The city Health Department said last week that programs in place to defray the cost of flu shots make it feasible for all children ages 6 months old to 5 years old to be vaccinated by Dec. 31 to attend city-regulated child care or preschool.

Several physicians told Crain’s that any extra burden placed on parents would be worth the added layer of safety provided by increased immunization. There were five pediatric flu deaths in the city during the most recent flu season.

The department will begin enforcing the rule during the upcoming school year. The state Court of Appeals ruled last week that the city Board of Health was acting within its authority when it created rules mandating immunization in December 2013. A group of five families had filed a lawsuit in 2015 to block the rule, and two previous court decisions had been in their favor. The appeals court’s decision lifts the injunction that prevented the city from putting its mandate into effect.

In response to a question about the cost of the vaccine, a Health Department spokeswoman noted that the uninsured rate for children is 2% statewide. The federal Vaccines for Children Program offers free vaccines to children who are uninsured, Medicaid eligible, American Indian or underinsured. The city Health Department said more than 80% of sites that offer pediatric immunizations are participating.

“There’s not a child who can’t get the vaccine,” said Dr. James Gough, a pediatrician in the Flatbush section of Brooklyn. He participates in the program and works with families who are insured but can’t afford out-of-pocket costs for the flu shot.

Gough said his office already encourages parents to schedule check-ups in the fall, when children can receive a flu vaccine. He said the importance of flu shots outweighed any negative consequences that would result from banning children from early childhood education until they get the shot.

“There’s not two sides to this argument,” he said. “I’ve come down on the side that it’s probably best to bite the bullet. You prevent diseases. Kids should have this vaccine.”

Dr. Melissa Stockwell, associate professor of population and family health and pediatrics at Columbia University, noted that children are already required to show that they’ve had other immunizations against diseases including polio and pertussis to attend preschool.

“We’re doing this to try to protect children from what we know can be deadly,” said Stockwell, who is also a pediatrician at New York-Presbyterian’s Audubon clinic in Washington Heights.

Stockwell said pediatric practices should be prepared with a reliable stock of flu vaccine in the fall and could help families by offering or extending their Saturday hours. “We can help by making our offices accessible,” she said.

Dr. Katy Burris, a dermatologist whose son is 17 months old, said she fully supported the mandate. Given the number of visits children make to the pediatrician in early childhood, she said, a flu vaccine could be fit into that schedule and wouldn’t impose an excess burden on parents.

“Being a parent isn’t easy,” she said. “A sick child is way more of a burden for me than a 10-minute appointment with a pediatrician.”

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