When medical treatments or vaccines are hard to get, it’s usually because of too much demand and not enough supply. But in the case of COVID-19 vaccines for kids, it’s the other way around: low demand for the shot is tanking supply.

While the U.S. Centers for Disease Control and Prevention recommends that anyone ages six months and older get vaccinated against COVID-19, parents are finding it hard to track down kid-sized doses. Usually, they would rely on their pediatricians for all childhood vaccines, but many are not stocking the latest COVID-19 shot.

Why not? And how can you secure a shot for your tot?

Stocking the shot is now financially risky for pediatricians

When the COVID-19 vaccine was first authorized for kids, it was during the public health emergency, so the federal government bought doses for the entire population. State health departments distributed these through mass vaccination clinics, pharmacies, and to doctors’ offices. But ever since the Biden Administration declared the end of the public health emergency in May 2023, doctors must buy doses on the commercial market, just as they do for other childhood vaccines. That means they need to estimate how many doses they expect to use and hope that their calculations match up with demand. At the start of the respiratory virus season, the math was even riskier: insurers weren’t ready with the proper codes to reimburse doctors for vaccines they administered. “It led to fear among some pediatricians of spending anywhere from $70 to $130 a dose for a vaccine with no assurance that they would be paid back by insurance companies,” says Dr. Jesse Hackell, chair of the committee on practice and ambulatory medicine at the American Academy of Pediatrics (AAP). “COVID-19 vaccines are expensive, and pediatric [practices] operate on very thin margins, so it’s very hard to take a loss on anything.”

The AAP has been working with manufacturers to reduce the financial risk for doctors, including shipping vials in smaller quantities and negotiating the ability to return unused doses. Pediatricians can now return both unopened and partially used vials to both Pfizer and Moderna, for refunds or credits to their accounts with the manufacturers. While Pfizer adopted this policy in October 2023, Moderna did not do so until Jan. 2024. Some pediatricians may not be aware of these policy changes—plus, the refunds or credits can take months to receive.

Not all pharmacies will vaccinate babies

State laws vary on what age pharmacists can begin vaccinating babies, but most start at age two (New York) or three (Texas), which leaves infants out. Some retail pharmacies have staffed their stores with additionally trained health care providers who can vaccinate younger babies, but those vary by location.

Demand is dismal

How vaccines are bought and sold isn’t the only factor affecting whether pediatricians decide to stock the shot. Even when the government was supplying doses, demand for vaccines for babies was very low. “We had stocks that the government provided, and they were expiring ,” says Hackell. “The numbers show only less than 1% of kids under age two were fully vaccinated. The demand was so low that pediatricians decided at that point that it wasn’t worth stocking it.” Only 12% of all children ages six months to 17 years have received the updated shot so far, and this low demand is one reason why Hackell says that his practice in suburban New York decided not to stock doses of the COVID-19 vaccine.

Children are also a unique population when it comes to vaccination. About half of U.S. children under five are covered under Vaccines for Children, a government-funded program that provides free shots for all of the recommended childhood diseases, including COVID-19, for under- and uninsured children. Pediatricians may stock these doses, but cannot use them for insured children.

Hackell says that since manufacturers are now making it possible for doctors to order smaller quantities of the COVID-19 shot, 10 doses at a time, some practices are pooling resources to purchase even these small orders to increase the chances that the doses don’t go unused.

Storage is difficult

While the vaccines can now be stored in normal freezers and refrigerators, unlike the super cold temperatures required when the vaccines were first distributed, that convenience means that their shelf life is shorter. Vaccines can be stored frozen until their expiration date, which is generally several months, or stored in refrigerators for 10 weeks for the Pfizer vaccine and 30 days for the Moderna shot.

How to get your child vaccinated

All of these factors combined mean that parents eager to get their babies vaccinated “don’t have a lot of good options,” Hackell says. “While I understand the [economic] hesitation to stock doses, unfortunately that leads to some kids not being served as well as we’d like them to.”

But it is possible. Some pediatricians are referring families to their local health departments, and CVS MinuteClinics will vaccinate babies beginning at 18 months at all of their locations. Some hospitals are also providing shots for pediatric patients, so it’s worth reaching out to your local health care providers to find the nearest location for getting your child vaccinated.