Rush is on: With vaccine orders placed, doctors, pharmacies prepare for a flood of young children

The United States has already taken orders from doctors, clinics and pharmacies for millions of child-sized doses of the Pfizer-BioNTech COVID-19 vaccine, so the nation can be ready the moment shots for children 5 through 11 are authorized. 

The vaccine, which could be authorized as soon as Tuesday evening or Wednesday, will be immediately shipped "to tens of thousands of pediatricians, family doctors, children’s hospitals, community health centers, rural health clinics, and pharmacies," White House coronavirus response coordinator Jeff Zients said this week.

As with adults, the Pfizer-BioNTech vaccine will be delivered in two shots, three weeks apart. The child dose is one-third as large as for adolescents and adults, and it will be shipped in an orange-labeled bottle to distinguish it from the purple-labeled adult dose.

States and localities began placing orders for the child-sized doses last week, though they won't be shipped until the vaccine is authorized for children. The minimum vaccine order is for 300 doses, so the first orders have tended to be for larger health care providers, said Claire Hannan, executive director of the Association of Immunization Managers.

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"Most are focusing on pediatric practices, but some are focusing on health departments or schools or large-scale clinics," Hannan said. 

Because not all pediatricians will immediately have the children's dosage of the vaccine, parents should call their health care provider to see if they will have them available, she said.

Children will be able to get the COVID-19 vaccine in multiple settings, depending on where they live and local availability, but for many it will be at their doctor's office, said Dr. Lee Savio Beers, president of the American Academy of Pediatrics, said. 

"The younger a child is, the more likely the family is to get their vaccine at the pediatrician's office," she said.

Families should be aware that not everyone will be able to get their shots immediately.

"The health care workforce is stretched right now, and there’s a lot of staffing shortages. A lot of sick kids who need to be cared for right now. It’s all hands on deck," Beers said.

Another potential venue will be pharmacies. More than 400,000 American pharmacists are trained and legally able to administer shots to people "across the lifespan," said Mitchel Rothholz, chief of governance and state affairs for the American Pharmacists Association.

For adults, pharmacists have been a major provider of COVID-19 vaccine. More than 70% of shots have been given in pharmacies, according to the Centers for Disease Control and Prevention.  

Many pharmacies have already ordered the children's dosages. "They're prepositioning and now waiting until they're authorized to give it," Rothholz said. 

When COVID-19 vaccines were first made available, many people stood in line for hours to get shots. Today the system is much more built-out and smoothly functioning, Rothholz said.

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"Much of what we do now is appointment-based, to even out the flow of people," he said. It's a good idea to bring books or toys or other playthings to keep kids occupied while they are waiting for their shots and during the mandatory 15-minute observation period afterward, he added.

"If your child is into electronics or books, bringing along something that distracts them can help," Rothholz said.

The timeline for availability of kids' shots  began Tuesday when a Food and Drug Administration advisory committee voted to recommend the vaccine be authorized for children. 

Next, the FDA must sign off on an expanded emergency use authorization, which is expected within the next few days. Then an independent panel advising the Centers for Disease Control and Prevention will review data on the safety and effectiveness of the vaccine on Tuesday. If it gives it a thumbs-up, CDC Director Dr. Rochelle Walensky must add her support before vaccines become available.