Caitlin Chmiel was furious and worried when her 2-year-old tested positive for COVID-19 the week the federal government approved vaccines for the nation's youngest kids in mid-June - when quicker action meant her daughter might have been vaccinated and had more protection against the virus.
Born seven weeks premature in March 2020, Chmiel's daughter spent her first 19 days of life in pandemic lockdown in a neonatal intensive care unit. When she was able to leave the hospital, she entered into an uncertain world that was masked and defensive against COVID-19. And her parents spent the next two years counting the days until they could protect their frail daughter from it, too.
The video above is from a previous report.
For Chmiel and her husband, the vaccine's delayed arrival in Texas was a cruel irony. At the moment it was available in late June, their daughter was already infected with COVID-19 and fighting it off.
Her daughter recovered from the virus after several days of fever and is finally eligible for her vaccine.
"We were so relieved when the vaccines were first made available for adults, but for our family that was not the end to the pandemic," said Chmiel, 36, of Bryan. "We waited and waited for 18-plus months while it seemed the whole world moved on."
In the two weeks since the federal government allowed emergency use of COVID-19 vaccines for children younger than 5, nearly 32,000 Texas kids in that age group have been vaccinated.
Toddlers are getting vaccinated at a slower rate than older children
The percentage of children ages 6 months to 4 years who received at least one dose of a vaccine increased slowly during the first 12 days that the state started reporting their vaccination numbers. The rate has increased slower than children in older age groups during the first days they were eligible to receive a vaccine.
That accounts for just over 1% of the state's youngest residents, a lower rate than doctors had hoped, but faster than the national rate for kids that age - even as Texas deals with a lower-than-average vaccination rate across the state.
Health officials expect the numbers to pick up when more pediatricians launch their vaccine programs in the coming weeks, and hope they do; cases and hospitalizations are climbing again this summer due to new, highly transmissible variants of the virus.
But Alexis Madison, a San Antonio real estate agent and mother, won't be adding her children to those numbers any time soon.
She may wind up getting them shots out of sheer necessity, she said. But she is not convinced her children, ages 1 and 4, need them right now. Madison is wary of what she believes is intense pressure by the government to get them vaccinated. And she's not sure she trusts the science that says the vaccines are safe for kids their age.
"I'm just kind of watching to see, when other parents decide to get their kids vaccinated, how they are," said Madison, 32, who got vaccinated herself only so she could travel without hassles. "If it becomes mandatory for something, OK fine, I'll just get them vaccinated so they can play a sport or whatnot. But it's not mandatory right now, so I'm not making them get it."
Vaccine acceptance by parents of Texas babies and toddlers is slower than the medical community had hoped it would be after COVID-19 vaccines were approved for use in children ages 6 months to 4 years old in late June.
On June 17, the U.S. Food and Drug Administration granted emergency use authorization, after frequent delays over several months, to Pfizer's COVID-19 vaccine for children ages 6 months to 5 years, as well as to Moderna's vaccine for kids ages 6 months to 6 years. The Centers for Disease Control and Prevention recommended their use the following day.
So far, just over 1% of the estimated 1.8 million Texans under 5 have gotten at least one dose. Nationwide, the number is slightly lower, with less than 1% of the country's 29 million kids under 5 having their first doses.
Hesitancy with the vaccine rises among parents of younger kids because they tend to be more skeptical about the need for them, said Dr. Jaime E. Fergie, director of pediatric infectious diseases and hospital epidemiologist at Driscoll Children's Hospital in Corpus Christi.
When the vaccine was made available to Texas kids ages 5 to 11 in November, nearly 6% of the population was vaccinated in the first two weeks. For children ages 12-15, when they were approved for the vaccine a year ago, more than 11% were vaccinated in the same time frame, according to the Texas Department of State Health Services.
