Everett Clinic physician, Dr. Yuan Po Tu was featured, among other prominent voices, in a Healthline article that discusses how some states make it difficult for children to get vaccinated for the flu.
- Currently, 30 states have laws requiring children to get flu vaccinations at a medical office.
- Some experts say children should be able to get flu shots at pharmacies and drugstores to help reduce the spread of the illness.
- Concerns over liability as well as updating medical records on vaccinations are some of the reasons for the restrictions.
It seems so easy.
Getting a flu shot for children is an option frequently staring parents in the face at least once or twice a week when they go to drugstores and pharmacies.
There’s no waiting for a doctor’s appointment, having to take time off work, or jostling for parking at a busy medical center. People can get their child a flu shot while picking up paper towels and skin lotion.
But having your child vaccinated against the flu isn’t as easy as it seems in most of the United States.
Currently, 30 states have age restrictions on children being able to get flu shots anywhere but a medical office, and three states don’t allow children to be vaccinated in pharmacies at all.
That’s despite the fact the Centers for Disease Control and Prevention (CDC) recommends everyone who is at least 6 months old get vaccinated every year. Children who are 6 months to 8 years old may need two doses in a single season, according to the CDCTrusted Source.
“There is no reason to have laws restricting pharmacists’ ability to vaccinate,” Dr. Amesh Adalja, FIDSA, a senior scholar at John Hopkins Center for Health Security in Maryland, told Healthline. “Vaccines are very safe, and there are clear guidelines on who can be vaccinated and what side effects to anticipate.
“It is not dangerous to have pharmacists vaccinate. On the contrary, it is dangerous to erect artificial barriers to vaccination,” he added.
Why have restrictions?
During the 2017-18 flu season, about 42 percentTrusted Source of children didn’t get a flu shot, according to the CDC. At least 180 children died from flu the same season.
The American Academy of Pediatrics doesn’t object to children being vaccinated at pharmacies.
So why wouldn’t authorities do everything possible to get as many children vaccinated as possible?
“One of the reasons is that while many adults choose to get the vaccine in their local pharmacy, most children have a designated pediatrician who needs to send a prescription for it,” said Dr. Galit Sacajiu, MPH, an specialist in internal medicine at Elitra Health in New York City. “Many pediatricians will not do this either because they want to maintain continuity of care for their patients as well as to keep consistent how many vaccines they will be administering year over year.
“For these reasons, many states ban pharmacies from administering flu vaccines to anyone under 18,” she said.
There may be other factors inside the pharmacies working against all-age vaccinations, according to Dr. William Schaffner, an infectious disease specialist at Vanderbilt University in Tennessee and medical director of the National Foundation for Infectious Diseases (NFID).
“There likely is an element of liability concern because younger children are not as docile as adults,” he told Healthline. “Pharmacists may not have the same degree of experience providing injections to unruly children as do nurses in a pediatrician’s office. Also, the environment in the pharmacy does not have the privacy of an examination room in a physician’s office.”
The importance of child vaccinations
Three states – Vermont, Connecticut, and Florida – don’t allow anyone under 18 to get flu shots at pharmacies. Seventeen states — including California, Washington, and New Hampshire — have no age restrictions.
In the middle are the 30 states with cutoff ages ranging from 2 to 13. Even then, many require prescriptions.
“Many experts do not believe that this should outweigh the convenience for parents to get their children vaccinated in pharmacies, as any barrier that can be removed is a step in the right direction for increasing the rate of vaccination,” said Sacajiu.
The statistics bear that out.
“Children younger than 5 years old — especially those younger than 2 — are at high risk of developing serious flu-related complications,” said Dr. Yuan-Po Tu, an internal medicine specialist at the Everett Clinic in Washington. “A 2017 studyTrusted Source [by the CDC] was the first of its kind to show that flu vaccination can significantly reduce a child’s risk of dying from influenza. Each year, children die from influenza infection. Although pediatric deaths from influenza are uncommon, it’s devastating to lose a (child).”
Children usually play with other children daily. And they don’t always practice the best hygiene.
“An important advantage of vaccinating young, healthy children is that they tend to respond with the best protection against the flu, which means they don’t spread it to their family, daycare, or schools,” Jeffrey A. Goad, PharmD, MPH, the chairman of the department of pharmacy practice at Chapman University in Irvine, California, and a member of the board of directors of NFID. “Parents should think about the influenza vaccine just like any of the other vaccines they get for their children. It’s not anything special. It’s routine.”
Changing the rules
The rules can change, depending on circumstances.
“During the  pandemic, there were emergency orders lowering age limits for pharmacists to vaccinate,” Adalja said. “However, legislation takes time to change, and we will hopefully see states repeal these onerous restrictions and make vaccinations as easy as possible.”
Some states are making it easier for kids to get their flu shots at pharmacies.
In 2014, the New Jersey legislature voted to lower the age limit of pharmacy vaccination to 7.
New York didn’t allow anyone under 18 to get flu shots at pharmacies until 2018, when Gov. Andrew Cuomo signed an executive order allowing children 2 years and older to get flu shots from pharmacies. During the ensuing 9 months, children received about 9,000 flu vaccinations from New York pharmacies.
“For pharmacist-based immunization, we do see states moving toward expanding age groups and not requiring prescriptions — all important steps to providing greater access and convenience for people to get vaccinated,” said Goad.
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