In a matter of weeks, more than a million children ages 5 to 11 in Pennsylvania and New Jersey are expected to become eligible for COVID-19 vaccinations, yet many pediatric offices in both states are not yet carrying the doses.

“I would say we have a little over a month to make sure as many of our pediatric providers in our city who want to be involved can be,” said Amber Tirmal, immunization program manager for the Philadelphia Department of Public Health.

Many pediatric offices participate in the federal government’s Vaccines for Children Program, which provides doctors’ offices with free doses of vaccine for children who are uninsured or underinsured. Those offices must go through another layer of approval to carry COVID-19 vaccines. Statewide, about 62% of the 1,290 pediatric providers participating in that federal program are also eligible to provide the COVID-19 vaccine. In Philadelphia, about 60% of the 150 VFC participating offices are approved.

Participation in New Jersey is even lower. Less than 200 out of 800 pediatric practices participating in VFC are either now providing COVID-19 vaccine doses or will in the next two weeks, according to that state’s Department of Health. The state has held conference calls with pediatric vaccine providers, statewide pediatric and immunization associations, and other stakeholders to boost participation, a Health Department spokesperson said.

“We’re trying to better understand that now,” Felicia Taylor, chief executive of the New Jersey chapter of the American Academy of Pediatrics, said of the low enrollment rate for COVID-19 vaccine. “As part of our organization we think the best place for kids to be vaccinated is in the medical home, which is in the pediatricians’ office.”

Health officials aren’t panicked over the number of pediatricians carrying COVID-19 yet. All current COVID-19 vaccine providers, from public clinics to pharmacies, are automatically approved to administer doses to children, and counties throughout the region are partnering with school districts to host vaccination clinics within schools. They also believe there’s still time to get more pediatricians enrolled. But they acknowledge the trust families have in their pediatricians is especially critical in boosting vaccinations among young children.

“We have a longstanding relationship of trust with our families,” said Kate Tigue, a Lackawanna County pediatrician who serves as secretary and treasurer of the Pennsylvania chapter of the American Academy of Pediatrics. “I fully anticipate our patients and their families are going to want to receive their vaccines in the place where they get medical care.”

Pfizer and its German partner BioNTech reported Monday that children ages 5 to 11 can be given a dosage a third the amount adults and teens receive and still develop highly protective antibody levels. Side effects were the same or less severe than teenagers experienced.

The vaccine will be available to younger children once the Food and Drug Administration grants emergency use authorization, expected as soon as Halloween. Vaccination has been approved for children ages 12 to 15 since May.

» READ MORE: Pfizer says its COVID-19 vaccine works in kids ages 5 to 11

Between Pennsylvania and New Jersey, there are 1.2 million children ages 5 to 9, according to the U.S. Census, and 1.3 million ages 10 to 14. Getting them vaccinated will bring down COVID-19 cases overall and will help keep schools from being disrupted by outbreaks.

“The more people who are vaccinated – regardless of age – helps reduce the possibility of the virus or its variants from spreading in the community,” O’Neill said.

Health officials in Philadelphia, Pennsylvania, and New Jersey are working to boost the number of pediatric providers that carry COVID-19 vaccine, officials said. Those efforts include outreach to practices directly and through the state chapters of the American Academy of Pediatrics. Philadelphia’s health department is emphasizing to local offices that the vaccine has proven to be stable for up to a month in regular refrigeration, meaning practices don’t have to invest in specialized cold storage units.

In Pennsylvania, a practice can be approved to carry the vaccine in less than a week, health officials said.

Barriers to providing doses

The biggest issue is that Pfizer vaccine shipments arrive in packages with a minimum of 1,170 doses.

Such a size “is prohibitive for smaller provider sites that may only need to vaccinate 100 patients or less,” said Mark O’Neill, a state Department of Health spokesperson.

In Philadelphia, the health department plans to divide deliveries into smaller batches before sending them to doctors.

The federal government’s contract with Pfizer renews at the beginning of October, Tirmal said, and there remains uncertainty whether that will result in shipments more manageable for doctors’ practices.

“We are anxiously awaiting news of smaller quantities being available,” O’Neill said, “which we understand could come by the middle of October.”

Another complication are federal regulations requiring all COVID-19 vaccine shots be reported to health departments within 24 hours of administration. Some pediatric offices still report other vaccinations on paper, Tirmal said, which likely won’t be quick enough. City health department spokesperson James Garrow said they will accept spreadsheets from practices to ease the process.

The New Jersey pediatrics association is conducting a survey to understand why more doctors there have not yet enrolled as COVID-19 vaccine providers, Taylor said. She expected to have a better understanding of their obstacles in a few weeks, she said, but said “it’s hard to tell” how effective outreach efforts will be in increasing the number of pediatric providers able to carry the vaccine.

How intense demand will be isn’t clear, health officials said. While children and teens only rarely get seriously ill with the virus, they can transmit it to adults. As schools have reopened, COVID-19 cases among children have ballooned, with 10 times as many cases in Pennsylvania children this month as at the same time a year ago.

» READ MORE: 20,000 Philly schools employees must get vaccinated by Sept. 30. Here’s what happens if they don’t.

Tirmal thinks there may be parents who won’t want their children to be among the first to receive doses. Tigue feels differently.

“We have a pent-up demand and excitement for this vaccine,” she said. “When it rolls out we will have hundreds of thousands of kids who want this vaccine.”

Her practice has spent months educating parents about the safety of vaccines for children, and thinks that too often, legitimate questions are mistaken for hesitation. Tigue has a 6-year-old, and knows what child vaccination will mean for families.

“It affects every aspect of our lives in what we choose to do and what we avoid doing,” she said.

Vaccines in schools

The city health department is not planning to directly partner with the Philadelphia School District to vaccinate children, Tirmal said. Last winter, the district worked with Children’s Hospital of Philadelphia to stand up vaccination clinics that inoculated thousands of educators and other staff. The district now requires vaccination for all staff, or they must submit to two COVID-19 tests weekly; it didn’t respond to questions about whether there will be a similar effort for students.

Counties throughout the region said they would be coordinating vaccination efforts with school districts. Lower Merion’s district has already offered doses to students 12 and older, but a spokesperson there said the district’s ability to serve younger children depends on how supply is distributed.

“The district sees value in getting as many of our young students vaccinated as we can, as quickly as we can,” spokesperson Amy Buckman said. “But we will need more information about the rollout before finalizing decisions on what role LMSD can play.”

The Chester Upland School District has been hosting clinics at schools in an effort to drive up vaccinations — 16% of eligible youth are vaccinated in the city of Chester — and hopes to offer doses to younger children when available.

“I think the success of this effort and any other effort in our community rely on grassroots effort and buy-in,” said LeRai Martin, a nurse and consultant for the school district’s vaccination effort. “Hopefully we’ll see an exponential increase in people wanting to be vaccinated because they know us.”

Staff writer Kristen A. Graham contributed to this article.