During that time, the delta variant was making an alarming and devastating impact on the nation's children, killing twice as many Texas kids in August through October 2021 than COVID-19 did the entire first year of the pandemic. That likely fueled early interest in the vaccine for children ages 5 and up, while recent months with lower community spread have likely bred what Fergie called "complacency" among the parents of the state's tiniest residents.
"The uptake [for younger children] has been low; it's been pathetic," Fergie said. "I think the misconception is that COVID-19 in children is not important. But even though the impact on children is much less than on adults, there is still death for children, and hospitalizations are rising. There are still very powerful reasons to vaccinate children."
Children accounted for nearly 20% of all COVID-19 cases reported in the U.S. throughout the pandemic. But they are less likely to develop serious illness or die than are patients who are decades older, and the mortality rate has been relatively low compared with adults.
Still, at least 155 Texans age 19 or younger have died from COVID-19 since the beginning of the pandemic, according to state health data. One-third of them were younger than 10.
Some 61% of Texans are fully vaccinated, compared with 67% nationwide.
"Children have fared better overall than adults, and it is true when you look at the entire U.S. population," said Dr. James Versalovic, pathologist-in-chief at Texas Children's Hospital in Houston. "One can certainly come to that conclusion. But the fact is that hundreds of children in the U.S. have died of COVID-19 in this pandemic. Thousands have been hospitalized. We've seen this impact directly at Texas Children's."
Some of the patients have had underlying conditions, but many did not have any known conditions, he said.
"So it's difficult to predict, and I think the message to parents continues to be, 'Why take a chance?'" Versalovic said. "When you don't know if your child is vulnerable and could be exposed at any time, and certainly we know that's happening today with many infections in communities."
Omicron still a threat
The omicron variant caused cases and hospitalizations to skyrocket in January, particularly among children, followed by several months of dipping numbers across the nation.
But in recent weeks, two new, highly contagious subvariants of omicron are causing hospitalizations and deaths to swing upward again - adding urgency to calls by hospital and state officials to keep vaccinating and boosting children.
At Texas Children's Hospital in Houston, the number of patients with COVID-19 on normal days when the numbers are low and steady hovers between below 5 and up to 10, Versalovic said.
Last Thursday, that number had gone past 30, he said.
In Corpus Christi, the positivity rate among the patients at Driscoll Children's has shot up recently as well. In April, less than 1% of patients were testing positive for COVID-19 upon admission into the hospital, Fergie said. Last week, it was 12.5%.
Fergie doesn't dismiss or judge the concerns of parents like Madison, the San Antonio mom who is waiting to have her children vaccinated. But he wants to reassure them that the vaccine is safe and effective, and the best tool for staving off serious illness from exposure. The vast majority of kids who were hit the hardest by COVID-19 were unvaccinated, doctors have said.
"All parents want to do what's best for their children," Fergie said. "But they're not all thinking that there is really a problem with COVID in children. There is long COVID in children. There's multisystem inflammatory syndrome. If they're concerned about whether the vaccine is safe, the answer is yes."
Demand hasn't been very high yet at the People's Community Clinic, a federally qualified health center in Austin, said Dr. Louis Appel, chief medical officer and director of pediatrics at the clinic.
The clinic has its supply in stock and plans to finish training staff and start administering the vaccine to the newest age group this week, Appel said.
Most providers he knows in the medical community who have their own young kids have been eager to get them vaccinated, said Appel, who is also president-elect of the Texas Pediatric Society.
The rest of the public seems a bit more divided, he said.
"Generally what I've seen and heard is sort of similar to the older-kid vaccines," Appel said. "There's a group of folks that are very eager to get it, and they get it early, and then other folks who are willing and interested in getting it but kind of waiting."
Madison is a bit further from "willing and interested," but she's not anti-vaccine, having taken her kids in dutifully to get their other childhood shots over the years. She just doesn't see that there is as much urgency for the COVID-19 vaccine in her children's situation, she said.
