COVID-19 Vaccination for Caregivers in the Pediatric Medical Home: A Call to Action to Improve Community Vaccination Rates

At a time when safe and effective vaccines are readily available and the highly transmissible Delta variant of COVID-19 is widely circulating, COVID-19 cases are once again rising across the US. In addition to the morbidity and mortality associated with increasing rates of infection, as we approach the back-to-school season, there is significant concern about children not being able to participate in daily in-person learning if infection rates continue to rise. This is a particularly urgent issue as children have already missed out on so much in-person learning during the pandemic, with a disproportionate impact on children from racial and ethnic minority groups living in poor communities.¹ Children have experienced significant trauma from the fallout of the COVID-19 pandemic, and school and childcare shutdowns have contributed to a marked increase in behavioral health concerns along with learning loss. Minimizing the burden of COVID-19 through increased vaccination is of urgent importance to help prevent morbidity and mortality and to keep children in school.

Pediatric clinicians are uniquely poised to improve community vaccination rates by vaccinating caregivers along with their own patients in the pediatric medical home. Pediatricians talk about vaccines with patients and families daily and have substantial experience discussing vaccine hesitancy and concerns. Parents rely on their pediatric clinician for vaccine information most often, and a physician’s recommendation is associated with higher rates of uptake for specific vaccines.^2,3 In addition, pediatricians have frequent touch points with families over time, as children are typically seen for care more frequently than their caregivers are for their own health care. Thus, the pediatric medical home represents a unique opportunity to provide a convenient and trusted space for vaccination. Pediatricians can address the major factors identified by the World Health Organization related to vaccine hesitancy: convenience, confidence, and complacency.⁴ Families generally have confidence in their medical home, and primary care clinicians can help those who are worried by building confidence in the safety and efficacy of the vaccine while also decreasing complacency by clearly discussing the risk of COVID-19 infection.

At this point in the pandemic in the US, COVID-19 vaccines are available at numerous community locations. However, vaccine availability is insufficient for those with transportation barriers and competing job and family demands in an era of increasing vaccine hesitancy. Many individuals, particularly individuals from racial and ethnic minority groups, report vaccine hesitancy related to long-standing mistrust of historically racist medical and research practices.^5,6 In addition, Black and Hispanic adults are more concerned than White adults that they will have to take time off from work due to feeling ill from adverse effects from COVID-19 vaccination and are more likely to report concern about being able to get a vaccine from a place they trust.⁷ Importantly, this population has experienced a disproportionate impact from COVID-19 infection, and we have seen significant disparities in vaccination rates.

Acknowledging that the pediatric practice is a convenient site for families to receive the vaccine with pediatric clinicians who can relay vaccine information with confidence, the Golisano Children’s Hospital Pediatric Practice recently started offering the COVID-19 vaccine to all patients who are eligible for the vaccine as well as any other eligible individual who accompanies their child. Golisano Children’s Hospital Pediatric Practice serves more than 13 000 patients, most of whom are children from racial and ethnic minority groups who reside in a city with high rates of poverty (Rochester, New York). We aim to administer vaccines to adolescents who were already being seen in our office and to provide a comfortable and trusted place for families to ask questions and receive the vaccine.

We are now offering the Pfizer/BioNTech COVID-19 vaccine to any eligible individual in the office during our regularly scheduled clinic hours and are also offering unique vaccination clinics during our evening back-to-school physical nights in the late summer and early fall. Through our experience offering the COVID-19 vaccine to caregivers in our practice, we have found the following: (1) in addition to adolescent and young adult patients receiving the COVID-19 vaccine in the practice, we have provided the vaccine to several caregivers each day (more than 60 doses administered in 1 month); (2) a number of caregivers have reported appreciation for the convenience afforded by getting the vaccine while they were already at a visit for their child; (3) some caregivers have taken the opportunity to receive the vaccine together with their children in solidarity; and (4) several caregivers have stated that they appreciate the comfort and trust of getting the vaccine in the pediatric practice (Table). We have administered more than 1400 vaccine doses in total since mid-May 2021.

Table.  Examples From COVID-19 Vaccination Initiative of the Golisano Children’s Hospital Pediatric Practice

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Logistically, vaccinating family members and other nonpatients in our practice required some preparation and additional staffing. We needed a method for scheduling vaccine encounters in the electronic medical record (even for those not previously registered), securing adequate and appropriate vaccine supply and storage, ensuring adequate nursing resources, and developing workflow protocols. We also encouraged all team members who interact with patients and families in the practice (eg, physicians, nurse practitioners, nurses, social workers, behavioral health specialists) to ask about the COVID-19 vaccine, offer the opportunity for discussion with a clinician, and inform them of the opportunity to receive the vaccine in the office if desired (with second booster doses scheduled 3 weeks later for the Pfizer vaccine). In addition to the effort from our dedicated practice staff, the institution was able to support additional part-time nursing coverage (4 hours per day) for vaccination efforts using their COVID-19 emergency funds.

As a pediatric community, we are committed to helping ensure access to the COVID-19 vaccine for all eligible individuals and addressing any concerns about vaccine safety and efficacy. We recognize the urgency of this issue with the arrival of a new wave of highly transmissible infections and the impending start of the school year. We encourage leaders in other pediatric care settings to consider similar initiatives to help protect both children and families in their communities.

Corresponding Author: Andrea Milne Wenderlich, MD, MS, Department of Pediatrics, Golisano Children’s Hospital, University of Rochester School of Medicine and Dentistry, 601 Elmwood Ave, PO Box 777, Rochester, NY 14624 (andrea_milnewenderlich@urmc.rochester.edu).

Published Online: October 8, 2021. doi:10.1001/jamapediatrics.2021.4214

Conflict of Interest Disclosures: None reported.