COVID Vaccines for the Under 5s Are Coming

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Brigid Bergin: It's The Brian Lehrer Show on WNYC. Welcome back, everybody. I'm Brigid Bergin from the WNYC and Gothamist newsroom. Millions of Americans have contracted COVID during the past two years. While adults were able to get vaccinated to protect themselves against COVID, children under five years old have been waiting for the introduction of a vaccine for their age group.

Roughly 13 million children in this country have gotten COVID since the start of the pandemic, according to the American Academy of Pediatrics, with the full total estimated to be much higher than that, but some good news. Later in this month, the FDA and CDC are expected to finally roll out a COVID vaccine for toddlers and infants, and as a mother of a toddler, it can't come a moment too soon. With me now to talk about children's vaccines and what this milestone will mean for all of us is Katherine Wu, staff writer for The Atlantic. Two of her recent articles are, Vaccines For The Littlest Kids Have Already Flopped, and Don't Wait To Get Your Kid Vaccinated. Katherine, welcome to WNYC. Thank you for joining us.

Katherine Wu: Thank you so much for having me.

Brigid Bergin: Katherine, I showed my hand here. I am an anxious parent and I have been eagerly waiting for the approval of these vaccines. Can you remind us a bit about the timeline here? Why has it taken so long?

Katherine Wu: The first thing to keep in mind was the way that these vaccines rolled out is, the plan was always to start with the adult population. That was the population that the vaccine makers tested the vaccines initially in, and then they followed what's called an age de-escalation structure. They went younger and younger by age brackets, 12 to 15-year-olds, 5 to 11-year-olds, and the under 5 group was last in line, though that didn't necessarily mean it had to have taken a year and a half after the adult vaccines.

Really, I think a lot of parents and scientists were hoping that the under five vaccines would come much sooner, as early as last fall, but there were a series of delays as the vaccine makers were making absolutely sure that the vaccines are both safe and effective. I think many parents may remember that Pfizer got some unexpectedly disappointing news in December when they saw that their vaccine wasn't producing quite enough antibodies when they gave it only as a two-dose series. It really has been a very long time. I think this is a reminder that maybe we don't have to follow age de-escalation in the future. Maybe there's a way to get kids their vaccines faster, if this ever happens again.

Brigid Bergin: Listeners, are you one of the millions of parents who have been waiting for a child's vaccine? How soon are you planning to vaccinate your children? What are your expectations, concerns? If you're an educator or a caretaker who works with children, is this a relief? How do you think vaccines will help children adjust to this new normal that we're living in? We want to hear from you, give us a call at 212-433-WNYC or tweet @BrianLehrer. That's 212-433-WNYC. Katherine, I know that not all parents are feeling quite the same sense of eagerness. What are some of the concerns you continue to hear from parents when it comes to vaccinating toddlers and infants?

Katherine Wu: Yes. This is a really important topic. There was a poll conducted in April. Of course, that was two months ago when the numbers may have shifted slightly since then, but only about a fifth of parents who responded said they were really eager to get their infants and toddlers vaccinated, that they were going to do it right away. The rest said they were maybe going to wait and see or were saying, "We're never going to do this unless it's absolutely required or absolutely not," but I think there are so many reasons why parents are hesitating or reluctant or are refusing. I think some of these may feel familiar if we think back to the reluctance that has plagued the entire vaccine rollout in the United States.

A lot of parents are worried that the vaccines aren't safe, that they don't work, that there is something about them that could actually be dangerous for their child, or that there's no point, my kid already had COVID, why bother, or the pandemic's over, I feel no rush to go and get them a shot. The caveat here, obviously, the pandemic is not over, but I think a lot of these concerns are amplified when we think about this youngest age group.

Parents are understandably so protective of their littlest kids. They have their whole lives ahead of them. They can't necessarily articulate all of their thoughts and feelings and how they're feeling about COVID and how they're feeling about vaccines. I think this is a really tough decision and we do have to make room for that, but it does seem like the younger kids are, the more reluctant a lot of parents have been.

Brigid Bergin: You talked about the idea of parents whose kids maybe have already had COVID, and I'm wondering, what do experts say about the need for vaccination? We know that if you've had COVID, it creates antibodies, is that enough? Or why wouldn't experts encourage a parent to vaccinate their child, even if their child had already gone through a bout of COVID?

