See more of the story

One month into the latest expansion of COVID-19 vaccine, only 7% of Minnesota's eligible preschool-age children have received their first shots.

Public health officials expected a slower start, compared with a 25% first-shot rate for children 5 to 11 in the first month they became eligible last winter. But interest has been below even those low expectations.

Jon and Kelsey Barrick weren't aware their 2-year-old was eligible but said they weren't planning shots for him or two older siblings because they had immunity built up from recent coronavirus infections. The Darwin, Minn., parents have been vaccinated and had their children wear masks for much of the pandemic, but they don't sense as much risk now.

"Now summer's here, and we're outside all the time," the father said.

Adults divided evenly into eager, tentative and opposed groups when they became eligible for COVID-19 vaccines during the past year-plus, but that balance has shifted, said Dr. Gigi Chawla, chief of general pediatrics at Children's Minnesota. Most parents seem to be in wait-and-see mode for their children ages 6 months to 4 years, she said.

Timing has been a factor. Incentive was high when COVID-19 vaccine options were added for children 5 to 11 in November as the severe delta pandemic wave was peaking in Minnesota, filling up adult and pediatric hospital beds. The latest expansion by comparison came during a lull of COVID activity in the summer, when parents lack urging from schools or preschools to seek vaccination.

As COVID-19 levels peaked in January, 31% of parents told the Kaiser Family Foundation they planned to vaccinate their preschool-age children right away. On Tuesday, new survey results showed 7% of U.S. parents had gotten these children vaccinated and only another 10% planned to do it right away. Over the same timeframe, parents definitely against COVID-19 vaccination of preschoolers increased from 26 to 43%.

Andy Dass of Minneapolis said he was waiting on vaccination for his two preschoolers because they had COVID-19 and were still within a window of immunity post-infection.

"Our plan is sometime soon — in the next month or so," he said.

Many parents want to delay shots for their children until another COVID-19 wave makes the need apparent, but doctors said that is problematic because of the vaccine schedule. The Moderna vaccine for this age group requires two doses over four or more weeks. The Pfizer version comes in three doses over 11 or more weeks, meaning a child who receives a first dose now won't be fully protected by the start of the school year.

Access has been a concern as well, because the preschool COVID-19 vaccine is being routed through pediatric clinics rather than retail pharmacies — although some free events have been scheduled in the Twin Cities.

Some parents are waiting until scheduled annual or semiannual well-child appointments — to avoid the loss of time or money from an additional clinic visit — but Chawla said that was factored in to initial estimates.

"Despite all of that, we are still seeing less uptake than we expected," she said.

Minnesota's dashboard on Tuesday showed 22,428 children younger than 5 who had received a first dose and 766 who had completed the initial schedule.

Dr. Christine Stewart of Minneapolis didn't hesitate to get her 18-month-old daughter vaccinated when the option arose, and she returned on Tuesday for a second Pfizer dose at the Children's Minnesota Partners in Pediatrics clinic in St. Louis Park.

"She hasn't been out to dinner, to the grocery store or really anything normal," Stewart said of her daughter. "We're just trying to get her vaccinated so we can get back to some semblance of normalcy."

Even though the dominant omicron BA.5 subvariant is causing a high rate of breakthrough infections in people with immunity, "any protection is better than no protection," said Stewart, a plastic surgeon.

The risk-benefit value is weighing on decisions — with only two of Minnesota's 12,907 COVID-19 deaths involving children age 4 or younger. The Kaiser survey showed that 80% of U.S. parents are concerned about side effects of the vaccine for their preschool-age children — regardless of whether they had been vaccinated themselves.

Side effects were rare and mostly mild during the clinical trials and in the first month of eligibility for the lower-dose vaccines — with the Pfizer shot having 10% of the strength of the adult version and the Moderna shot having 25%.

The vaccinations of 537,000 Minnesotans 17 and younger have produced 1,200 reports to the federal Vaccine Adverse Event Report System (VAERS). Nearly 1,000 of the mostly voluntary reports from patients, clinicians, manufacturers and others involved mild symptoms and no medical response, or events in which vaccine was given inappropriately. In some cases, parents lied about the age of their children to get them vaccinated earlier.

Seventy-two of the unverified reports described serious incidents, meaning children needed hospitalizations or suffered severe or disabling illnesses or injuries after vaccinations. VAERS documents illnesses or injuries following vaccinations in order to spot potential trends, but this is not proof that the shots were at fault.

Chawla said the low COVID-19 death numbers belie other threats to children that make the benefits of vaccination far greater than the risks: "Not all kids who get COVID are fine. They do get sick — sometimes they do get really sick, and sometimes they do have more of a long COVID-type of illness" in which symptoms linger beyond infections.

The expansion of vaccine eligibility for preschoolers hasn't come with as much hoopla from the state of Minnesota, which offered Visa gift cards and drawings for college scholarships to incentivize vaccinations for children age 5 to 17.

"At this point we believe it best to allow Minnesota's provider network — primarily medical systems, pediatricians, family practice providers — to continue to take the lead … because of their relationships with families and expertise caring for this age group," said Garry Bowman, a spokesman for the Minnesota Department of Health.

How strongly clinicians are promoting the vaccine is unclear. Nationally, the Kaiser survey found that 70% of parents had not yet discussed the shots with a pediatrician.