COVID-19 Vaccine Provider Availability and Vaccination Coverage Among Children Aged 5–11 Years

United States, November 1, 2021-April 25, 2022

Jennifer DeCuir, MD, PhD; Lu Meng, PhD; Yi Pan, PhD; Tara Vogt, PhD; Kevin Chatham-Stevens, MD; Seth Meador, MPH; Lauren Shaw, MS; Carla L. Black, PhD; LaTreace Q. Harris, MPH

Disclosures

Morbidity and Mortality Weekly Report. 2022;71(26):847-851. 

In This Article

Abstract and Introduction

Introduction

COVID-19 can lead to severe outcomes in children, including multisystem inflammatory syndrome, hospitalization, and death.[1,2] On November 2, 2021, the Advisory Committee on Immunization Practices issued an interim recommendation for use of the BNT162b2 (Pfizer-BioNTech) vaccine in children aged 5–11 years for the prevention of COVID-19; however, vaccination coverage in this age group remains low.[3] As of June 7, 2022, 36.0% of children aged 5–11 years in the United States had received ≥1 of COVID-19 vaccine.[3] Among factors that might influence vaccination coverage is the availability of vaccine providers.[4] To better understand how provider availability has affected COVID-19 vaccination coverage among children aged 5–11 years, CDC analyzed data on active COVID-19 vaccine providers and county-level vaccine administration data during November 1, 2021–April 25, 2022. Among 2,586 U.S. counties included in the analysis, 87.5% had at least one active COVID-19 vaccine provider serving children aged 5–11 years. Among the five assessed active provider types, most counties had at least one pharmacy (69.1%) or public health clinic (61.3%), whereas fewer counties had at least one pediatric clinic (29.7%), family medicine clinic (29.0%), or federally qualified health center (FQHC)* (22.8%). Median county-level vaccination coverage was 14.5% (IQR = 8.9%–23.6%). After adjusting for social vulnerability index (SVI) and urbanicity, the analysis found that vaccination coverage among children aged 5–11 years was higher in counties with at least one active COVID-19 vaccine provider than in counties with no active providers (adjusted rate ratio [aRR] = 1.66). For each provider type, presence of at least one provider in the county was associated with higher coverage; the largest difference in vaccination coverage was observed between counties with and without pediatric clinics (aRR = 1.37). Ensuring broad access to COVID-19 vaccines, in addition to other strategies to address vaccination barriers, could help increase vaccination coverage among children aged 5–11 years.

This cross-sectional analysis used COVID-19 vaccine administration data reported to CDC by jurisdictions, pharmacies, and federal entities through immunization information systems, the Vaccine Administration Management System, and direct data submission.§ Among 3,142 U.S. counties, 2,586 (82.3%) were included. Two states (Texas and Idaho) and eight California counties with populations <20,000 were excluded because of restrictions on reporting of vaccine administration data to CDC, and Michigan was excluded because of incomplete data on COVID-19 vaccine administration. Counties were also excluded if provider type was missing for >25% of active providers in the county (5.1% of counties). Active providers were defined as those who reported administration of ≥1 Pfizer-BioNTech pediatric COVID-19 vaccine dose by April 25, 2022. COVID-19 provider enrollment data were used to classify active providers into the following provider types: pharmacies, pediatric clinics, family medicine clinics, FQHCs, and public health clinics. School-located vaccination clinics could not be included because vaccine administration in these locations was not reported separately from other provider types, such as pediatric clinics and pharmacies. For active providers and for each provider type, counties were dichotomized into those with at least one provider versus those with no providers. COVID-19 vaccination coverage was defined as the number of children aged 5–11 years who received at least one dose of pediatric COVID-19 vaccine during November 1, 2021–April 25, 2022, divided by the county population aged 5–11 years.

