Pharmacist-Provided Immunizations and Updates on COVID-19 Vaccines and Recommendations - Episode 9

Introducing COVID-19 Vaccines to Parents of Infants and Toddlers

Ed Cohen, PharmD, FAPhA, drives a discussion around the new inclusion of infants as young as 6 months old within the COVID-19 vaccine recommendations and how to educate parents on the topic.

Ed Cohen, PharmD, FAPhA: Let’s switch gears. In my introductory remarks, I mentioned that there has been an approval to immunize patients all the way down to 6 months of age. The anticipation is that fewer than 25% of parents will take their younger children to be immunized. There are all kinds of angst in the air around this. I’m hearing from some of my chain partners that they’re limiting the number of stores that will be given the vaccine to provide the service because they think that parents may not embrace this. What are your thoughts around that? It goes back to Mary’s hesitancy question and Wes’s discussion about the different types of vaccine and knowledge. You all touched on this. How are we going to go to the parents of these young children? Some are so excited because they want their kids to be able to go [places] and not worry, but that’s 20% of the population. What about the other 80%?

Lynette Chastain, PharmD, BCACP, TTS: This is difficult. Any time you make a decision for a child under 5 years of age, it’s a big decision with any kind of medication. As pharmacists, we put a lot more thought into what we’re prescribing this population, so I understand the concern, and I appreciate their thought going into it and trying to research what’s best. But we have to understand that COVID-19 impacts those children. If you look at causes of death, it’s up there with things like cancer and homicide. It’s relatively low, but it’s important for us to protect these children if we have the opportunity to do so.

We found that the vaccine is effective. We tested it first in patients aged 5 to 12 years. The adverse effects [AEs] are very similar to what we experience as adults. Usually, the AEs are very short-lived. You have fever, irritability—those things usually get better. There may be lymph node swelling, especially near the armpit where the shot is given. As you’re giving these shots, you want to be sure to tell parents what to expect so they aren’t worried after the fact. We should educate and be honest about our goals with giving immunization, and the clear benefit of things like less risk of hospitalization if they get sick. It’s rare, but we don’t know which child is going to be affected. You’d hate to see a family member affected. It’s important that we speak on that and take their thoughts into consideration.

Traci Poole, PharmD, BCACP, BCGP: I’d like to reiterate the impact of having this virus long-term. It concerns me for children, especially those who get the virus and do OK, because who knows what’s going to happen in a few years when their immune system fully develops? Or they have another problem in which having had COVID-19 in the past adds to a worsened outcome or something like that?

Wesley Nuffer, PharmD, BCPS, CDCES: I also think that we have to emphasize the carrier piece. A lot of times, if you have a child who’s immunocompetent, they may not get extremely sick. Although to Traci’s point, COVID-19 doesn’t discriminate. It isn’t the very old and the very young who are getting sick. I had a completely healthy 30-year-old individual who was in the ICU [intensive care unit] for over a month. There’s this “it can happen to anybody“ scenario. But I’ve had a number of situations before children could get vaccinated—before the approvals—where a child ended up getting sick and then visited grandparents, and then somebody got very sick and had comorbid diseases, and it ended up being a very unfortunate situation.

Good communication [is important]. I completely understand that you may not want to vaccinate somebody that young and that we’re very protective of our children. I also understand that my children are both teenagers now, but during their first 5 years of life, I was the sickest I’ve ever been in my entire life. Kids aren’t good at washing hands. They’re all getting better [at this]. COVID-19 has taught us all how to be cleaner and less infectious. But that population poses a unique risk of transmitting disease. If parents aren’t wanting to take that step, you need to be very cautious and let them know that with a child, it’s hard to know whether they’re sick or if it’s allergies or what’s going on, so it’s important to limit their exposure to individuals who could get very sick if exposed.

Mary Bridgeman, PharmD, BCPS, BCGP: We’ve begun to rethink of the pharmacy as the health care destination. We’ve seen a transformation of immunization spaces within the community pharmacy environment to accommodate and offer privacy for vaccines. There are some pharmacies in my town that use smoky glass to provide privacy. In expanding the demographic for these vaccines, we also have to accommodate and ensure that we’re prepared to administer to infants and that it’s a comfortable experience for the child and their caregiver alike.

Ed Cohen, PharmD, FAPhA: Correct me if I misspeak: pharmacy can only immunize down to patients 3 years of age.

Traci Poole, PharmD, BCACP, BCGP: The PREP [Public Readiness and Emergency Preparedness] Act allows that, but every state has their own age [range]. In Tennessee, I can have a collaborative [practice agreement] for any age, basically. It depends on your state, but the PREP Act allows vaccinations down to age 3 years.

Ed Cohen, PharmD, FAPhA: Traci, in your state, you can have children as young as 6 months. How are pharmacists thinking about immunizing babies per se?

Traci Poole, PharmD, BCACP, BCGP: I’m not sure many people are interested, to be honest. Our personal collaborative [practice agreement] was written before the pandemic for patients aged 9 and up. When we took on the first cohort of children, that was pretty taxing because pharmacies aren’t set up that well for young children. When you’re trying to add other layers of things, it can get difficult. It makes the customer and patient base uncomfortable when a child is screaming in the middle of the waiting area and whatnot. I’m not sure how Tennessee is planning on rolling that out, but I have heard from some chain pharmacists that they’re very hesitant and not looking forward to having that population come in.

Transcript edited for clarity.