On June 18, 2022, the COVID-19 vaccine was approved by the federal government for children under 5. In this short episode of the Health Centers on the Front Lines podcast, our Senior Fellows Wanda Montalvo, PhD, RN, FAAN, and Jennie McLaurin, MD, MPH, MA, draw on their experience as healthcare providers and parents to discuss the benefits of vaccination and common parent concerns. Listen to this as an audio podcast, watch the video below, or read the transcript at the bottom of the page:

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Episode Transcript

Transcript

Dr. Wanda Montalvo: Hi, everyone. My name is Dr. Wanda Montalvo and I’m one of the senior fellows at the National Association of Community Health Centers. I’m a nurse by training. Very quickly, the National Association of Community Health Centers was founded in 1971 to promote efficient, high-quality, comprehensive health care that is accessible, culturally and linguistically competent, community-directed, and patient-centered for all. And I am joined today by my colleague Dr. Jennie McLaurin, introduce yourself.

Dr. Jennie McLaurin: Sure. Thanks, Wanda. Glad to be with you all today as we talk about vaccines and children. I’m a pediatrician with a public health degree as well and have many years of experience serving in community health centers and nationally with vaccine readiness and information.

Dr. Wanda Montalvo: Thanks. And I just wanted to kind of set the stage for our conversation today and just to let our audience know that America’s health centers play a vital role across our country, serving as medical homes to the country’s most vulnerable populations. We have providers that really care for people across the spectrum, from the early birth of our children all the way to older adults. And we are located all over the country with over 1440 local health centers with multiple sites and care for over 29 million people. Health centers make communities and people healthier and stronger, especially in these challenging times. And, you know, using COVID as a backdrop and I kind of want to frame a little bit that, you know, as a mom, myself and grandmother, that this has been a really big, you know, difficult road to navigate. And I think, especially as I think about our children and the confusion that there is in the public about the various guidance and things like that. I wanted to speak with you today, Jennie, about, you know, what some of these things mean and how we help people kind of navigate this and understand this, especially for our health centers and the patients that they serve. So the first thing that kind of comes to my mind is, you know, as caregivers and choices and everything else, but also the confusion that there is around the language and the terms we use. I’m one of the first ones that come to mind when people hear the term, you know, what does emergency use authorization actually mean? When we’re talking about the vaccine and the vaccine for our children.

Dr. Jennie McLaurin: Yeah, that’s a great question, Wanda, because we have had so many new terms just thrown at us emergency use authorization as something that the Food and Drug Administration is allowed to implement when there is a national emergency. So it’s happened before. It happened with swine flu and Ebola and other things over time that maybe haven’t grabbed our attention quite as much because we weren’t necessarily thinking about vaccines. We might have been thinking more about drugs, and drug readiness. And I think the most important thing for people to understand as parents and as patients ourselves is that emergency use authorization is not rushing of preparation and a skipping of oversight. The drugs have to get through a number of clinical trials before they’re allowed to be part of an emergency use authorization. And immediate emergency use authorization does have an independent safety board that’s required. So it’s an independent board and it evaluates all the data to make sure that patient safety is paramount. And if there’s any question about it, it doesn’t get past the difference between the regular one and regular authorization and emergency use. There are shorter times in the clinical trials required, but they still require clinical trials and they still require a certain number of people to have received the drug or the vaccine in question and outcome data on them. And until they get that, everything is very limited and not allowed. So I think that’s important to know. It’s important to know that there’s still an FDA review, there’s still public meetings, and then there’s an emergency use decision that gets made and monitoring continues after that emergency use decision. So all of it keeps going. And in some ways, it’s just that the FDA says instead of meeting like, say, every six months on this product, we’re going to have emergency meetings that people have to come to that weren’t regularly scheduled.

Dr. Wanda Montalvo: Right. So, I mean, I think from my kind of, you know, perspective and listening to you is that that the rigor is the same and that a lot of people have been working on this for many years. None of this occurred overnight. Recently, I was participating and using a Twitter space where like 300 parents were discussing this vaccine. And it ranged, you know, from vaccine acceptance to vaccine hesitancy to those that were skeptical about, you know, the vaccine itself and not too many on this particular call, but people that were anti-vaccine. But most of the people on this call were really, really kind of trying to grapple with what is the right decision for our family. So as you think about this, you know, What are these and why do they exist around childhood vaccines in particular?

