Podcast: Vaccines approved for younger kids

Jim Dryden (host): Hello and welcome to “Show Me the Science,” conversations about science and health with the people of Washington University School of Medicine in St. Louis, Missouri, the Show-Me State. As we continue to detail Washington University’s response to the COVID-19 pandemic, in this episode we talk about vaccines for young children. The FDA and CDC have approved emergency use authorization for the first vaccine for kids ages 5 to 11. That’s a big deal, according to Dr. Jason Newland, a Washington University infectious diseases specialist who sees patients at St. Louis Children’s Hospital and who has been involved in the clinical trials evaluating the safety and efficacy of vaccinating 5- to 11-year-olds against COVID-19.

Jason Newland, MD: The science is there to show that there’s safety in the vaccine. We have done a randomized, placebo-controlled, double-blinded trial, and we’ve looked at safety in over 1,500 children 5 to 11 years of age. We’ve followed them out, and we do not see any serious adverse events associated with these children.

Dryden: So now that the vaccines are available for children as young as 5, Newland is recommending that parents get their kids’ vaccinations scheduled as quickly as possible. He says the availability of the vaccines for young children is another potential game-changer in the battle against COVID-19.

Newland: Having children 5 to 11 be eligible for a vaccine is a ginormous deal. We know that over the summer, during the delta surge, that we saw an increase in number of cases in children. A lot of them are in the unvaccinated, or not eligible, right? So not only do we have teenagers not vaccinated who got it. We had a lot of children who just weren’t eligible to receive vaccine get COVID-19. Now, thankfully, while our hospitalizations did go up, we have learned vaccinated individuals are less likely to be infected. They’re definitely less likely to end up in the hospital. There’s still been over 600 children who have died of COVID-19. There’s been over 5,000 to 6,000 children suffer from Multisystem Inflammatory Syndrome in Children, which is a lot of words to say it’s a really bad disease that lands kids in the hospital four to six weeks after having a mild to asymptomatic COVID-19 infection. Put all that together, getting another 28 million people eligible for a vaccine is going to have a tremendous impact on the health of children and also the health of adults.

Dryden: But there still is some resistance out there to vaccination. Did you have any hesitant parents to deal with? Or what would you tell a parent who’s worried?

Newland: So first, we have been blessed to be in a place where we can help conduct the COVID-19 vaccine trials for children. Washington University and St. Louis Children’s Hospital have supported being on the cutting edge. Specifically, parents that want to be a part of a vaccine trial are all in. They know it’s going to be a lot, but they see the science. They want to be a part of the science, part of the solution to making life safe for children and the adults around them. But with that being said, after we had the approval for the 12- to 15-year-olds with the Pfizer vaccine, we saw exactly what you stated, which is adults who were a little nervous but got the vaccine were just not ready to have their teens vaccinated. They felt like, “I can take the risk, but I’m not sure I’m ready for my children to take the risk.” And there is no doubt that will be seen with this vaccine being approved for 5- to 11-year-olds. So what do we do? I think, what do I do? One is we say the science is there to show that there is safety in the vaccine. We have done a randomized, placebo-controlled, double-blinded trial, and we’ve looked at safety in over 1,500 children 5 to 11 years of age. We’ve followed them out, and we do not see any serious adverse events associated with these children. We additionally have hundreds of millions of doses of this vaccine given to both teenagers 12 and older as well as adults, and yes, we have seen concerns about myocarditis, mainly young men 12 to 30 have seen that; but the risk there is 60 per 1 million doses. So we all have to think, well, what is that risk when it comes to getting COVID-19, to have your heart involved? Well, if you just look at that Multisystem Inflammatory Syndrome, which involves the heart, it’s 315 per million. Right? So the risk of getting COVID-19 and landing with heart issues is much higher than getting the vaccine. So I think you have to give that data. I also think you have to be kind, and you have to listen, and you have to meet people where they are and continue to have the conversation because while there will be people that are adamantly opposed, there are way, way, way more people who are just trying to consider and think through what is best for their child. And in the end, there is no doubt the safety of this vaccine has outweighed the risk, and we’ve seen dramatic improvements in those who are vaccinated, in the sense they don’t get re-infected for sure, very likely, and they don’t die, and they don’t end up in the hospital.

Dryden: The last time that I was here with you talking about this, the CDC had just changed masking guidelines, and we were all looking forward to a summer of not having to wear masks, which turned into a summer where we had to wear masks. Are we going to get to the point, if enough kids get vaccinated, that maybe in some situations, we can lose the masks?

