Following last week's recommendation from FDA's advisory committee, FDA formally authorized the vaccine for ages 5-11 on Friday, making roughly 28 million people in the United States eligible for vaccination.

This Tuesday, November 2, CDC's Advisory Committee on Immunization Practices will meet to develop formal recommendations for which subgroups of children should receive the pediatric Pfizer Covid-19 vaccine. Whether the committee recommends broad use of the vaccines for all eligible kids, or narrower use for high-risk subgroups (e.g., kids with underlying health conditions) remains a contentious topic to be determined. But with rollout on the near horizon, the message is clear: we are moving into the next critical phase of fighting the pandemic.

Health care leaders need to be prepared, and so do the millions of parents who will consider vaccinations for their children. Amid a myriad of important considerations, we've narrowed in on five essential factors to keep in mind right now.

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1. Expect clinical and administrative complexities upon rollout.

   It's promising to hear that the United States has purchased over 50 million pediatric doses in preparation for approval, but challenges will go beyond supply and demand in this rollout. The pediatric dose of the Pfizer Covid-19 vaccine has different clinical and administrative characteristics than the adult version. It will use a different size needle, a different dose and dilution, is stored differently, and comes in different packaging. To ensure safe and efficient administration of pediatric Covid-19 vaccines, health care leaders should have plans in place for sites where vaccines are going to be available. And because roughly 25% of parents are concerned they won't be able to vaccinate their child at a trusted place, staying on top of changing guidelines is as important as ever for facilitating rapport.

   Amid the current booster rollout and preparations for flu season, keeping these complexities in mind will be a large undertaking for health care workers. To best prepare, leaders should equip staff with necessary knowledge, standard operating processes, and updated trainings to help facilitate vaccine uptake.

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3. Flexibility and convenience will be critical for parents. Education and empowerment will be important for children.

   Parents have the final say over their child's vaccination decision. And while keeping parents top-of-mind is necessary for a successful rollout, it's still important to place value in the questions, concerns, and thoughts that children may have.  

   According to a statement from the White House Briefing Room, children aged 5 to 11 will be able to get their Covid-19 vaccine at their pediatrician's office, pharmacy, or potentially even their school. Vaccination clinics should offer flexible hours and convenient locations so parents don't have to take off work to get vaccinated, and kids don't have to miss school to get their shots. Additionally, since kids may have side effects from the vaccines, organizations should support parents who may have to take time off work to help kids with side effects.

   Parental guidance is important, but it should not absolve society from paying attention to the role children can play in this pandemic. Kids can and should learn about Covid-19, the vaccines, and what it all means for them. Kids are dealing with the pandemic like the rest of us, so health care leaders must continue to prioritize efforts to educate kids and empower them with knowledge and information about the vaccines. Some organizations, like the Smithsonian Science Education Center, have even launched instructional materials designed for use in and out of school to encourage young people to become trusted sources of information about Covid-19 in their communities.

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5. Parental skepticism may become a bottleneck for child vaccine uptake—but health care leaders can help.

   According to a recent poll from the Kaiser Family Foundation, parents continue to be more cautious about getting their younger children vaccinated. Only 27% of parents said they'd vaccinate their child right away, one-third would wait and see, and 30% say they would absolutely not vaccinate their kids. Additionally, vaccination rates for older children are still lagging, as data from KFF shows that only 48% of parents of children ages 12-17 say their child has received at least one dose of a vaccine.

   Much of this skepticism stems from concern and confusion about the risk and benefit of Covid-19 vaccination for children. Throughout the pandemic, most public health messaging stated that children are at lower risk of developing severe complications from Covid-19 than older adults. As a result, parents are starting to weigh whether the potential for rare—yet serious—side effects from the Covid-19 vaccine (such as myocarditis and pericarditis) outweigh the risks of Covid-19. This calculus, coupled with the lack of long-term studies of adverse events related to the Covid-19 vaccine, are fueling hesitancy for parents.

   Health care leaders—and pediatricians in particular—must proactively share information about the vaccine and the risks and benefits with parents and patients. They should also consider partnering with local community leaders (e.g., educators, pediatricians, religious leaders, etc.) to expand their reach and surface concerns from the frontlines.

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7. Prepare for a new front in the war against misinformation.

   Even before Covid-19, there has been a wildfire of misinformation surrounding vaccines. Strong emotions associated with the topic, coupled with vocal parents with strong perspectives, meant that any information was susceptible to exacerbation. Covid-19 is no exception. With emerging data and evidence about the kids' vaccines, and some experts expressing skepticism about whether all eligible kids should be vaccinated, misinformation will undoubtedly arise.

   Health care leaders should proactively address vaccine concerns and pay attention to the rumors circulating in their community. They must also help make sense of complex science and confusion driving the misinformation. We've detailed six specific ways health care leaders can fight misinformation. The battle against misinformation did not start with Covid-19, and it will not end with it either. But there is a role each person can play in combatting the pseudo-science of our time.

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9. If not taken seriously, children can drive a Covid-19 surge (and they already have)

10. There appears to be a narrative spreading that kids are not affected by Covid-19. But recent data from Britain suggests that children are behind their 'longest-running covid surge. In October, school-aged children were 15 times as likely to be infected as 80-year-olds. And since previous trends in other countries have predicted outcomes for America, we should take this data seriously. As we enter flu season, a double hit of Covid-19 and the flu could seriously overwhelm hospital infrastructure.

    Beyond infection rates, recent evidence has revealed that Covid-19 can also be a health threat to children, even if the overall risk for severe illness stays low. For example, children's overall risk of getting infected is similar to that of adults, children are much better at transmitting the virus than earlier studies suggested, and they may experience symptoms that last for weeks or more if infected. All of this is to say that we should act with urgency to protect children.

    If we discount the importance of kids being vectors for transmission, it's not unreasonable to ask: Will unvaccinated children perpetuate or even fuel the next stage of the Covid-19 pandemic?

Parting thoughts

We will very soon have more guidance from CDC about which subgroups of kids (or if all eligible kids) should get Pfizer's pediatric Covid-19 vaccine. And while there are certainly more than just five considerations to keep in mind, we think these are the critical factors for health care leaders to address right now. With proper care and attention, this next step in protecting the population can prove to be an impactful progression in the fight against Covid-19.