Dr. Jennie McLaurin: Yeah, I think parents are always thinking about what they allow their children to receive in their bodies, whether that’s a vaccine or a drug or a certain type of food nutrition. And we’ve seen vaccine hesitancy and vaccine acceptance have been limited previously. This isn’t a new thing. What’s new is that everybody all at once in the country is getting the same vaccine at the same time so it’s just made more obvious and a bigger conversation than we’ve had in the past. But always, as a pediatrician, I’ve had parents with either skepticism or very healthy questions wanting to make sure that this is the right vaccine for their child. And it’s a continuum there. There are a few parents that just sort of accept anything that their clinician says that they should get. But I think most parents want to know, like, why now and why in combination and why so often and all those other questions. And they deserve thoughtful answers to those questions. I think there’s always that risk-benefit and there’s always considerate individual consideration in the vaccine. But that said, for any vaccine that gets recommended, the CDC is super conservative as an organization. So they and the FDA are too. So we don’t recommend vaccines for children unless we have overwhelming evidence that their risk outweighs the benefit. All of those organizations are extremely conservative when it comes to recommending anything universally for children.

Dr. Wanda Montalvo: I’d also kind of say that most of them are also parents. It’s one of the things that, you know, stay with me as well, that, you know, they are also going through this with their own personal life. COVID doesn’t care about status or where you are, where you live. Right. It’s an equal opportunity spreader. When I think about it. But, you know, I think as a parent, I would say, okay, so the news I kind of hear sometimes is, you know, coverage smiles in children. We’ve heard that. And so, you know, why vaccinate? Is it riskier to vaccinate or to get COVID as a young child?

Dr. Jennie McLaurin: Yeah, that’s a great question. And actually, we can say similar things about a number of the other vaccines we get, like chickenpox. It is true that COVID is typically and that’s what we need to underline, typically mild in children. But when it’s not, it’s pretty awful. We don’t know as much as we need to know about long COVID yet it’s frightening. We know that anywhere from 15 to 30% of humans who get COVID, even if they’re asymptomatic but they’re positive, end up with long COVID. And we don’t know enough about long COVID and we have no treatment for it right now. So that’s one huge thing. And yes, children also are susceptible to long COVID and we don’t know which children. So we know that those who get vaccines, both adults and children, are less likely to get long COVID. Not completely unlikely, but less likely. We also know that they’re less likely to pass on COVID to somebody else who will then get a long COVID. So that’s one huge thing. The other thing is peculiar to children, and that’s the multisystem inflammatory disease that children can get just with COVID. It’s very similar to something that we used to call Kawasaki disease. It’s devastating. It can cause heart attacks, it can cause sudden death. It can cause horrible arthritis and joint problems. And so it’s a devastating, devastating onset that happens a few weeks after COVID and children end up in that intensive care unit for it. So we can’t pick out which children are going to get that and we can’t pick out which children to get long COVID. So it’s that risk-benefit game and also that risk-benefit game for everybody else’s child. So on. You said, you know, you’re a mom and a grandma. I’m a mom, but I’m also a pediatrician. And my neighbor and super close friend is a child who recovered from leukemia that required a bone marrow transplant. He couldn’t go to school anytime somebody was sick. So for COVID, all these children in the nation who are already suffering, they’re already having a hard go of it because of their autoimmune disease or their cancer, are trapped inside their houses like little prisms because of the risk of getting the disease. So we need to be aware of those children, too, and prevent them from getting sick.

Dr. Wanda Montalvo: I think as laypeople and as a nurse, I’m always trying to think through, you know, what are we asking people to decide on? It’s replacing a decision-making burden on people. And oftentimes there are all these statistics and it doesn’t make sense when you’re not in that space of research or anything else. So can you give a simpler analogy of what we’re thinking in terms of protecting our children and others? One way to think about when we have our children vaccinated, you know, what’s the protective value of that?

