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With teens and adolescents lagging in COVID vaccination rates, Maryland doctors are working to close the gaps

Erin O’Brien, a Baltimore County mom to three teenage boys, had each of her sons race to get a COVID-19 vaccine as soon as he became eligible.

“My kids were pushing each other out of the way to see who could be first to get vaccinated,” said O’Brien, whose youngest is 12 and oldest is a freshman in college. “It eased my mind. It made their lives a little more normal, just playing baseball in a group or going to a restaurant.”

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O’Brien said the return to the pre-pandemic life, and a belief in the science, were enough to motivate her and her kids to get the shots. But other families likely will need more convincing.

Though adolescents have been eligible for a COVID-19 shot for months, they continue to have the lowest rate of vaccination in Maryland and across the country, a status unlikely to change anytime soon, even after the most-used vaccine from Pfizer/BioNTech got an official stamp of approval this week.

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The U.S. Food and Drug Administration approved the Pfizer vaccine Monday for those 16 and older, though kids as young as 12 still can get it under an emergency use authorization, which makes drugs available to consumers when the benefits outweigh risks during a crisis.

But without mandates like those cropping up for adults, and surveys showing lingering hesitancy and access issues, many adolescents may remain unvaccinated. Doctors and others in the community say they will lean on their role as trusted medical providers to close the gap as millions of kids head back to school and face increased threats from the surging and more contagious delta variant of the coronavirus.

Dr. Aziza T. Shad, chair of the pediatrics department at the Herman & Walter Samuelson Children's Hospital at Sinai, stands outside the hospital.
Dr. Aziza T. Shad, chair of the pediatrics department at the Herman & Walter Samuelson Children's Hospital at Sinai, stands outside the hospital. (Barbara Haddock Taylor)

“Spending time to allay their fears about the side effects is definitely helping convince them to get the vaccine,” said Dr. Aziza T. Shad, chair of pediatrics at the Herman & Walter Samuelson Children’s Hospital at Sinai Hospital. “Explaining the importance of getting adequate data for approval in the 12- to 15-year-old group should help, but yes, I think the exclusion [from approval] may make it a little harder.”

Shad said the Pfizer vaccine is safe for younger teens, and formal approval is expected. In the meantime, the children’s hospital is seeing more COVID-19 cases, she said, including in unvaccinated young children.

The Pfizer vaccine received emergency authorization in May for adolescents as young as 12, months after older age groups.

Nearly 290,000 Maryland kids, just over 64% of those ages 12 to 17, have gotten at least one dose. That compares with about 80% of those 18 or older, and more than 94% of seniors, according to state data.

About 67% of all Marylanders have gotten at least one dose. Nationally, the adolescent age group is the only one with fewer than half with at least one dose.

But the group may yet close the gap. The percentage of adolescents getting their first dose has been higher across the country in recent weeks than the percentage of adults.

Public health and medical professionals said the increase in first doses could be linked to concerns about the spread of the delta variant, a more contagious strain of the disease likely fueling the rise of infections found in children. Children’s doctors in Maryland and elsewhere have warned that delta, coupled with a surge in other respiratory viruses, could have devastating effects on the health care system this fall and winter.

“Seeing what we know from other states, where delta has caused effects already, I think we can use that as a prediction that we may be outstretched at some point this fall,” said Dr. Rebecca Carter, a pediatrician at the University of Maryland Medical Center in Midtown. “We know there’s only so many resources available, and there’s a potential to be drained if we don’t take a more proactive approach.”

The rise in vaccinations also may be related to efforts among family doctors to get more patients vaccinated, emphasizing that it will give household members more freedom to participate in extracurricular and social activities, said Dr. Deborah Badawi, president of the Maryland chapter of the American Academy of Pediatrics.

They will do the same once younger children become eligible for the vaccines, said Badawi, a developmental-behavioral pediatrician and an assistant professor of pediatrics in the University of Maryland School of Medicine. She expects most to get vaccinated in a doctor’s office.

“Parents are more likely to want to have a conversation about it,” she said, adding that the pediatrics association is working with the Maryland Department of Health and local health departments “to determine how best to distribute vaccine to primary care offices so that it will be more readily available in that setting.”

A national survey conducted by the Kaiser Family Foundation found about half of parents generally say they are “very” or “somewhat” worried about their child getting seriously sick from COVID-19. Those willing to get their adolescent a vaccination tended to be vaccinated themselves, and they also were more likely to be Democrats, with higher levels of income and education.

Half of unvaccinated parents say they will “definitely not” get their adolescent vaccinated, and there still is worry about the vaccine itself, particularly among parents who are Black or Latino.

About 40% of parents of young children not yet eligible to be vaccinated say they plan to “wait a while to see how it is working” before seeking a dose, according to the survey. Main concerns about the vaccine among parents of unvaccinated children are long-term or serious side effects.

But people can be moved with one-on-one conversations tailored to individual health concerns, said Dr. Sarah Polk, medical director of the Johns Hopkins Bayview Medical Center Children’s Medical Practice. She and her colleagues have had success convincing parents who are on the fence, she said.

“People are eager for the opportunity of someone they trust that has health care knowledge to say to them, ‘Yes, you, Miss X, should be vaccinated,’” said Polk, who also co-directs the Johns Hopkins Center for Promoting Salud/Health and Opportunity for Latinos, called Centro SOL. “I attempt to sound firm, but I also want to keep the door open for ongoing conversations.”

Polk said she believes some fears about vaccines are specific to communities of color.

“As a white person, I don’t belong to a group that has been historically experimented on or mistreated by the health community,” she said. “I do try to be careful of my tone. ... I want to be clear, but not doctrinaire.”

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In Baltimore, where vaccination rates are relatively low compared with the rest of the state, physicians are working on meeting families where they are, said Dr. Arlene Tyler, a pediatrician and medical director of school-based health at Baltimore Medical System, which operates federally qualified health centers serving thousands of the region’s uninsured or underinsured.

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That means setting up stations at school open house events and coming prepared with vaccines in case kids or their families are ready to roll up their sleeves. Tyler and her colleagues also are spending more time during patient visits reviewing the benefits of vaccinations, mask-wearing, hand hygiene and social distancing, often working with translators.

Many families delayed wellness visits, and routine vaccinations, last year due to the pandemic. About 68% of the 9,900 children served by Baltimore Medical System haven’t been vaccinated against the coronavirus, she said, in large part due to those delays.

Now, amid a “back-to-school rush,” Tyler said she has more opportunities to broach the topic.

Tyler finds that emphasizing vaccines’ ability to protect older family members and relatives, and their effectiveness at staving off more lethal variants, helps parents warm to the idea of vaccinations. But outreach in doctors’ offices alone won’t be enough to persuade the masses, she said.

“It comes down to us partnering with other entities that they trust: their local church, or having the school principal, or teachers, or counselors talking about it in a positive way,” Tyler said. “Our main goal, regardless of who encourages them, is shots in arms to make sure we protect them.”

Baltimore Sun content editor Steve Earley contributed to this article.

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