Viktor Pulido got his second dose of the COVID-19 vaccine just in time for his first day of school as a kindergartener.

Viktor, who was not quite 5 at the time, squirmed as the jab of his second vaccine dose pierced his upper arm at the Washoe County Health District, but it was over so quickly he didn’t have much time to fuss. His sister, almost 2 years old, mimicked her brother, but she, too, received her dose without much drama.

“It was really quick. They’ve gotten shots before,” Viktor’s mother, Karla Hernández, said in an interview. “They might cry. It’s no big deal to us. We come for that, and then we were out of there. My son had a low-grade fever that afternoon. We gave him some Tylenol, and that was it.”

The COVID-19 vaccinations for her son and toddler daughter were a relief for Hernández. She was worried about the start of the new school year and what it might mean for her family if her children were not fully vaccinated and exposed to COVID, the flu and other viral diseases.

“My son, when he started PreK this previous school year, he came down with RSV,” Hernández said, referring to the common respiratory virus. “He ended up in the hospital for three days. He was on oxygen.”

Though Hernández said choosing to vaccinate her children was easy, immunization rates have remained low for children newly eligible for the COVID-19 shots. Since COVID-19 vaccines became available to young children in late June, only about 4,100 children under the age of 5 have been vaccinated, or about 2 percent of the 202,000 Nevada children in that age bracket who are eligible. 

The state’s under-5 vaccination rate ranks 47th in the country, only ahead of Mississippi, Alabama and Louisiana, per an Aug. 3 report from the American Academy of Pediatrics.

Misinformation and divisiveness have vaulted the topic of vaccines from personal decisions made with the help of health care professionals into the political arena. Anti-vaccine protesters have disrupted school board, county and city meetings across the country, spouting unfounded conspiracy theories and furthering fears around the vaccine.

Experts have also attributed the slow vaccination rate for young children to apprehension over how recently the vaccine was developed. But the consensus from pediatricians and medical experts is that the COVID-19 vaccine is the best way to protect against the risk of serious illness, hospitalization and death — even for children under 5.

Hesitant to trust

Breakdowns of vaccines by population show that as of Wednesday, children under the age of 5 make up about 6.2 percent of Nevada’s population but only account for 0.2 percent of the population that has received their vaccines — a vast gap relative to other age groups within the state.

Increasing the vaccination rate among the youngest age group could be difficult. July polling from the nonprofit Kaiser Family Foundation indicates that more than 4 in 10 parents say they will “definitely not” vaccinate their eligible children under the age of 5 for COVID-19. 

Only 17 percent of respondents said they had gotten, or would get, the vaccine for their children. Less than a third of parents in the poll said they are waiting to see how vaccinations go, and 13 percent of parents said they would only vaccinate their children if it’s required. 

Sherilyn Duckworth, the executive director of Immunize Nevada, a statewide nonprofit dedicated to providing outreach and access to vaccines, said this is not the first time health care professionals have experienced vaccine hesitancy, nor will it be the last.

“Many parents are still in that phase of being hesitant to vaccinate their kids,” she said. “They are still hesitant to trust the government and trust that these vaccines are safe for their kids.”

Part of the distrust stems from the experiences of historically marginalized communities at the hands of health care professionals. Duckworth said examples include the Tuskegee Experiment, in which Black men were given syphilis and then observed to see what the untreated disease would do to their bodies, and the “father of gynecology” James Marion Sims’ experiments on enslaved Black women without the use of anesthesia because he did not believe they felt pain.

“Too many studies have targeted populations of color and have led to so many health disparities, and the government has to acknowledge their wrongdoing,” Duckworth said. “We’ve got to have these sensitive conversations. Because it’s a part of our history, right? We can’t erase it. We can’t change it.”

The perception that COVID-19 does not affect children as negatively as adults also plays into vaccine hesitancy for children, Duckworth said. Data from the state shows that less than 1 percent of COVID deaths in Nevada have been among children under the age of 10 and that age group makes up only about 5.3 percent of all COVID cases in the state. 

But Duckworth emphasized that the perception of COVID not being as harmful to children is a myth. COVID can negatively impact children and can lead to adverse effects, she said, adding that children who catch COVID can also contribute to community spread and carry the disease to vulnerable people such as grandparents.

Reports from the Centers for Disease Control and Prevention indicate that the existing COVID-19 vaccine offers protection against serious illnesses caused by the currently circulating variants. But the Biden Administration plans to offer reformulated booster doses in the fall to increase COVID vaccine effectiveness. The updated booster vaccines will target both the original strain of the virus and newer Omicron subvariants.

