Every year, pediatricians order vaccines in anticipation of the winter respiratory virus season. But plummeting demand and confusion about vaccine recommendations has thrown the process into chaos forcing some doctors to gamble and order vaccines they may not be able to use. 

This year, Denver area pediatrician Stephanie Stevens is taking a conservative approach to her seasonal vaccine order. She’s starting out with a fraction of the COVID and flu shots she bought last year. It’s important for her to get the calculations right because the seasonal and childhood vaccines together make up a large part of her business costs. 

“Our vaccine costs are about 25% of the cost of running our practice,” Stevens said, “So that's a very a very big part, and our margins are very small.”   

It sometimes it costs her more to buy and store the vaccines than insurance companies pay to put shots in arms. 

“I think our supply will be fine,” she said, “I think it'll be more of a worry on the demand side.”

Demand for flu and COVID shots has been falling over the last few years. But this year there are two new factors pediatricians are contending with.

One is confusion. poll from KFF, a health policy research organization, found half of parents aren’t sure if the government is actually recommending healthy kids get a covid shot. They are not. 

Dr. Judith Grossberg runs Pediatric Alliance, a group purchasing organization that helps practices across the country get their vaccines.

“People are not ordering right now,” Grossberg said of the COVID shots, citing widespread uncertainty over coverage. “They're waiting to see what's going to happen. Are insurance companies going to pay for COVID this year.”

Insurers are only required to pay for the vaccines that the government recommends. AHIP, an insurance trade group, said in a statement it'll, “continue to support broad access to critical preventive services, including immunizations.” 

In many states, pediatricians' offices are the only places babies and toddlers can get the vaccines. Pharmacies, where most adults can go, often can’t give shots to young kids. 

That’s why Grossberg says many of the pediatricians she works with are taking a risk and ordering anyway. If they can’t use all the shots, manufacturers will take some back.   

 “You’ve got to be careful,” Grossberg cautioned. “You don't want to end up with a lot of vaccine that you can't return.” 

That means that pediatricians like Stevens, might have to eat the costs of unused shots.  

“Then it really puts a huge financial strain on us as a small pediatric practice and a small business,” Stevens said. 

That’s why she’s starting out with small orders now, and if more parents end up wanting shots — then she’ll order more.