COVID-19 has hit Christina McInnis’ house in Foley, Ala. three different times in the past year. She and her husband have four kids, ranging in age from 17 to 9, so COVID wasn’t entirely unexpected.  

After the first two bouts, last December and in February, McInnis and her husband and their two teenage daughters were vaccinated. Then their 11-year-old daughter, who at the time was too young to be vaccinated, tested positive shortly after school started in August.  

Now that a COVID-19 vaccine has been approved for younger children, McInnis plans to get her 11-year-old and 9-year-old vaccinated. 

“I’m not the first to sign up for vaccines,” said McInnis, CEO of an agriculture software business based in Foley. She said that when it comes to her kids, she has been cautious in the past about some vaccines, such as the one for HPV. “But I do my due diligence, consult with our pediatrician and family members who are doctors. We’re vaccinating our children (against COVID-19) to get back to a life.  

“This is our way out of the pandemic.” 

The McInnis family of Foley, Ala.

Late last month, the U.S. Food and Drug Administration announced children ages 5-11 are eligible for the Pfizer-BioNTech COVID-19 vaccine. In some Deep South states, vaccination rates for other childhood diseases like measles or whooping cough are among the highest in the nation. In Mississippi, for example, 99% of kindergarteners are vaccinated against measles, mumps and rubella.  

But it’s a different story when it comes to COVID-19: The Deep South lags behind every other region in overall COVID-19 vaccination rates. Alabama, Mississippi, Louisiana, Georgia and Tennessee all fall in the bottom 10 U.S. states, where less than half of adults and teens are vaccinated against COVID-19. 

And demographic groups that tend to express more concern over vaccinating their children against COVID-19 are, in many cases, disproportionately represented in the South compared to other areas of the country: unvaccinated parents, Republicans and Independents, Hispanic and Black parents, rural residents and those without college degrees. 

“We’re not going to see children across the country all vaccinated (against COVID-19) to the same degree,” said Dr. William Schaffner, professor of infectious diseases at Vanderbilt University Medical Center in Nashville, Tenn. “I would expect the vaccination of children would lag behind in those communities. 

“Over time, I think we’re going to see a divide once again.”

Brittany Cosby with her son River Raines, 5.

A growing share of cases

Brittany Cosby has gotten the COVID-19 vaccine for herself. So have her parents. But she’s hesitant to vaccinate her son, who is 5 and has epilepsy. 

“Whenever he runs a fever, he’s at risk of a seizure,” she said. “I’m concerned that if I were to get him the shot and he runs a fever, that would cause his seizure threshold to go up. 

“I don’t want him to be the first in line. I want to see how it affects his peers and to get more information.” 

As of mid-November, more than 6.6 million children have tested positive for COVID-19 since the beginning of the pandemic, according to the American Academy of Pediatrics. And while children are far less likely than adults to have severe symptoms or require hospitalization, they now comprise a larger share of U.S. COVID-19 cases than they did earlier the pandemic. 

In early November, children represented 27% of reported weekly COVID-19 cases, even though they make up just 22% of the U.S. population. 

Schaffner said it’s been difficult to change parents’ perceptions, often based on information available much earlier in the pandemic, that the COVID-19 doesn’t affect otherwise healthy children. What they think they know about kids and COVID needs to be updated, he said.  

“The delta variant being so much more contagious, it began to make inroads into younger adults, adolescents and children,” Schaffner said. “So the rule that children are not affected (by COVID-19), that’s incorrect. They’re less affected (than adults) but still often seriously so.”

As of early November, more than 8,500 children ages 5-11 had been hospitalized due to COVID, he pointed out. 

“That’s not trivial,” he said. “A third of those children who were hospitalized required care in an intensive care unit. And as of last week, 95 children in that age group had died of COVID. Those are enormous tragedies which can be profoundly reduced if we would vaccinate children.” 

Another reason to vaccinate, Schaffner said, is that even though nearly all kids will recover if they contract COVID-19, research has shown some children will suffer longer-term effects. 

“There’s a syndrome we’ve discovered, which occurs about a month or two after children recover from COVID, called the Multisystem Inflammatory Syndrome in Children: MIS-C,” said Schaffner. It’s a condition in which the heart, lungs, kidneys, brain and other organs can become inflamed.  

Children with MIS-C “often have to be admitted to the hospital,” he said. “Virtually all of those children survive, but it’s a frightening illness.” 

It leaves parents like Cosby with difficult decisions to make. 

“(My son) has had all his other vaccines, but this is so new, and you don’t know how your child is going to respond,” she said. “And it complicates matters when your child has the potential for seizures.  

“If you don’t have any underlying conditions, there shouldn’t be a reason not to get the shot,” she said. “But when it’s your child? I just want more information.” 

‘Contentious’ debates

The school district in Austin, Texas where Cheryl McLaurin’s children attend school has already offered Saturday drive-up COVID-19 vaccinations for kids ages 5 and up. 

McLaurin and her husband plan to get their kids, ages 8 and 10, vaccinated as soon as possible. But she’s found that parents’ viewpoints on vaccinating their kids “can be a little contentious.” 

Earlier in the school year, masking requirements in her school district prompted outrage among some parents, she said. And while most parents she knows plan to vaccinate, she said a vaccination requirement for children could prompt a similar backlash. 

“I’m pretty sure if there is a vaccine mandate (for school kids) in the next six months,” she said, “it would create a big issue.” 

Conversely, it’s a stringent childhood vaccination law in McLaurin’s home state of Mississippi that has helped make that state a national leader in childhood disease vaccination rates. Mississippi requires immunizations against childhood diseases before a child can enter public school and doesn’t allow religious exemptions. 

But similar laws for COVID-19 vaccinations seem unlikely, particularly in the South, where political leaders have publicly vowed to fight against federal mandates. A few weeks ago, Alabama passed a law that requires parental consent for anyone under 19 to get a COVID-19 vaccine, a carve-out from existing state law which allows anyone 14 and older to consent to medical treatment.  

But there are other ways to improve child vaccination rates, said Schaffner. The FDA’s recent change in storage requirements for the vaccine means that it’s now easier for pediatricians and other small-scale businesses to offer the vaccine. 

“You don’t have to go to a mass vaccination center or your health department; kids can receive the vaccine in a place that is familiar to them and their parents, with someone they trust, and I think that’s going to be hugely important over time,” he said. 

Some public school systems have chosen to offer on-site COVID-19 vaccines to students ages 5 and older, to make it easier for families to access the vaccine. A few Southern districts are jumping in; Miami-Dade County schools in Florida launched 70 vaccination sites this month.  

Christina McInnis’ daughters get prepped for their COVID-19 vaccinations. (Contributed)

McInnis said she’d love to see school-based offerings and mobile vaccination clinics in communities around her home state. 

“If we’re making this vaccine easy to get, I think more and more people will do it,” she said. “Right now, it is a little difficult to get (for children). If my pediatrician doesn’t have it, I won’t get it.” 

She also wants to see more parents sharing their kids’ vaccine experiences publicly. When one of her daughters got the second dose, she said, her daughter ran a low-grade fever and stayed in bed for a couple of days. It would have been nice to know to expect that, she said.  

In the same way that parents swap advice about giving Tylenol to their babies after their early childhood immunizations, “we should prepare moms so they won’t overreact,” McInnis said. “Because at the end of the day, it’s about my responsibility to my children.” 

And above all, she said, rather than turning the vaccination question into a fight, she wants to see everyone “give grace to parents who are trying to navigate this world.”