adolescents and adults, and have among the nation’s highest overall covid-19 death rates, according to a review of state vaccination and death data by The Washington Post. Their slow uptake of children’s — as well as adults’ — vaccines have heightened fears that another pandemic wave could hit hard as families gather for the holidays and spend more time indoors.

“I think it is a potentially dangerous situation,” said Paul Offit, director of the Vaccine Education Center at Children’s Hospital of Philadelphia. “You’re going to have a large number of susceptible people all in one place, especially in communities where vaccine rates are generally low and the transmission is higher.”

Those concerns increase as colder weather drives families inside for social gatherings and playdates, Offit said, adding. “It is, at its heart, a winter virus.”

Many parents rushed to get their young children vaccinated after federal officials signed off on the long-awaited pediatric dose of the Pfizer-BioNTech vaccine earlier this month. More than 3.6 million kids, nearly 13 percent of the nation’s children ages 5 to 11, have received a first dose since Nov. 2.

But state data show huge differences in uptake that appear to mirror the distribution of adult vaccines: While parents in states like Massachusetts and Rhode Island raced to get their children vaccinated, the pattern has been much slower in swaths of the South as well as in states like Wyoming and South Dakota.

Vermont, which also leads the nation in adult vaccinations and booster shots, has already vaccinated more than a third of newly eligible children. But Mississippi, Alabama and Louisiana have only immunized about 3 percent of children in that age group. Mississippi and Alabama have the highest overall covid-19 death rates in the nation. Louisiana comes in fourth, after New Jersey.

“I can’t tell you how discouraging and depressing I find that,” said Mark Kline, senior vice president, chief medical officer and physician in chief at Children’s Hospital New Orleans. “Two-to-three percent — that’s heartbreaking actually, when you stop to think that virtually all ... the hospitalizations, and certainly the deaths that we’re seeing now, are all preventable.”

Kline said his hospital has seen many parents eager to get their kids vaccinated, but he has also counseled families that are split over the decision and tried to answer questions from those who are hesitant or skeptical.

Among the bottom 10 states for vaccines given to younger children, eight are in the South: Alabama, Mississippi, Louisiana, Georgia, Tennessee, West Virginia, Delaware and Oklahoma. Meanwhile, Maryland, Virginia and North Carolina are the only Southern states dispensing the shots at or above the national average.

Children ages 5 to 11 became eligible for the two-dose coronavirus vaccine from Pfizer on Nov. 2, 2021. (Video: Luis Velarde/The Washington Post, Photo: Cincinnati Children’s/The Washington Post)

Some other states have also seen low children’s immunization rates. Wyoming and South Dakota — which along with their neighbors in the Upper Midwest have recently seen infections spike — have vaccinated about 6 percent and 11 percent of young children, respectively.

Public health experts speculate that recent drops in cases, especially in the South following the summer surge caused by the delta variant, may have convinced some parents they can afford to wait.

“I think a lot of parents are willing to vaccinate their kids, but they’re kind of doing a wait-and-see approach,” said Peter Hotez, a professor of pediatrics and molecular virology at Baylor College of Medicine and co-director of the Texas Children’s Hospital Center for Vaccine Development.

But Hotez noted that coronavirus cases have recently been rising among children. According to data collected by the American Academy of Pediatrics, the number of new infections in children jumped by 32 percent over the two weeks ending Nov. 18, after heading downward for several weeks, a troubling sign ahead of the colder weather.

Most children’s cases are mild with far fewer resulting in severe illness and hospitalization than in adults, but they are as likely to spread infection as adults. A small number of children who contract coronavirus are also at risk of developing a serious condition called multisystem inflammatory syndrome, or MIS-C, that often leads to hospitalization.

“I’m pretty worried that we’re going to see another big wave of children’s hospital admissions as we move further toward the end of the year,” Hotez said.

Despite the slow initial embrace of children’s vaccinations in some states, the Biden administration has hailed the shots’ rollout as a success because of how quickly the pediatric vaccine was made available.

“This was essentially a full rollout from scratch, if you will, because there was no product in the field that could be used for kids,” said Natalie Quillian, the White House deputy covid-19 response coordinator. Shipping of the pediatric dose, which is one-third of that given to adolescents and adults, began days before federal officials gave the green light.

Officials expect those numbers to continue to increase, following a pattern similar to those for adults and adolescents. By Christmas, the White House anticipates between 10 and 12 percent of young children will be fully vaccinated, which Quillian called a “huge step forward.”

Nationally, nearly 70 percent of adults and more than 60 percent of children ages 12 to 17 have received at least one vaccine dose.

Health officials in some of the slower states said that they are facing an uphill battle combating misinformation and, in some cases, strong anti-vaccine sentiment.

In Louisiana, where Gov. John Bel Edwards (D) supports adding the coronavirus vaccine to the required panel of inoculations for all K-12 students, health officials are tackling opposition to vaccine mandates. On Monday, Louisiana Attorney General Jeff Landry (R) vowed to fight the health department proposal, which he said had “fatal flaws.”

Meanwhile, state public health officials are urgently trying to convince parents to get their kids vaccinated. On Sunday, the state health department distributed 470 shots, mostly to children, during a vaccine clinic held inside a video arcade and bowling alley. Louisiana is also giving $100 gift cards to anyone who gets a first dose before the end of the month.

“Without many more families getting their children vaccinated, we know many children in our state remain unprotected and we know that our state remains vulnerable to future, equally devastating surges,” said Aly Neel, a spokeswoman for the Louisiana Health Department.

In Alabama, just under three percent of young children have received the first dose of their coronavirus vaccine.

“We are disappointed in those numbers, we would certainly like for them to be higher,” said Karen Landers, an assistant state health officer and pediatrician. Landers said that Alabama hospitals have had to implement surge protocols after children’s wards and children’s hospitals were overwhelmed during earlier pandemic waves.

“We'd rather not do it again,” Landers said. “I want people to get vaccinated. Our state has suffered terribly. People have died. We don’t want our citizens to suffer anymore.”

Some parents have gotten that message. Kim Johnson, 37, who lives in Decatur, Ill., said she was driven to get her son and daughter vaccinated because many of her neighbors refuse to get immunized.

“That’s actually caused us to rethink how our kids socialize,” Johnson said. “We used to have kids in the house all the time … and now we limit even our kids going into other people’s houses or allowing their children into ours. So, it’s kind of caused some rifts in friendships.”

Her 8-year-old son has had his first shot and her 10-year-old daughter is scheduled to get one next week.

“She has such a fear of shots,” Johnson said. “We really talked it up … that I know it’s not fun, but sometimes we have to do these things to keep us safe — and to keep other people safe.”

Similarly, Autumn Tolbert, 46, of Fayetteville, Ark., signed up her daughters, Viola, 8, and June, 6, on the first Friday after the shots were made available. “I had never seen two kids more excited to get a shot in my life,” she said.

Tolbert said she has many neighbors, friends and extended family members who have not been vaccinated. Just under eight percent of young children in Arkansas have been given a first dose thus far, and fewer than half of adults have been fully vaccinated, according to state data.

Tolbert’s social media feeds have been filled with posts about people landing in the hospital with the coronavirus, trying to raise money to pay medical bills on GoFundMe, and grieving those who have died because of the virus.

“It’s even more sad to see it after the vaccines have been available because they feel so preventable,” she said. “I don’t want to see my child have long-term lung damage or heart damage and be in the hospital because I was too scared, and maybe too hardheaded, to understand the science behind vaccines.”