Katherine Wu: It's a great question. I think it's been coming up a lot recently, especially since quite recently, the CDC published a study showing that majority of Americans have already had a SARS-CoV-2 infection, and the rates appear to have been especially high among young children. As you pointed out, it is true that many infections do leave antibodies behind them, but I think the big risk here is that not all infections actually do leave behind detectable antibodies, and those antibodies don't last terribly long. The basic idea here is infections are a pretty inconsistent way to defend yourself. Some of them may offer some protection, others may not. A lot of that protection may not last.

If there's an opportunity to get your kid a vaccine to boost that protection, solidify it, and build upon it, it's absolutely essential to do so. It's also important to keep in mind that a lot of these recent infections were with Omicron variants, which may leave some protection behind, but actually, there's been a lot of research to show, most of it in adults, to be fair, but the protection left behind by an Omicron infection may not offer much protection against a different variant. That is going to be a concern because more variants are on their way. We are not done with this virus and that is, I think, the forward-thinking we need to have when we think about the importance of these vaccines.

Brigid Bergin: Absolutely. I think we have a caller who is eager to get his kids vaccinated. Ted in Floral Park, welcome to WNYC.

Ted: Hey, thanks a lot for taking my call. Good to be with you.

Brigid Bergin: Can you tell us how are you thinking about vaccinations for your younger children?

Ted: We have three kids, one is seven and he's had his vaccination doses. My wife and I have both been vaccinated and boosted, but we have a child who is almost four and one who is 13 months. I was listening to the news and hoping this would happen and looking forward to getting them vaccinated as well, but my wife argues and thinks that the urgency has waned and that the threat is less. She's probably also just doesn't totally trust that the vaccine is safe for them since it's taken so long for it to be approved. We're in a holding pattern waiting for it to be available, but then we have to decide who's going to win this argument.

Brigid Bergin: Ted, thank you so much for your call. Katherine, I want to get you to jump in because I know you talked to parents and families who had similar concerns and similar notions that the pandemic was waning, the lack of urgency. How did the experts that you talked to respond to that?

Katherine Wu: Ted, I am certainly not here to tell you or anyone else what to do, but I hear these concerns and as was said just now, I've been hearing these a lot. I think we do have to keep in mind that the pandemic is not over. If we look at national statistics, this really is our second-largest surge of the pandemic. Cases have been rising all over the country, hospitals have been filling again.

The big concern is that kids under five are our primary unprotected group right now, especially with masks having disappeared, people having approached, I think recent months, as if the pandemic is over, has removed a lot of the precautions that were shielding kids from the virus. If anything, it feels like the urgency about vaccination has actually gone up, not down. The comment about your wife's worries about safety, I totally understand that, but another way to think about it is because these vaccines have taken so long, I certainly wish they had not taken so long, but that has given even more time to vet the vaccine safety in adults, in adolescents, in younger children, now all the way down to the littlest kids.

The younger the vaccines go, the more that experts prioritize safety. In fact, the Moderna and Pfizer vaccines are 1/4 of the adult dose or 1/10 of the adult dose. That was specifically to ensure that they were giving the minimum possible dose that would still be effective to make sure that we weren't giving kids any unnecessary side effects. That gives me enormous confidence that there is going to be a really really good safety signal. Hopefully that will just be shown in spades next week at the FDA meeting.

Brigid Bergin: Katherine, we are, it sounds like, so close to this vaccine finish line. We got a tweet with a question from a listener asking why New York City has dropped the under five mask mandate so close to the vaccine finish line, especially since so many will be at least initially reluctant to vaccinate. This was a decision that was announced yesterday that kids age two to four who were still required to wear masks in school will have the option to not do that starting on June 13th.

It's been a big source of controversy among some parents. I'm wondering, you have talked and written about this so-called new normal. Do you think that shift might be something that could dissuade parents from taking advantage of these vaccines once they're approved?

Katherine Wu: It's an interesting question. I certainly can't speak for any of the people who made the decisions about this mask mandate, but I do think the timing is really unfortunate. I wish they could have waited at least a couple weeks so that some of the first kids might have been able to at least get their first shot, which will hopefully start around June 21st. This does unfortunately follow the national pattern as of late. This is really one of the last mask mandates that we have been hearing consistently about, and that it's going away is not ideal but unfortunately not surprising.

I think this really does reflect this attitude that I think has actually been counterproductive in terms of encouraging parents to vaccinate their children because when these mask mandates go away, when precautions go away, when capacity limits go away, it sends this implicit signal that these little kids did not need to be vaccinated for things to come back to normal. That's honestly the opposite message that we want to send. We want to make sure that as many people are protected as possible, regardless of age. This idea that we're not safe until everyone is safe I think still rings true because clearly the pandemic is still going on. The fact that so many remain unvaccinated is an enormous part of that.