Associations between provider availability and vaccination coverage among children aged 5–11 years were measured using generalized estimating equation models with negative binomial regression to account for clustering of counties within states.** Because the active provider definition might have undercounted providers that did not report identifying information with their vaccine administrations, a sensitivity analysis was also conducted in which active providers were defined as those reporting either administration or inventory of at least one Pfizer-BioNTech pediatric COVID-19 vaccine dose. Rate ratios were calculated with 95% CIs to compare vaccination coverage among counties with and without active COVID-19 vaccine providers overall and by each provider type, with multivariable models controlling for SVI and urbanicity.†† P-values <0.05 were considered statistically significant. Analyses were performed in SAS (version 9.4; SAS Institute). This study was reviewed by CDC and conducted consistent with applicable federal law and CDC policy.§§

Active providers of COVID-19 vaccine to children aged 5–11 years were primarily concentrated in parts of the Northeast, Midwest, and several counties in the West (Figure); this distribution approximately corresponded with COVID-19 vaccination coverage among children aged 5–11 years. Most counties had at least one active provider (87.5%), with the most common being a pharmacy (69.1%) or public health clinic (61.3%); fewer counties had at least one pediatric clinic (29.7%), family medicine clinic (29.0%), or FQHC (22.8%) (Table 1). More than one half (1,322; 51.1%) of counties had no pediatric clinic, family medicine clinic, or FQHC. Among all counties, median vaccination coverage among children aged 5–11 years was 14.5% (IQR = 8.9%–23.6%).

Figure.

Number of active COVID-19 vaccine providers per 10,000 children aged 5–11 years and COVID-19 vaccination coverage among children aged 5–11 years, by county — United States, November 1, 2021–April 25, 2022

In univariate models, the presence of at least one active provider in a county was associated with higher vaccination coverage when compared with having no active provider in a county, irrespective of provider type (Table 2). These associations remained significant after adjusting for SVI and urbanicity. In the adjusted models, the largest associations with vaccination coverage were found for active providers (aRR = 1.66) and pediatric clinics (aRR = 1.37). Public health clinics were associated with the smallest difference in vaccination coverage (aRR = 1.16). The sensitivity analysis in which active providers were defined as those reporting either administration or inventory of at least one Pfizer-BioNTech pediatric COVID-19 vaccine dose yielded similar results.

*https://www.hrsa.gov/opa/eligibility-and-registration/health-centers/fqhc/index.html
SVI is a composite measure calculated from the following 15 indicators: 1) percentage of persons with incomes below poverty threshold, 2) percentage of civilian population (aged ≥16 years) unemployed, 3) per capita income, 4) percentage of persons aged ≥25 years with no high school diploma, 5) percentage of persons aged ≥65 years, 6) percentage of persons aged ≤17 years, 7) percentage of civilian noninstitutionalized population with a disability, 8) percentage of single-parent households with children aged <18 years, 9) percentage of persons who are racial or ethnic minorities (i.e., all persons except those who are non-Hispanic White), 10) percentage of persons aged ≥5 years who speak English "less than well," 11) percentage of housing in structures with ≥10 units (multiunit housing), 12) percentage of housing structures that are mobile homes, 13) percentage of households with more persons than rooms (crowding), 14) percentage of households with no vehicle available, and 15) percentage of persons in group quarters. The 15 indicators are categorized into four themes: 1) socioeconomic status (indicators 1–4), 2) household composition and disability (indicators 5–8), 3) racial and ethnic minority status and language (indicators 9 and 10), and 4) housing type and transportation (indicators 11–15). These indicators are combined into a final score that is ranked from 0 (lowest vulnerability) to 1 (highest vulnerability). https://www.atsdr.cdc.gov/placeandhealth/svi/index.html
§ https://www.cdc.gov/coronavirus/2019-ncov/vaccines/distributing/about-vaccine-data.html
County population totals used to calculate vaccination coverage among children aged 5–11 years were obtained from the National Center for Health Statistics (NCHS) vintage 2019 bridged-race postcensal population estimates (https://www.cdc.gov/nchs/nvss/bridged_race.htm). The population of children aged 5–11 years in counties included in the analysis ranged from 33 to 839,738.
**Robust SEs were used.
††County-level SVI data were obtained from CDC/Agency for Toxic Substances and Disease Registry 2018 SVI database. County-level urbanicity data were obtained from the 2013 NCHS Urban-Rural Classification Scheme. https://www.cdc.gov/nchs/data_access/urban_rural.htm
§§45 C.F.R. part 46, 21 C.F.R. part 56; 42 U.S.C. Sect. 241(d); 5 U.S.C. Sect. 552a; 44 U.S.C. Sect. 3501 et seq.

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