COVID shots for young kids arrived in June. Few have received them.

In June, when the Food and Drug Administration authorized emergency use of coronavirus vaccines for children younger than 5, physicians expected apprehension among parents—after all, 4 in 10 parents with young children said they would definitely not get their youngsters vaccinated, according to a July Kaiser Family Foundation survey.

But doctors and public health experts never expected there would be this little interest in vaccines for young children.

Even in places with strong pro-vaccine sentiments, few young children have received shots, including in the District of Columbia, which has the highest percentage vaccinated. In D.C., barely 21% of children 6 months to 4 years old have received one shot, and just 7.5% have received both doses, according to the Centers for Disease Control and Prevention.

In Alabama, Louisiana and Mississippi—which occupy the bottom of the list—the rates are even more dismal: less than 0.2%. Health officials worry that the lackluster vaccination uptake might leave the nation vulnerable to coronavirus clusters in the fall and winter.

Just under 325,000 young children are fully vaccinated nationwide, according to the CDC. While some parents blame a lack of access, experts believe misinformation surrounding the shot for younger children is driving vaccine hesitancy.

Peter Hotez, an infectious-disease physician and pediatrician at the National School of Tropical Medicine at Baylor College of Medicine, said he’d hoped vaccination rates would improve as the months went by, but they remain stagnant.

“I thought maybe it was just the summer, and people were traveling,” Hotez said.

Nationwide, vaccination rates with a single dose increase with the age of children. Children younger than 5 have a 6% single-dose vaccination rate; for children 5 to 11, it’s six times higher, at 38%; and 12- to 17-year-olds have the highest vaccination rates among youths, at 70%.

The low vaccination rates among the youngest children reflect inadequate communications about the shot, according to Hotez.

“We haven’t done a good job explaining the long-term developmental consequences of long-COVID for younger children,” Hotez said. “And future coronavirus variants are a very likely possibility.”

From March 2020 to June 2022, 1.9 million children ages 1 to 4 tested positive for the coronavirus and 202 died. These numbers are low compared with the data on deaths among adults: Since the dawn of the pandemic, COVID has killed more than 1 million U.S. adults. Still, scientists remain concerned about the enduring consequences of children being infected with the coronavirus, saying we don’t have enough data to determine whether children will develop long-term issues from a single coronavirus infection or multiple infections.

Zachary Rubin, a pediatric allergist and immunologist in Illinois, said the death of even one child from an illness that could be prevented by a vaccine should be reason enough for parents to vaccinate their children. He said there needs to be more concern among parents about the long-term effects of the virus in younger children, such as brain fog and disorders involving smell—symptoms that are harder to diagnose.

“An infant or toddler won’t be able to tell you if they’ve had fatigue or constant headaches, so you wouldn’t know if something was lingering even when the obvious physical symptoms subsided,” Rubin said.

Parents’ hesitation about vaccination comes against a backdrop of eroding trust in public health guidance. A 2021 Harvard study found that many Americans are concerned about how public health institutions function. In the past decade, the public health system has experienced a decline in positive ratings.

Megan C., a New Jersey mother who spoke on the condition of anonymity because of concerns about her family business, has children ages 8 and 3. She said her decision not to vaccinate her son and daughter doesn’t stem from a political movement. Instead, Megan C. said, it reflects her lack of trust in the health care system.

“I’m not doing this because it’s a mom movement right now of, ‘You know what? I’m standing up to big pharma and not vaccinating my children.’ Absolutely not,” she said. “I’m doing it because in the past, the health care system has failed me horribly.”

The choice to not vaccinate her children was personal for Megan C.—a decision she thinks all parents should be able to make based on their own family’s needs.

“I don’t care what [other parents] choose. They’re your kids. And I wanted the same choice for my family,” she said.

Some parents lament the failure to sufficiently promote vaccines for younger children. When the FDA announced the shots would be available, Rachel Devore, a New York mom of sons ages 6 and 3, said she didn’t get any notice from her children’s doctors.

“My pediatricians never approached me—I was the one who called them the day after I heard that the vaccines came out,” Devore said. They weren’t apprehensive about giving her children the vaccines, she said, but they weren’t as forthcoming as she thought they would be.

Devore said many of her friends weren’t aware the vaccine for children younger than 5 was authorized by the FDA until they found out from social media.

“After I posted that I had gotten my boys the vaccine, a mom I am friends with on Facebook reached out to me saying that she didn’t know the vaccines were available and thanked me for posting about it,” Devore said.

Rubin, the pediatrician, said he wishes there had been more robust promotion of vaccines by public health officials across platforms such as Facebook, Instagram and TikTok.

“I don’t see a strong presence from governing agencies to promote for kids under 5 and to debunk these myths,” he said.

That scant messaging stands in stark contrast to when the coronavirus vaccines first came to market in December 2020 for adults. The cry then: “Get the shot.” The messaging was strong and in-your-face.

Politicians including House Speaker Nancy Pelosi, D-Calif., and Senate Minority Leader Mitch McConnell, R-Ky., were pictured getting their jabs, the phrase “Fauci ouchy” was coined, and posters were plastered at bus stops in cities everywhere. The priority was immediate and dire. But now, 2 1/2 years into the pandemic, the urgency surrounding vaccinations for children under 5 has seemingly cooled.

“The messaging has been insufficient,” said Kimberlee Wyche-Etheridge, a pediatrician and senior vice president of health equity and diversity initiatives with the Association of State and Territorial Health Officials. “Once the country got into COVID overload, there was a step back in the importance of vaccinations once our youngest children were eligible for the vaccines.”

A more robust drive from local public health authorities could boost vaccination rates, said Ankhi Dutta, a pediatric infectious-disease specialist at Texas Children’s Hospital and Baylor College of Medicine. As time has passed, physicians face another issue: The waning fear surrounding the coronavirus has made people more “comfortable with having COVID.”

“Parents need information from someone they can trust, and that person should be their family practice provider,” Dutta said.

The American Academy of Pediatrics strongly urges parents to vaccinate their children, but pediatricians said access has been an issue. Unlike adult vaccines offered at pharmacy giants such as CVS and Walgreens, children younger than 18 months must get their shots from a pediatrician. CVS’s MinuteClinic administers the vaccine only to children 18 months and older. Children ages 3 and up can get the vaccine from Walgreens. In many cases, parents of children younger than 5 have to make appointments with their pediatricians for the shot.

Physicians in Florida and Massachusetts report having to discard vaccines because of lack of demand, according to reports in the Miami Herald and Boston Globe.

“Any vaccine that is wasted is a vaccine that’s available for someone who may need it to stay healthy,” Wyche-Etheridge said.

Anecdotally, vaccine hesitancy among parents seems to be driven, in part, by this calculation: How does the rare chance of death from the virus compare with the rare prospect of a significant vaccine-related complication?

“We can’t blame parents for being fearful of doing this,” said Samira Armin, a pediatrician from Houston who urges parents to get the vaccine for their kids. “They feel like they are protecting their children, but they should also be [aware] they could be making a choice of their child getting COVID multiple times, which has been shown to have negative and cumulative consequences on their future health.”

Armin said reactions to vaccines—pain, headache, muscle pain or chill—happen within a few days of receiving the shot. So, if a child is going to get one of these side effects, a parent will know immediately.

“It’s like having three glasses of wine; you’re either going to have a hangover the next day or not. The hangover won’t show up three weeks later,” Armin said.