Brigid Bergin: Listeners, are you a parent of a child who may soon be eligible for the vaccine? How are you planning to vaccinate your children and what are your concerns? Are you eager for this? Are you an educator or caretaker who works with children? Do you feel a sense of relief that finally these kids will now be eligible? How do you think this will help children adjust? We want to hear from you. Call 212-433-WNYC, that's 433-9692, or again you can tweet at us @BrianLehrer. Katherine, let's talk some more about the vaccines themselves. You wrote about how Pfizer's trio of doses for kids under five has a very tentative efficacy of 80%. Why very tentative? What's the fuller picture conveyed by that 80% figure?

Katherine Wu: I think it's important to keep in mind here that the way that Pfizer was-- well, actually, both Pfizer and Moderna were evaluating their vaccines was through an approach called immuno-bridging. That basically means that their primary goal was not to actually get a definitive efficacy number. This vaccine reduces severe disease by 90%. That was not necessarily their goal. Their goal was to see if their doses of vaccine produced a strong enough immune response in kids. Antibody levels comparable to what they saw in adults who got a larger dose.

They did see that they met what's called their primary endpoint, but they also had enough cases of COVID to estimate a very tentative efficacy number. The reason it's so tentative is because at the time they produced that estimate, only 10 cases of COVID had happened in their study, which is a very small number. Imagine if we added five more cases to that. The number could shift a decent bit. I'm not expecting it to fluctuate to a wild extreme, but we just have to be a little careful when saying that number because it wasn't really the primary goal. We do expect it to budge at least a little bit when the final data comes through.

Brigid Bergin: That's interesting. We have another tweet that came in from [unintelligible 00:14:34] a listener said, can your guest address the FDA waiting on approving Moderna's under five vaccine until Pfizer had data? It contributes to skepticism. Can you respond to that?

Katherine Wu: I unfortunately cannot speak for the FDA, but this has been, I think, a topic of much discussion in recent weeks. I can really only speak to what I have heard and what companies and the FDA have said in the public record. Basically, Moderna began the process of submitting their data weeks and weeks ago. It has taken quite a long time, a surprisingly long time, longer than this entire process took, for instance, when Pfizer was submitting data for the 5 to 11-year-olds last Fall.

A lot of parents and experts have been a little confused that there was also this message put out at some point that the FDA might want to wait to evaluate both the Pfizer and Moderna vaccines at the same time to "reduce confusion". I suppose there is an argument for that but this also did delay things. Certainly there is the possibility that Moderna's vaccine could have received an authorization a little sooner. How much sooner? We can't say, because these data submissions do take time, but I think this entire news cycle around that has caused some trouble.

The FDA certainly did say at multiple points they weren't going to wait, that they were moving as expediently as possible but I don't have any additional insight beyond that. Certainly the reporting on this has caused a lot of frustration and I do really understand that.

Brigid Bergin: Let's hear from another parent. Laura in Brooklyn, welcome to WNYC.

Laura: Hi, thanks for having this discussion. For us parents who have been waiting a long time to have our young toddlers vaccinated, my daughter will turn four at the end of June and she has a friend in school who has already turned five and been vaccinated. They used to plan sleepovers for the past six months. I would say, well, that really can't happen until you get vaccinated. She started to understand what that meant as we talked more about it and her friend now is vaccinated. She wants to be vaccinated as soon as possible so she can have a sleepover.

Brigid Bergin: Well, happy birthday to her. I hope she gets to have her sleepover after she gets vaccinated soon. I know that the wants and needs of children of those age can be very demanding. It's good that she also learned what it meant to be vaccinated. Katherine, we have another caller, Brian in Jackson Heights. Brian, welcome to WNYC.

Brian: Hi. Hey, Brigid.

Brigid Bergin: How's it going? Are you eagerly awaiting this vaccine approval?

Brian: Oh my God, I can't wait. I have a two year old who was born at the end of March in 2020. My wife is currently pregnant with our second and he doesn't really get it. Vaccines, no vaccines, masks are pretty typical to him, but I think when it comes to the risk calculation that we have to do as parents, talking to friends who don't have kids, all of our friends who don't have kids, it's just like, "If I get COVID, that's fine," but for us, it always comes back to, well, what if Theo gets it? Knowing that he's vaccinated will just make, I think, existing in the world a little bit easier, a little peace of mind.