Dr. Jennie McLaurin: Sure. So that’s a great way to think about this because the numbers are way too huge. You know, the numbers are just so enormous. So when I talk to families about childhood cancer or trying to protect another child in the classroom, I often will use a sort of 30 people, 25 person, 72 person kind of analogy. And so one of the analogies that almost everybody can relate to is a school bus. So you want to think about your child getting on a school bus and everybody else’s child getting on a school bus. Course, those are grimy places, and what the potential is to either protect the other children on the school bus or your own child. So when we talk about risk and if I’m going to say your risk is one in 100 for this or one in a thousand for that, a simpler thing to say is if you’re on a school bus with 72 children, Probably two of those children are going to be immunocompromised. At least one of them probably is a childhood cancer survivor. A couple of them will probably have autism disorder, which is very difficult for prevention reasons and protection. And a couple of them may have another sort of intermittent chronic disease like asthma that requires occasional steroids and things that make life a little bit more difficult. So at any one time, there are at least half a dozen children on that school bus that are at risk. And we’re not even including those that might live with their grandparents, right. Where that might go to daycare, might have somebody else. So we’ll add a couple more for that. So then we’re going to say, okay, let’s say there are about ten kids on that school bus still, you know, we can’t hurt them all just in the back, the ones that are at high risk. There’s no way to reduce risk in a school bus with the air and all of that containment. So if we’re okay with ten of those kids on a school bus getting COVID, then we have to realize that with today’s variants, and how contagious they are, each of those ten children is probably going to end up contaminating the whole school bus by the time we’re dead. All of a sudden, all our school buses are filled, and that’s why the numbers get so big. So for every child that we can immunize on that school bus, it’s like the size of the school bus gets cut in half. Okay, so let’s say we immunize five kids on that school bus, then you put, you know, five, then to 72, whatever that is, and you get down to 12, 12 people being problematic or 13. And so you can just exponentially either increase the risk or decrease the risk when you start immunizing. And I think that’s what we also need to understand is for everybody we immunize our bubble of concern gets sharply cut not just by one, but by everyone. That child would come in contact with that.

Dr. Wanda Montalvo: You just gave that analogy. And I thought about my daughter who works with children all the time. She’s a face painter and balloon artist. And, you know, the importance of all of us having a role in keeping each other safe as good neighbors, which reminded me of the We Can Do this conversation they had with America Ferrera, and it was aired on April 28th. It’s on YouTube. We’ll provide, you know, links to this. But I really appreciated her conversation because she was pregnant at the peak of the pandemic and she spoke about her own lived experiences being a new mom, having some children in her family that qualify for the vaccines, and others that did not keep them safe. But also, I think the role she had in modeling for her children, the importance of vaccination, and following the guidelines to keep her family, her extended family, and her community safe as one but the other. I think that is really hard to navigate, or at least be very aware of, is where people obtain information from and the risk there is in certain communities to be more, I think, at risk to myths and disinformation. And I’m wondering in your world, in Pedes, you know, what are some of the things you have heard that are very concerning?

Dr. Jennie McLaurin: Yeah. This disinformation is at a level that I’ve never seen before. There’s always been disinformation and misinformation, and it’s always been true in the vaccine world. But this is a real new level. So just for our listeners, misinformation has just kind of given you the wrong information. I didn’t really mean to. I sort of believe it, but maybe I just got messed up or, you know, I’m just repeating what somebody else said to me. Disinformation is very purposeful and there are disinformation campaigns going on. Most of them are from folks who are located in other countries, and it’s purposeful to cause discord and to keep us from being successful. So for those people who think that they’re being patriotic or really looking at all sides carefully, be very careful about the sides that you’re looking at because they’re well covered and they’re well hidden. They sound true. They’re very sophisticated. Misinformation isn’t very sophisticated usually. So you can usually quickly get to the bottom and check out a source and go, Oh, no, that’s not what it says. There really isn’t mercury and this vaccine really didn’t use human embryos, that sort of thing. The disinformation that I’ve heard that has me very concerned is information that COVID shots will decrease fertility or cause infertility. That’s absolutely false. And the flip side of that, which is super important, is pregnant women are at the highest risk in all the high-risk categories of having severe COVID while pregnant and losing their babies, losing their own life. So it’s absolutely on the other side of things. There’s also no risk of getting the COVID vaccine while pregnant. So that’s important too. Another disinformation is that we’re on this campaign to immunize our children and even put them in trackers. I’ve heard that, which is bizarre. That’s like now we’re not putting on trackers that it’s a centralized government thing when in fact it really isn’t. There are a lot of different medical communities that are looking very carefully at these vaccines. The American Academy of Pediatrics exists to advocate for children. That’s not just for ourselves. And we’re pretty cautious as a group about recommending things for children. The plants where they’re getting made have lots of controls and oversight, and the FDA does visit the manufacturing plants. We only use a vaccine that has been manufactured in our country for children and for a very limited number of European countries. We actually don’t use vaccines that have been made in China on any of our vaccines or in Eastern Europe or in Asia. So sometimes we have misinformation that this stuff is made with poor quality oversight. Some vaccines are made in those countries, but they’re not used in American children. So also, we’ve had misinformation on the vaccine. We’ll give you COVID and absolutely a while. There’s nothing in it that could give you COVID. There’s no virus, there’s no active virus-like virus. So it can’t. Other things have you in mind for getting any that you’ve heard often?