Newland: So I like to refer to this as the glorious months of June and July when we were talking about the — it felt more normal, right? We did. We were walking into places without masks. We were going into indoor spots and saying, “Ah, I guess I don’t need the mask.” Man, that was awesome. I think yes! I think the reality of getting — of pulling back on some of our prevention or mitigation strategies is seeing what? Cases go down. And seeing that others aren’t getting infected, seeing our hospitalizations going down, seeing that we’re not having over 1,500 deaths in our country daily from COVID-19. These things, once you can do that, and our hospital systems are safe, and we are having less cases, you can talk about pulling back on masks. You can talk about not worrying about how every little cold could potentially be COVID-19, and the need for all the testing. But at this point in time, we still have a lot of work to do, I think, to get to there, but at least I can see the light. I think we all can see that light, and we’re having those conversations more and more, and yeah, I think it’s more likely than not we’ll talk about removing the masks again, hopefully this winter. Though I think we’re all concerned what’s going to happen next, and as much as I’d like to say I predicted exactly what was going to happen since March of 2020, I would be a liar if I told you that.

Dryden: So let’s ask you to predict. Kids can start getting the shot. They’ve got to get a second jab a few weeks later, so that puts us at Thanksgiving already. I’m assuming that Thanksgiving is not necessarily safe because not enough kids will have been vaccinated by then. But four weeks later, we’ve got Christmas and New Year’s, that part of the holiday season, what about getting together with the family this year?

Newland: There’s no doubt it’s easier to get together with families this year because you have large portions of your family already vaccinated. So if you’re already in that group, it’s much easier, though you have some younger children that, potentially, are just partially vaccinated. So, I do think it’s possible to get people together this year with some understanding of who is vaccinated and who’s not and having more of a normal Thanksgiving versus not. Now, if you’re in a group of people where you don’t know vaccine status, and you’re indoors, it’s still challenging, because we still have enough community cases of COVID-19 that it still has risk — maybe not as risky as it was last Thanksgiving, when we had our winter surge. Christmas looks even a lot better, or the Christmas season or the winter holiday season, looks a lot better in the sense that we could even have many more millions of these 5- to 11-year-olds vaccinated, and you’re talking about a more normal Christmas, for sure better than last year. You know, we’re starting to see, maybe, you know, just kind of a stabilization of cases, so we’re still having in this country 70,000 cases a day, which maybe will change. We still have things to watch, so I don’t think it’s as clear that we’re completely out of this, and everyone’s worried about wintertime, as we get more inside. So, I guess I will summarize by saying yes. Winter holidays, including Thanksgiving, Christmas, Hanukkah, these sorts of holidays — yeah. I think you can have a more normal, but it’s not completely without risk. I think you have to take into account what’s our daily case rate? What’s your vaccination status? And, really, what are your plans and the numbers coming to be a part of those?

Dryden: As you said, these vaccines have been studied more extensively, and in more people, than probably any vaccines ever before. But with the kids getting shots now, I’m imagining that there’s a research opportunity that didn’t exist previously, when adults were getting the shot, and that would involve studying the antibody response in a less mature immune system. For instance, old people like me, we know my antibody production goes down after six months. Maybe it doesn’t do that in kids. Maybe it takes a different course.

Newland: You’re not old. Let’s just start off that route. You’re not old. Um, well, yeah. There is an opportunity, and that’s why these vaccine trials have a number of things in them to be able to look at what antibody levels are and what, you know, what kind of breakthrough infections we might have, and when do we have to consider boosters for them or not? You know, we’re blessed to live in a country that embraces the importance of science and the importance of research. You know, the National Institutes of Health have gone all in in response to COVID-19. That includes vaccination and studying these things. And that’s why we have mix-match vaccine dosings that we’ve learned about in the, you know, the past couple of weeks. That’s why we’ll continue to monitor, you know, how the vaccine should even be rolled out for children. I mean, we’re going to go down to as young as 6 months of age. Right? That’s just like influenza vaccine. And we’ll learn about even timing between shots, right? Right now, we’re at four weeks for Moderna, three weeks for Pfizer. There could be some discussions as well. Should we extend the intervals between, even for the youngest? Maybe it should be three months, and how do we do that? I mean, these research questions are there, and I think that’s why we’re blessed to be in a place that will evaluate that. The other piece of this research is what’s the next variant? Are we going to have another variant? What’s going to happen with the other respiratory viruses because we’ve had such a weird winter respiratory season that actually because a summer respiratory virus season. There’s a lot of unanswered questions going forward, but I would say we will understand it better. And to circle back, and finally with the vaccines, I predict potentially we’ll have a vaccine that’s kind of like the influenza, and we’re going to have to get it every year, every couple of years, based on how we respond. And then there will be other new vaccines that will come out, potentially, against COVID-19, and there will be new therapies. Again, we’re lucky we live in a country that really focuses on this and does these amazing trials so that we can have answers.