Brigid Bergin: Brian, thanks so much for your call. I think the flip side of what Brian is describing, the peace of mind, is also the idea of the risks that unvaccinated children face and health conditions that can result from COVID should parents opt not to vaccinate their children and their child contracts COVID. Katherine, can you talk about some of those, what we're learning about the conditions that affect children who get COVID?

Katherine Wu: I think this is really important to talk about because I think unfortunately, the narrative that has been pushed since the start of the pandemic is that kids are "low risk" or even no risk, which is absolutely not true. Kids can get very seriously sick. COVID can kill them. They can get a rare but very, very dangerous inflammatory condition called MIS-C, they can get long COVID, which for a little kid feels especially devastating because they could spend years, possibly the rest of their lives, we don't know, with chronic debilitating symptoms that could affect how they learn, how they interact with the rest of the world.

Of course, even just catching the virus in a "mild case" could threaten other people in the home, especially if there's someone vulnerable there, a grandparent for instance, or someone who's immunocompromised. This is enormously impactful for kids and every classroom closure, every teacher or school nurse who quits is going to impact a child's life in some way.

I know there's been a lot of comparisons of, oh, kids have severe outcomes less of the time than adults do, but I've heard a lot of people, rightly so, push back on that comparison because it's not the right one to make. We wouldn't compare rates of cancer between age groups in that way. The more important comparison to make is how does an unvaccinated child fair and how does a vaccinated child fair? What difference could we make in a kid's life in protecting them from COVID, which is now a vaccine-preventable disease and is about to become a vaccine-preventable disease for everyone in America over the age of six months?

Brigid Bergin: Let's go to Graham in Inwood. Graham, welcome to WNYC. I understand you have a four-year-old daughter.

Graham: Yes, thank you for having me. Fan of the show. I have a four-year-old daughter and I am immune-compromised. We heard the first rumors of an under-five vax maybe January of this year. The parents, I think we all justifiably feel a little left behind, like our little ones weren't getting the attention or the respect that the rest of the people were. Another factor to me is a child that young cannot ever be left alone. If the child isn't vaccinated, basically the entire family isn't vaccinated in terms of how we have to run our lives.

My daughter's had it twice and luckily, both times were mild, but that's awful to have seen the positive twice. Having said all that, the second it's available, we'll be the first in line. Choosing to not get vaccinated is Social Darwinism, as far as I'm concerned. We will be there with bells on waiting for the shot.

Brigid Bergin: Graham, thank you so much for your call. I think that there are a lot of families probably feeling something similar to what you were describing. We've had several people asking, Katherine, about how long they should wait if their child has had COVID recently, how long they should wait before getting this vaccination once it's been approved. I'm wondering if in your conversation with experts, if that's something that came up.

Katherine Wu: I think at this point there is probably not a reason to wait. There was some discussion about this among adults last year primarily, but really, now the recommendation is that, of course, if you are currently infected and in isolation, finish your isolation, feel better, make sure that you are not actively sick and feeling really terrible, but then you are clear to go and get a vaccine. We certainly don't want to infect anyone at the pediatrician's office if someone is actively isolating and you also don't want to be sick when you're getting a vaccine.

In terms of waiting and maybe relying on some of those antibodies left behind, this brings us back to our earlier conversation. I don't think we can count on those antibodies. It's not a bad idea to just go and get those vaccines, treat it as your first dose, your second dose, or your third dose down the line, if that becomes relevant for you. Don't wait beyond just completing isolation and making sure that that infection is gone.

Brigid Bergin: Katherine, we got a tweet again which I'm wondering if you spoke with experts about. If a child is turning five in August, is there any recommendation for waiting for the 5 to 12 vaccine as opposed to this new vaccine that's being approved for those under five?

Katherine Wu: Great question. I think every time we have had a new age group green lit for vaccines, this question has come up. Do I wait for my child to get the bigger dose? Across the board, every expert has told me, "No, don't wait." If it's truly my child is turning five tomorrow, sure. If it's going to be more convenient to wait an extra day, I think that's totally fine, but if it's going to be months from now, don't wait. We don't know when the next surge is going to be. We're in a surge right now. We don't know what sorts of exposures could happen between now and August.

I know August feels like it is really coming up, but as I think many parents can now say, waiting just a few extra weeks for a vaccine can feel like an interminable nightmare. Don't wait. We know that vaccines are actually dosed, not by size or weight or anything like that, but really by immunological age. When you're this young, your immune system's quite feisty. It responds really well to quite low doses of vaccine. Your almost five-year-old is going to respond really well and make tons of antibodies in response even to that smaller dose.