Dr. Wanda Montalvo: No. But, you know, ever again, I always kind of filter through if I’m trying to figure all this out and, you know, where do I go to? And I think for us, working with our community health centers across the country, we did interviews with health centers and patients. And over and over again, the core theme that came forth was, that I trust my physician and the health center. I trust my nurse in the health center. And I strongly urge, you know, people, please connect with your pediatrician and your clinical team in a health center and ask them the question that you’re confused about. You know, I’m not well, I’m a researcher. I’m not an epidemiologist. I’m not a virologist. So there are things I don’t know. And I always go back to, you know, the clinical leaders that I know have done the work and can guide me in the right way, but also to look to trusted sources, things that are vetted that I know, you know, people with the right information are putting this stuff together. And for us, you know, we’re in partnership with HHS. We can do this campaign. And I encourage people to please visit that site. Things that I think might help those that are listening are that they do have frequently asked questions for parents and guardians about COVID and the vaccine. You know, if you look at that and you still have questions, take those questions, you know, to your physician. There’s additional information that’s geared towards, you know, supporting our staff, which we shouldn’t assume that everyone from the front desk to the AMA too, you know, across our health system understands and has all the answers. So there are resources there for our staff to help provide information. So it’s communicating about, you know, who is eligible for the vaccine. And, you know, really great, I think guidelines to ask the pediatricians, should I get my child vaccinated against COVID? And what are the questions you should ask your clinician to guide you? I mean, as you stated. Right, I think, you know, none of us go into this health care system to do bad things. We come into this health care system because we’re committed to prevention and primary care and keeping our community and our patients safe in our community and healthy. And so. Those are the things that I would strongly urge people to consider. I think navigating this has a lot of still questions in the air and information changes. So please turn to your health center in your local community. Ask the questions. Go to trusted resources like we can do this dot gov and any last closing comments.

Dr. Jennie McLaurin: Well, I’m thankful to all the families that have been part of the vaccine trials for children because this is something families should be assured of, that they require more out of those families. A longer follow-up, and more safety guidelines. And it’s taken a long time to get to the point where we have a vaccine for children, not because it wasn’t safe, but because they want it to be super, super safe. So effective. So it has to be both. Right. So realize that, yeah, your child might still get COVID if they get vaccinated. But the risk for serious disease, which is what all of us as parents and caregivers are worried about, is just dramatically less. And the worry of COVID ruling our lives the way it has in the last couple of years is dramatically less. And I know we’re all tired of this, but the vaccine really is safe, effective, affordable, and hopefully will be seen as the gift that it is by those who are ready to take it. And I agree. Go to people you trust. Facts need to be true, but they have to be joined by emotion and trust. So hopefully your community health center is a place where that happens. And absolutely we can do this website. The American Academy of Pediatrics and the CDC. Get your facts and don’t listen to all the nonsense out there. There’s too much of it.

Dr. Wanda Montalvo: Exactly. Well, thank you. I want to thank our listeners and I want to thank Matt for putting this together so that we can help promote accurate information because we care. And our goal here is to help advance correct information to keep our community safe. Thank you so much.