Fewer than a third of Pennsylvania and New Jersey children have been vaccinated with both doses of the coronavirus vaccine, despite plentiful availability three months after the shots became available for the 5-to-11 age group.

Despite officials’ pleas for vaccination during the omicron surge, the vaccination rate for children peaked at the end of November, the month the shots were authorized, and has remained low since, largely due to hesitancy among parents or a desire to wait longer before getting their child vaccinated.

“We’ve made real progress in the last few weeks on pediatric vaccinations,” Philadelphia Health Commissioner Cheryl Bettigole said this week, “but no, the rate is not nearly high enough.”

With federal regulators poised to consider authorizing the vaccine for children 6 months and older, the low immunization rate among kids 5 and up shows how pervasive hesitancy among parents is as public health officials seek to get all children protected against the virus.

“Absolutely not enough kids are getting vaccinated,” said Elana McDonald, a Philadelphia pediatrician with offices in Port Richmond, Kensington, and Oxford Circle whose organization, Twin Sister Docs, has been running vaccine clinics at schools in the region.

Just over a fifth of all 5- to 11-year-olds in the United States have been fully vaccinated. Vermont has the highest share of kids vaccinated, with 52%. New Jersey and Pennsylvania fall in the upper-middle of the pack, according to the New Times analysis, 24% in Pennsylvania and 28% in New Jersey. In Philadelphia, 30% of kids 5 to 11 have had both shots.

The demographic has the lowest vaccination rate of any age group in the United States. Among 12- to 17-year-olds, 54% in Pennsylvania and 68% in New Jersey have completed their primary vaccination series with two doses of the Pfizer vaccine, according to CDC data analyzed by the New York Times.

Pennsylvania health officials would like to see children vaccinated “at a much higher level than the current level,” Department of Health spokesperson Mark O’Neill said late Thursday.

Overall, parents’ enthusiasm about getting their children vaccinated against the coronavirus tends to decrease with the child’s age, according to national surveys conducted by the Kaiser Family Foundation.

After an initial rush during the first few weeks of November by eager parents who had been waiting for the shot to be authorized, the nationwide vaccination rate fell sharply, a trend mirrored in Pennsylvania. It had a slight uptick in December, though stayed at a low level, and declined over January, according to a Kaiser Family Foundation analysis of CDC data.

» READ MORE: Lifting COVID-19 mandates likely still ‘several months away’ in Philadelphia as omicron recedes

“Demand is down tremendously,” said Marc Ost, co-owner of Eric’s Rx Shoppe, as he stood in the empty Horsham pharmacy on Tuesday with three employees and six nursing and pharmacy students, waiting for someone to walk in and ask about vaccination.

It was a different scene in November, when the vaccine first became available. The pharmacy vaccinated more than 12,000 school children at massive clinics in school gyms nearly every night of the week for about a month. When pediatric appointments were posted online, Ost recalled, they were booked immediately.

Now, if he opens 100 appointments, 10 to 20 might be filled, he said.

In Schwenksville, at Mayank Amin’s Skippack Pharmacy, each night still sees a few dozen children getting first or second vaccine doses in the store. But, Amin said, the pace is nothing like it was at the start, when he hosted school clinics where as many as 1,000 children were vaccinated at once.

Montgomery and Chester Counties lead the state in percentage of children vaccinated, with more than 45% of 5- to 9-year-olds and more than 60% of 10- to 14-year-olds having gotten at least one shot, according to state data, which is broken down in five-year increments and does not include full vaccination.

Delaware and Bucks Counties are not far behind. (In Philadelphia, which logs vaccinations separately, 47% of children 5 to 11 have had at least one dose.)

Pennsylvania acting Health Secretary Keara Klinepeter visited UPMC Children’s Hospital of Pittsburgh on Thursday to promote the vaccines, asking all parents to get their kids vaccinated as soon as possible, saying it’s “a critical step to support health-care workers and to protect kids.”

Getting more children vaccinated

Combating the slow vaccination means reaching hesitant parents: what McDonald, the Philadelphia pediatrician, said is a “slow, day-by-day process.” She talks patients through the choice every day.

“Parents always want to make sure they’re doing the right things,” McDonald said. “But what I explain to them is that this vaccine really is no different than any other vaccine that we’ve given.”

Getting the vaccine means families can “have a lot more comfort in moving through the rest of their pandemic — and also more safety, not just for their children but for all the people around their children,” said Lori Handy, medical director of infection prevention and control at Children’s Hospital of Philadelphia.

Even in an area with the highest child vaccination rate in the state, Montgomery County’s medical director, Richard Lorraine, said some parents are hesitant about immunizing their children.

He debunks the most common concerns he hears: “There is absolutely no evidence to suggest impairment of fertility, and our experience with vaccines really shows that no long-term effects appear after six months.”

» READ MORE: Nervous about getting the COVID-19 vaccine? Don’t believe these myths.

For some, those conversations are already working. Parents bringing young children to Skippack Pharmacy for shots recently have said they needed time to seek feedback from others before making their decision, Amin said.

For others, especially those who don’t have a strong relationship with a family physician or other health professional, more work needs to be done to reach them and share reliable information, Handy said.

Abington School District recently received a three-year, $44,000 state grant to do vaccine outreach, and is using the funds to pay for clinics, provide transportation to and from clinics, and support virtual Johns Hopkins University training for their vaccine “ambassadors.”

About 40% of elementary schoolers in the district have already been vaccinated, as have more than half of junior high students and nearly three-quarters of high schoolers, said Judy Bomze, the director of student services.

On Feb. 18, the district will hold its 12th clinic at the largest elementary school, she said, and will not make anyone preregister.

“The decision is 100% the parent or guardian,” said Bomze. “Our goal is to provide the facts about the vaccine, answer the questions, remove the barriers, and provide the opportunity.”

For now, the vaccine is authorized for emergency use by the FDA and isn’t required for schoolchildren by any states — though New Orleans and Washington, D.C., have mandated it and California has announced the vaccine will be required for middle and high schoolers once fully FDA-approved.

Once that approval comes, as it has for the nonpediatric Pfizer and Moderna vaccines, adding the COVID-19 shot to the list of immunizations required for children to attend school is one potential key strategy to solve the uptake problem.

“If we want to learn how to live within this pandemic and learn how to live with coronavirus without it causing such drastic setbacks — closing down schools, and restaurants and businesses closing because they just don’t have the staff to stay open — then sometimes you have to start to think about whether you do need to mandate it,” McDonald said.

» READ MORE: What can we learn from omicron? Here are 7 steps public health leaders say we should take before the next surge.

In Pennsylvania, the legislature could implement a vaccine mandate or the Department of Health could do it through a regulatory process. One could also be implemented in Philadelphia.

“We’re currently exploring several ways to boost vaccine rates at all ages,” Philadelphia health department spokesperson James Garrow said Thursday when asked about the possibility of an eventual school mandate in the city. “We’re nowhere near being ready to announce anything in this vein, but any announcement will have a significant amount of time before it goes into effect so whatever group is being given a mandate has time to get up-to-date before a deadline.”

There’s urgency to action, too, because the vaccination rate among children is so low that the virus can still spread readily among children, including in schools, Bettigole said. They can also spread it to older, high-risk family members and friends.

That message will continue to be important when the under-5 age group is approved for shots.

“There will be many families lining up to get their children the vaccine to help normalize their children’s experience,” said CHOP’s Handy. “There will also be families who have many questions.”