Jane Ellen Norman, 12, holds vaccination cards for her and her 14-year-old brother Owen outside Mercedes-Benz Stadium in Atlanta on Tuesday, May 11, 2021. The two were vaccinated Tuesday morning, after U.S. regulators expanded use of Pfizer's COVID-19 shot to those as young as 12. Credit: Angie Wang / AP

Maine faces a tight deadline and familiar access challenges as it works to vaccinate children over 12 against the coronavirus in schools prior to the summer, when access could prove to be more difficult.

Vaccinations for younger children began in Maine on Tuesday after Gov. Janet Mills mirrored a federal decision clearing the Pfizer two-shot vaccine for emergency use in children as young as 12, opening shots up to around 42,000 more children attending public schools here.

The U.S. vaccination program began with older and more vulnerable people. As it has advanced, children have represented a larger share of new cases. A report from the American Academy of Pediatrics and Children’s Hospital Association found 18 percent of Maine’s cases were in residents 19 or younger last week, 4 percent higher than the U.S. average.

The rollout for children in Maine will be more institutional than it has been so far as some schools coordinate with providers to deliver shots directly. Supply is not a problem as uptake among adults has slowed, but similar access challenges may remain and the state faces a short timeframe to vaccinate children before the summer months.

Relatively few existing sites were offering vaccines to children as of Tuesday because the Pfizer vaccine requires ultra-cold storage and enough space to hold the packs of 975 vials it comes in. Some providers, including Portland-based MaineHealth, began scheduling clinics for children over the age of 12 last week ahead of the announcement. Bangor-based Northern Light Health is reaching out to districts to begin school-based clinics in the coming months.

Dr. James Jarvis, who leads Northern Light’s COVID-19 response, said that effort will not disrupt the hospital systems’ efforts to immunize adults. But he said equity and hesitancy could prove to be barriers, noting that parents wary of the vaccine are unlikely to give children permission to get it and work commitments may make child vaccinations harder in the summer.

“Parents work, kids go to school, it makes it difficult to get them to places,” Jarvis said. “Those challenges make it critical to provide doses to children at school.”

A May 5 notice to schools from the Maine Department of Education characterized the early efforts as focused on speed with a goal of “connecting as many youth interested in getting COVID-19 vaccines to a provider as soon as possible, through all means possible.” Equity would be a second consideration, with the state planning to work with school districts to provide vaccines during the summer as well.

What equity means could differ depending on the school district. In Portland, Maine’s largest school system, the district is planning to work with its multilingual experts to make sure vaccine information is available to all, said Tina Veilleux, the nurse coordinator for the school district.

Vaccinations have not started there yet as the district works with schools to find space for sites and finalize target dates. Veilleux said that sets up a “tight” timeframe to vaccinate children fully before the summer months, but she was confident the clinics would come together.

In Bangor, the first clinic for students is on Friday at the high school. About 80 students had indicated interest as of Tuesday morning, said interim superintendent Kathy Harris-Smedberg. Vaccines will be given on a walk-in basis. If parents have not gotten vaccinated yet, they are welcome to do so alongside their child.

“It’s just about providing another layer of safety for families,” Harris-Smedberg said. “We know confirmed cases are manifesting outside the schools, and if a family member tests positive it’s likely others will too.”

There may be other opportunities to vaccinate children beyond schools, such as summer camps and places where low-income children receive summer meals, said Stephanie Eglinton, executive director of the Maine Children’s Alliance. Doing so before the summer would be critical to children’s mental health and safety, allowing them to participate in sports and socialize with peers in a normal fashion while stemming the increase in cases.

That also makes it critical for adults to continue to get vaccinated, Eglinton said, noting many children are still ineligible.

“We know it’s spreading in the community, and that just leaves younger children more vulnerable to catching the virus,” she said.