As Interest From Families Wanes, Pediatricians Scale Back on Covid Shots

When pediatrician Eric Ball opened a refrigerator full of childhood vaccines, all the expected shots were there DTaP, polio, pneumococcal vaccine except one.

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This is where we usually store our covid vaccines, but we dont have any right now because they all expired at the end of last year and we had to dispose of them, said Ball, who is part of a pediatric practice in Orange County, California.

We thought demand would be way higher than it was.

Pediatricians across the country are pre-ordering the updated and reformulated covid-19 vaccine for the fall and winter respiratory virus season, but some doctors said theyre struggling to predict whether parents will be interested. Providers like Ball dont want to waste money ordering doses that wont be used, but they need enough on hand to vaccinate vulnerable children.

The Centers for Disease Control and Prevention recommends that anyone 6 months or older get the updated covid vaccination, but in the 2023-24 vaccination season only about 15% of eligible children in the U.S. got a shot.

Ball said it was difficult to let vaccines go to waste last year. It was the first time the federal government was no longer picking up the tab for the shots, and providers had to pay upfront for the vaccines. Parents would often skip the covid shot, which can have a very short shelf life compared with other vaccines. Murals adorn the walls of the waiting room at Balls pediatrics practice.(Jackie Fortir/KFF Health News)

Watching it sitting on our shelves expiring every 30 days, thats like throwing away $150 repeatedly every day, multiple times a month, Ball said.

This year, Ball slashed his fall vaccine order to the bare minimum to avoid another costly mistake.

We took the number of flu vaccines that we order, and then we ordered 5% of that in covid vaccines, Ball said. Its a guess.

That small vaccine order cost more than $63,000, he said.

Pharmacists, pharmacy interns, and techs are allowed to give covid vaccines only to children age 3 and up, meaning babies and toddlers would need to visit a doctors office for inoculation.

Its difficult to predict how parents will feel about the shots this fall, said Chicago pediatrician Scott Goldstein. Unlike other vaccinations, covid shots arent required for kids to attend school, and parental interest seems to wane with each new formulation, he said. For a physician-owned practice such as Goldsteins, the upfront cost of the vaccine can be a gamble.

The cost of vaccines, thats far and away our biggest expense. But its also the most important thing we do, you could argue, is vaccinating kids, Goldstein said.

Insurance doesnt necessarily cover vaccine storage accidents, which can put the practice at risk of financial ruin.

Weve had things happen like a refrigerator gets unplugged. And then were all of a sudden out $80,000 overnight, Goldstein said. An unplugged refrigerator could spoil the vaccines inside, costing the practice thousands of dollars.(Jackie Fortir/KFF Health News)

South Carolina pediatrician Deborah Greenhouse said she would order more covid vaccines for older children if the pharmaceutical companies that she buys from had a more forgiving return policy.

Pfizer is creating that situation. If youre only going to let us return 30%, were not going to buy much, she said. We cant.

Greenhouse owns her practice, so the remaining 70% of leftover shots would come out of her pocket.

Vaccine maker Pfizer will take back all unused covid shots for young children, but only 30% of doses for people 12 and older.

Pfizer said in an Aug. 20 emailed statement, The return policy was instituted as we recognize both the importance and the complexity of pediatric vaccination and wanted to ensure that pediatric offices did not have hurdles to providing vaccine to their young patients.

Pfizers return policy is similar to policies from other drugmakers for pediatric flu vaccines, also recommended during the fall season. Physicians who are worried about unwanted covid vaccines expiring on the shelves said flu shots cost them about $20 per dose, while covid shots cost around $150 per dose.

We run on a very thin margin. If we get stuck holding a ton of vaccine that we cannot return, we cant absorb that kind of cost, Greenhouse said.

Vaccine maker Moderna will accept covid vaccine returns, but the amount depends on the individual contract with a provider. Novavax will accept the return of only unopened vaccines and doesnt specify the amount theyll accept.

Greenhouse wants to vaccinate as many children as possible but said she cant afford to stock shots with a short shelf life. Once she runs out of the doses shes ordered, Greenhouse said, she plans to tell families to go to a pharmacy to get older children vaccinated. If pediatricians around the country are making the same calculations, doses for very small children could be harder to find at doctors offices.

Frankly, its not an ideal situation, but its what we have to do to stay in business, she said.

Ball, the California pediatrician, worries that parents limited interest has caused pediatricians to minimize their vaccine orders, in turn making the newest covid shots difficult to find once they become available.

I think theres just a misperception that its less of a big deal to get covid, but Im still sending babies to the hospital with covid, Ball said. Were still seeing kids with long covid. This is with us forever. Ball treats patients from birth to age 21.(Jackie Fortir/KFF Health News)

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