When pediatrician Eric Ball opened a refrigerator full of childhood vaccines, all the expected shots were there 鈥 DTaP, polio, pneumococcal vaccine 鈥 except one.
鈥淭his is where we usually store our covid vaccines, but we don鈥檛 have any right now because they all expired at the end of last year and we had to dispose of them,鈥 said Ball, who is part of a pediatric practice in Orange County, California.
鈥淲e thought demand would be way higher than it was.鈥
Pediatricians across the country are pre-ordering the updated and reformulated covid-19 vaccine for the fall and winter respiratory virus season, but some doctors said they鈥檙e struggling to predict whether parents will be interested. Providers like Ball don鈥檛 want to waste money ordering doses that won鈥檛 be used, but they need enough on hand to vaccinate vulnerable children.
The Centers for Disease Control and Prevention get the updated covid vaccination, but in the 2023-24 vaccination season only of eligible children in the U.S. got a shot.
Ball said it was difficult to let vaccines go to waste last year. It was the first time the federal government was no longer picking up the tab for the shots, and providers had to pay upfront for the vaccines. Parents would often skip the covid shot, which can have a very short shelf life compared with other vaccines.
鈥淲atching it sitting on our shelves expiring every 30 days, that鈥檚 like throwing away $150 repeatedly every day, multiple times a month,鈥 Ball said.
This year, Ball slashed his fall vaccine order to the bare minimum to avoid another costly mistake.
鈥淲e took the number of flu vaccines that we order, and then we ordered 5% of that in covid vaccines,鈥 Ball said. 鈥淚t鈥檚 a guess.鈥
That small vaccine order cost more than $63,000, he said.
Pharmacists, pharmacy interns, and techs are allowed to give covid vaccines only to children , meaning babies and toddlers would need to visit a doctor鈥檚 office for inoculation.
It鈥檚 difficult to predict how parents will feel about the shots this fall, said Chicago pediatrician Scott Goldstein. Unlike other vaccinations, covid shots aren鈥檛 required for kids to attend school, and parental interest seems to wane with each new formulation, he said. For a physician-owned practice such as Goldstein鈥檚, the upfront cost of the vaccine can be a gamble.
鈥淭he cost of vaccines, that鈥檚 far and away our biggest expense. But it鈥檚 also the most important thing we do, you could argue, is vaccinating kids,鈥 Goldstein said.
Insurance doesn鈥檛 necessarily cover vaccine storage accidents, which can put the practice at risk of financial ruin.
鈥淲e鈥檝e had things happen like a refrigerator gets unplugged. And then we鈥檙e all of a sudden out $80,000 overnight,鈥 Goldstein said.
South Carolina pediatrician Deborah Greenhouse said she would order more covid vaccines for older children if the pharmaceutical companies that she buys from had a more forgiving return policy.
鈥淧fizer is creating that situation. If you鈥檙e only going to let us return 30%, we鈥檙e not going to buy much,鈥 she said. 鈥淲e can鈥檛.鈥
Greenhouse owns her practice, so the remaining 70% of leftover shots would come out of her pocket.
Vaccine maker Pfizer will take back all unused covid shots for young children, but only for people 12 and older.
Pfizer said in an Aug. 20 emailed statement, 鈥淭he return policy was instituted as we recognize both the importance and the complexity of pediatric vaccination and wanted to ensure that pediatric offices did not have hurdles to providing vaccine to their young patients.鈥
Pfizer鈥檚 return policy is similar to policies from other drugmakers for pediatric flu vaccines, also recommended during the fall season. Physicians who are worried about unwanted covid vaccines expiring on the shelves said flu shots cost them about $20 per dose, while covid shots cost around $150 per dose.
鈥淲e run on a very thin margin. If we get stuck holding a ton of vaccine that we cannot return, we can鈥檛 absorb that kind of cost,鈥 Greenhouse said.
Vaccine maker covid vaccine returns, but the amount depends on the individual contract with a provider. will accept the return of only unopened vaccines and doesn鈥檛 specify the amount they鈥檒l accept.
Greenhouse wants to vaccinate as many children as possible but said she can鈥檛 afford to stock shots with a short shelf life. Once she runs out of the doses she鈥檚 ordered, Greenhouse said, she plans to tell families to go to a pharmacy to get older children vaccinated. If pediatricians around the country are making the same calculations, doses for very small children could be harder to find at doctors鈥 offices.
鈥淔rankly, it鈥檚 not an ideal situation, but it鈥檚 what we have to do to stay in business,鈥 she said.
Ball, the California pediatrician, worries that parents鈥 limited interest has caused pediatricians to minimize their vaccine orders, in turn making the newest covid shots difficult to find once they become available.
鈥淚 think there鈥檚 just a misperception that it鈥檚 less of a big deal to get covid, but I鈥檓 still sending babies to the hospital with covid,鈥 Ball said. 鈥淲e鈥檙e still seeing kids with long covid. This is with us forever.鈥
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