Dryden: Back to the importance of vaccinating these young children. I know that there are certain diseases and disorders that are much more serious if they start in pediatric patients than — you know, cancers and even psychiatric illnesses, if they start very young, tend to have a really bad course. I’m wondering if it’s possible that when it comes to viral control, the reverse might be true? That if you have immunity built up when you’re 5, that you’re going to be much better off when you’re 55?

Newland: Great question. You know this long-term impact of your immunity to what’s going to happen later, I think, is one that we always try to understand. We definitely know that – well, first off, vaccination has changed the world. I mean, you think about my father, who grew up in the time of the polio vaccine and remembers standing in line to get his shot, also remembers the time when he wasn’t allowed to go to the swimming pool because you saw outbreaks of polio in the summertime. Point being is that vaccination obviously changed lives enough that you nor I have to worry about getting paralyzed from an illness like polio. Like, we don’t ever think about that. But that was commonly thought about. We don’t think about potentially having measles and having somebody being severely impacted from a neurologic condition that occurs seven to 10 years later. Especially if they get measles when they’re less than one year of age. And these neurological conditions could be fatal. The question will be: Is it going to be something like influenza, where we need to be vaccinated every year, and does it matter what vaccine you had the year before? Or do we get some durability with our vaccination that protects us from, you know, the consequences of COVID-19? And let’s not underestimate the consequences of a COVID-19 infection, especially among the unvaccinated. We know about, you know, long-haul COVID-19. While it occurs probably in about 5% to 10% of kids, in adults it’s been dramatic, right? This brain fog that occurs. And I remember hearing about that at first and going, “Really?” But, man, it is real. I’ve seen children with that Multisystem Inflammatory Syndrome who just — there is a brain fog and they’re sick. They’re very sick. And so in the end, COVID-19 is worse than flu. It’s much worse than influenza.

Dryden: And finally, what about the people who still drag their feet and whose illnesses are affecting all of you health-care providers who are exhausted after so many months of caring for COVID-19 patients?

Newland: You know, we have all gone through a lot since March of 2020. I can’t even remember how many months it’s been; it just seems like forever. And I think the one thing I have learned throughout this is: one, I can’t predict what’s going to happen next. Two, people are scared, probably more than anything about COVID-19, when they’re scared. Then there’s the others, like, “I don’t think I’m scared” but might be still scared. And, three, that when we have such an opportunity to be nice to each other and be kind to one another, that we probably should remember that the most. We need to remember to be kind to those who just aren’t ready to be vaccinated. And we need to remember that by being kind and listening and talking, we’re much more likely to have them become vaccinated than not. And as frustrated as we are about the unvaccinated who end up in the hospital and are sick and we’re mad about it, they’re probably more likely than not scared, and that’s why they weren’t vaccinated. They didn’t really have the right information. And so, for all those people listening, let’s remember to be kind and continue to have the conversations and not to be upset or disappointed in the person not vaccinated but be caring and understanding and try to get them vaccinated. Because even if they’ve had COVID, we know that by getting vaccinated afterward it will help protect them later. So I’m just like, please, please, please let’s be kind to one another as we continue to move through the pandemic and put it behind us.

Dryden: Newland says millions of pediatric doses of the vaccine already are in stock at various locations around the country, including many pediatricians’ offices. And it’s possible millions of children will get at least their first shot sometime this month, giving many of us one more thing to be thankful for this Thanksgiving. And he reminds that doctors, employers, school administrators and the rest of us do need to be patient with those people who remain hesitant.

“Show Me the Science” is a production of the Office of Medical Public Affairs at Washington University School of Medicine in St. Louis. The goal of this project is to keep you informed and maybe teach you some things that will give you hope. If you’ve enjoyed what you’ve heard, please remember to subscribe and tell your friends. Thanks for tuning in. I’m Jim Dryden. Stay safe.