Brigid Bergin: Katherine, misinformation has played a really damaging role in the efforts to increase vaccination throughout the population. How does the government plan to tackle misinformation about the vaccine for children under five?

Katherine Wu: That's a great question. I think, unfortunately, I don't have a great answer to that, because there truly has not been sufficient publicity about the under-five vaccines. Certainly, there's a lot of excitement. There have been advertisements about this, but I think a lot of experts have been concerned that there has not really been enough movement on this. Even in terms of logistics, ordering, where are kids going to get their vaccines? A big concern right now is a lot of pharmacies cannot even vaccinate kids under the age of three. A lot of pediatricians' offices don't yet have a plan for how kids under five are going to be vaccinated.

In terms of encouraging uptake, dispelling misinformation, that really requires engendering trust in the right groups, doing community outreach, having accessible vaccination sites, and making sure that people have a place to go to get their questions answered and their concerns addressed. A lot of vaccination sites have disappeared. A lot of the enthusiasm in general in the public has disappeared. People don't want to think about this anymore. I think this general atmosphere is contributing to a sense of [unintelligible 00:26:10] It's going to make it really difficult to dispel misinformation when there isn't a lot of enthusiasm acting on the other side. It feels very asymmetrical right now.

Brigid Bergin: I'm wondering how the timing of this vaccine approval is also contributing to that. It's Summer, kids are going to be outside. Can you see that is part of the rationale some parents may use to wait and delay vaccinating their under five-year-old kids because they won't be back in daycare or school until the Fall?

Katherine Wu: I think that is a concern. There's a couple of things to speak to here. I think first is, it is summer, the last thing people want to think about is like, "Oh, another trip to the doctor," having a kid who might feel a little feverish for a few hours after the vaccine. People want to go on vacation. They want to forget about their responsibilities and just have a good time, which I totally understand. We're also missing the end of the school year for a lot of kids. They're not going to be able to see their peers and talk to their teachers and their school nurses and hear from them like, "Get the vaccine." I think that is going to cause a few issues.

This has happened even a couple of months ago. We might have had a little more enthusiasm, a little more community cohesiveness, but honestly, the same reasons that people want to forget about the vaccines are actually reasons to get them. If there is going to be travel, if there is going to be a lot of visiting relatives that you haven't seen in a long time, that is extra reason to get your kid vaccinated. This virus is spreading everywhere. The way that it spreads everywhere is by people carrying it across towns, across state lines, across country lines.

This is actually a very important time to get vaccinated. Especially for both vaccines actually. There's weeks that separate the first dose and second dose, or in Pfizer's case, there's months that separate the second dose and third dose. You want to get your kids started on that now so that they're ready for this coming school year in the fall and fully vaccinated by then, up to date, to make sure that they're as protected as they can be when they start the school year. When we head into the colder months, we might expect another surge to come.

Brigid Bergin: I want to read another tweet that we got from Daniel. He wrote, we have a nine-month-old that we can't wait to get vaccinated. We live with a 102-year-old great-grandmother and we want to surround her with as much immunity as we can. It's also a civic duty to others who can be vaccinated, please vaccinate your babies. Listeners, thanks for your tweets. In our last question, I'm wondering how the rollout of this children's vaccine is expected to impact the overall population's COVID cases?

Katherine Wu: It's a great question. I think we don't have a super solid answer to that, but based on projected uptake, it's really hard to say. I think there is going to be a patchwork effect. If we think about certain parts of Massachusetts where I used to live, in the Boston Metro area, I know there are a lot of places where uptake of pediatric vaccines has been super high. We can also look at places like Puerto Rico where uptake of pediatric vaccines, also super high. They're actually leading the nation. It's really incredible to see. Places like that, where there are a lot of people vaccinated in communities, are just going to get this extra layer of protection.

The virus is going to have a harder time spreading, healthcare systems will be better protected, fewer outbreaks will happen, we will have less work time lost, socialization lost, but there are going to be other communities in the country where uptake remains incredibly low. Those are the places that I worry about because that is where the virus is going to have an opportunity to spread, to replicate, maybe create more variants and start this cycle over again. We really need to prioritize equity, access, and making sure that communities where vaccine uptake has been low, really get those rates up through whatever means possible. This is essential and we can't silo communities off and just assume that they're protected.

Brigid Bergin: Well, I will be among those eagerly waiting. We're going to have to leave it there for now. Thanks to Katherine Wu, staff writer for The Atlantic who joined us to discuss the rollout of vaccines for children ages five and younger. Thank you, Katherine.

Katherine Wu: Thank you so much for having me.

 

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