"People are not necessarily dying, like they were when it first started, so now it's being treated more like the common flu," she said. "Nowadays it's not as big a deal. We get tested positive, we stay home. We stay away from people, just like when we're naturally sick, right?"
Madison says she also feels comfortable waiting because she is almost certain that her entire household got the virus during the omicron surge in January, and because she believes her children are at low risk for being exposed.
For others, however, the wait was forced, and seemed like an eternity. Several parents told The Texas Tribune that they were angry that the U.S. Food and Drug Administration chose to hold its approval of the vaccines for the youngest kids until drugmaker Pfizer was ready for approval - even though competitor Moderna was first to get its data in for federal review and could potentially have been approved weeks or months earlier.
"A thing that was frustrating was the seeming lack of urgency to get a vaccine for the youngest kids approved," said Lyall Storandt, 37, an Austin father of two whose wife is a registered nurse. "Those extra days and weeks felt like an unnecessary slap in the face to those of us that have been waiting patiently."
When the approval finally happened, Storandt took his 3-year-old son to a local pharmacy for his vaccine as soon as he could - about 48 hours after the doses arrived in Texas.
It was a relief after a challenging two years staying at home with two children, he said. Now with the third grader going back to school in person and the younger finally able to start pre-K, life can start getting a bit easier, he said.
"I wouldn't say we're back to normal, but I am more comfortable taking the 3-year-old out in public now than I was prior to him getting his first dose," Storandt said. "What I am looking forward to is him starting pre-K in the fall and hopefully then getting my life back."
For Georgetown mother Courtney Albin Glazener, who was anxious to get her 2-year-old vaccinated, the wait was compounded by the fact that her pediatrician didn't have the vaccine available right away.
The FDA prohibits pharmacies from giving the vaccine to children younger than 3, but Glazener's son reached that milestone a week after the vaccine arrived in Texas - so he got his at their local H-E-B right after his birthday.
The toddler has eczema and asthma, and "his system is prone to overreaction to the littlest thing," she said, so the delays in the vaccine's approval were excruciating. Their older child got her shots as soon as she turned 5.
"We've always been anxious for our youngest to get it," Glazener said. "He was only 6 months old when the world changed. ... It has been two years since we have eaten in a restaurant or gone to the children's museum in Austin. We don't want to stop these activities, but we also don't want our kids to have a life-threatening bout with COVID."
Long wait times and pediatricians with no appointments available yet are common scenarios in Texas right now, but the situation is likely to get easier soon, doctors say.
The number of young kids getting their shots is also likely to increase faster once more pediatricians get their staff trained and start appointments, many as early as this week, Appel said.
The low early numbers, combined with reports by some parents that appointments were hard to come by at the large clinics that had the vaccines first, can be attributed not just to hesitancy but also to a slower rollout than previous vaccine programs, doctors said.
Vaccines for the youngest age group come in smaller doses than those for adults and older kids. Pfizer requires three shots for children under 4; Moderna requires two. But in spite of the differences, supply is plentiful, state officials say.
The recent surge in COVID-19 cases, however, is hitting not just kids but adults, too - including medical personnel - exacerbating an already historic pandemic-era staff shortage. That can hinder launch efforts that include updating systems and paperwork, and extra training on the new protocols, Appel said. "Getting all of those things in place just takes a little bit of time," he said.
The delays have been difficult on Chmiel's family, but the wait is nearly over. The toddler finally gets her shot this week.
And then, her mom said, she'll be able to emerge into a new, more welcoming world than the frightening one into which she was born.
"This vaccine means enrolling her in gymnastics and part-time preschool finally," Chmiel said. "It means letting her play with her peers at the park. It releases the huge weight off our whole family's shoulders that has been there for 27 months."
Carla Astudillo contributed to this report.
Disclosure: H-E-B has been a financial supporter of The Texas Tribune, a nonprofit, nonpartisan news organization that is funded in part by donations from members, foundations and corporate sponsors. Financial supporters play no role in the Tribune's journalism. Find a complete list of them here.
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