Duckworth said Immunize Nevada addresses vaccine hesitation by giving parents and members of the public access to health care professionals and making vaccine information available in various formats, languages and social media platforms. 

The organization partners with local health districts to organize vaccine clinics for low-income communities, undocumented people and those without health insurance. It also works with community leaders to set up partnerships and spread information about the vaccine via word of mouth. 

Duckworth said Immunize Nevada is doing its best to reach as many people as possible. But she worries about how a low vaccination rate could affect the community when the school year gets underway.

“I don’t want to scare anyone,” Duckworth said. “But we have to be realistic: COVID is not over.”

As for whether vaccines for children under the age of 5 may expire before they are used, Duckworth said she’s not worried about the problem and believes that more families will decide to get their children vaccinated. She added that as time passes, she expects people to become more comfortable with the vaccine.

“Yes, [children] are resilient. Yes, they are healthy and steadily growing,” Duckworth said. “However, that does not mean that they are exempt from being diagnosed with a virus. That does not mean that the virus would not take them up as a host.”

Vaccine wariness is nothing new

Natalie Vogel, a pediatrician and the medical director of Northern Nevada HOPES, a federally qualified community health center in Reno, said the childhood vaccination conversation this fall is the same one that happens every year, except it’s about a new vaccine.

Vogel said parents are trying to make the best vaccine decision with the information available. Though parents’ embrace of the COVID-19 vaccine for their young children has been less enthusiastic than she would like, she said that’s not a new problem. 

“As the vaccine came out in early 2021, there started being journal articles, and then press articles about vaccine hesitancy. And honestly, in my field, pediatrics, we’ve been dealing with that for 30 years,” Vogel said. “For us, it was like, ‘Oh, now you kind of get to play in our game.’”

Most parents, excluding a tiny minority, are very accepting of routine vaccinations, except the influenza vaccine, Vogel said. She noted that influenza vaccine acceptance tends to grow after people get sick or have family members or friends who have a terrible bout of the flu. Simply put, families gain understanding based on what they experience, she said.

Washington D.C. is the only jurisdiction that mandates students receive a COVID-19 vaccine. California has a pending statewide student COVID-19 vaccine mandate that has not yet been implemented. Twenty states, including Florida, South Dakota and Ohio, have banned a COVID-19 vaccine mandate.

School districts and politicians are shying away from requiring COVID-19 vaccines for attending school, but health districts in Nevada are offering the vaccine as part of back-to-school vaccine clinics. The state also made information on COVID-19 resources for testing, treatment and vaccination available to schools and families in English and Spanish and developed a guide to keep students and staff safe.

“This information is intended to remind all families that resources are available to keep everyone healthy as kids go back to school,” State Epidemiologist Melissa Peek-Bullock said in a press release promoting the guide and materials.

When talking to patients about vaccines, Vogel sees herself as a storyteller, weaving together the science, facts and information so her patients can make the best decision for themselves and their families. Sometimes she talks with patients about her own decisions surrounding her family and children.

“If I show my own humanity … my patients feel more comfortable,” she said.

The conversations are similar to those around mask-wearing. The clinic still requires masking, and if Vogel walks into a room where a parent or child is not wearing a mask, she’ll remind her patients gently but firmly by saying, “Hey, guys, I see a lot of people not wearing a mask. Remember you’re protecting me when you wear your mask.”

When a patient decides not to get vaccinated or there’s a disagreement, Vogel said she understands and continues to engage with the family and provide care. 

Shutting down her office or refusing health care for someone who is vaccine hesitant is not in the best interest of the community as a whole or for a child, she said. But Vogel acknowledged it’s a tricky balancing act talking to parents about vaccines giving the risk information and science behind vaccines while ensuring they understand the need for the vaccine.

“What’s hard about vaccines is we’re not vaccinating to prevent that one child from getting sick because we don’t know which one child will be exposed and who is going to have a hard time with it,” Vogel said. 

But she encouraged everyone to try and get a vaccine for the good of the community.

“We live in communities of people,” she said. “Because we can’t predict who is going to be exposed, we are protecting ourselves against the risk of serious illness, hospitalization and death as best we can with the one tool that can do that.”

Born and raised in Mexico before moving to Reno, Hernández, now 35, remembers receiving the smallpox vaccine, which left a small round scar that looks like a tiny indent on her upper arm. Growing up, Hernández had a half-sister who caught polio and experienced nerve damage and developmental complications because she was not vaccinated against the disease.

As the mother of two children and a member of a multigenerational household that includes an older family member with a pre-existing condition, Hernández said getting the COVID-19 vaccine was a top priority for her family. 

“It’s really important for my kids to be protected,” she said.