Montana Gov. Greg Gianforte's administration quashed plans for a public service campaign to promote covid-19 vaccinations for eligible teenagers over the summer, a former state health official said. That has caused public health and medical experts to plan their own ad campaigns in anticipation that the administration won't publicly back shots for kids as young as 5 when doses for young children roll out.

A state endorsement and ad campaign on television, radio and the internet could encourage and persuade undecided parents to get their kids vaccinated. The lack of one could contribute to Montana's continuing lag in vaccination rates and high ranking in covid cases, hospitalizations and deaths.

Jim Murphy, a former communicable disease bureau chief for the Montana Department of Public Health and Human Services, said state health officials began discussing plans to launch public service campaigns for the vaccine under former Gov. Steve Bullock, a Democrat. The plans included promotion of the vaccine for eligible teenagers, Murphy said.

Gianforte, a Republican, took office in January as the vaccines were rolling out around the country. In the months that followed, Murphy and other officials in the state health department began drafting language encouraging parents to get their teens vaccinated, he said. The governor's office had the ultimate say over what ended up in the ads and in late spring, Murphy said, the Gianforte administration scrubbed references promoting vaccines for kids.

"The word that our team got was that those scripts were being revised and we wouldn't be directly promoting teen vaccination for covid from a state level," Murphy said.

Murphy said the Gianforte administration expressed concern that the ads could be viewed as undermining parental consent. Many officials inside DPHHS thought the concern was unfounded as medical providers, pharmacies and public health departments administering shots all regularly deal with parental consent, he said.

Murphy retired from the agency at the end of June, and recently pointed out that the state's TV and radio ads since then lack any direct promotion for children and their parents. The first vaccine for children 12 and older was authorized in May.

Gianforte's office declined to make the governor available for an interview, but in a written statement spokesperson Brooke Stroyke said Murphy wasn't involved in the creation of promotional materials for covid vaccines under the Gianforte administration. Murphy disputed that assertion, and said many divisions within the health department, including the communicable disease and laboratory sections under his watch, helped craft vaccine public service announcements sent to the governor's office.

Stroyke said in the statement Gianforte encourages parents to talk to their health care providers about getting their children vaccinated against covid.

Gianforte's office said DPHHS will continue to revise its vaccine awareness campaign but did not say whether the state would promote vaccines for kids.

During a news conference last month, when asked, Gianforte also declined to say whether his office had plans to promote shots for teens or the estimated 90,000 5- to 11-year-olds in the state.

"We will have to see what guidance we get that accompanies the approval and we'll make decisions based on that," Gianforte said.

The Food and Drug Administration has authorized the emergency use of lower doses of the Pfizer-BioNTech vaccine for children ages 5 to 11. The U.S. government and states are now preparing to roll out the shots after Tuesday's official recommendation from the federal Centers for Disease Control and Prevention.

About 55% of eligible Montanans are fully vaccinated, compared with 68% of people nationally age 12 and up. Roughly 40% of eligible 12- to 17-year-olds have received both of their shots, according to state data. Nationally, nearly 50% of kids 12-17 are fully vaccinated, according to the Mayo Clinic.

Public health and medical experts worry the 5- to 11-year-old group in Montana will also lag behind national averages in the absence of a coordinated vaccination campaign targeting skeptical parents.

Hayley Devlin is the spokesperson for the Missoula City-County Health Department, one of the largest health departments in the state. She said typically it's the state health department that creates content for public health campaigns like social media ads, video or audio that can be repackaged at the local level.

"We haven't received any promotional materials from DPHHS as far as encouraging child vaccinations goes," Devlin said.

In the absence of a state-coordinated vaccine promotion for kids, Devlin has spearheaded the launch of the county health department's covid vaccination campaign for parents and kids.

However, Matt Kelley, CEO of the nonprofit Montana Public Health Institute, said smaller county or tribal health departments don't have the resources to undertake their own campaigns.

"We're working to find ways to help them increase their capacity by helping to provide some of that messaging, but also building their own skill sets so they can do it themselves," Kelley said.

The Montana Medical Association is also launching a statewide campaign aimed at parents of children ages 5 to 17.

Kelley said finding effective messages that boost vaccine uptake among kids, especially younger ones, is particularly important ahead of the winter, when conditions will become more ideal for the highly infectious delta variant to spread.

"Any parent knows how much crud comes home with kids when sick season hits in the winter. Covid is no exception to that," he said.

Montana schools saw nearly five times as many covid cases statewide during the first month of school this fall compared with last year's. Public health experts said that's largely due to fewer schools imposing mask mandates and other precautions. Kelley and others said this next round of kids becoming eligible for vaccines could help lower that transmission rate.

Jen Kates, a senior vice president and the director of global health and HIV policy at KFF, said, nationally, parents' feelings about getting their 5- to 11-year-olds vaccinated are similar to those expressed when shots were approved for kids 12 and up.

"About a third of parents say they're ready to go, rush out and get their kid vaccinated as soon as it's authorized and then there's a lot of wait-and-sees," Kates said.

Another third of parents don't plan to get their younger children vaccinated, and the rest say they're in the wait-and-see crowd, she said.

Kates said those wait-and-see parents largely decided to get their 12- to 15-year-olds vaccinated once their questions were answered.

Public vaccine campaigns for younger kids will be helpful in getting parents with questions to seek out pediatricians, which will be important for the upcoming rollout, she said.

Dr. John Cole, president of the Montana Chapter of the American Academy of Pediatrics, who practices in Kalispell, said his members have been having these conversations and will remind parents that while most kids infected with the covid virus do well, it's hard to predict who will be seriously affected.

He has seen children with multisystem inflammatory syndrome, or MIS-C, a rare covid complication in children that can be life-threatening.

"We need a consistent message," Cole said. "When we're hearing silence or not much of a message from the state level, I think that breathes a sense of nervousness or insecurity about the vaccine."