Now that children younger than 5 are finally eligible to get vaccinated for COVID-19, what does this mean for parents and caregivers? In this episode of the Health Centers on the Front Lines: COVID-19 podcast, Wanda Montalvo, PhD, RN, FAAN, our senior fellow and team lead for public health integration and innovation at NACHC, interviews pediatrician Lisa Costello, M.D., MPH, of the West Virginia University School of Medicine, about vaccine benefits as well as answers some commonly asked questions. For more resources about vaccines, view the HHS We Can Do This provider and patient education materials on pediatric COVID-19 vaccines.
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Dr. Montalvo Hi, everyone. So let’s get started. After a long wait, children are children younger than five years are finally eligible to get vaccinated for the COVID-19 vaccine. But what does this mean for parents and caregivers? We’ll be digging into these questions during this episode of Health Centers on the Front Lines. The podcast of the National Association of Community Health Centers, and I’m your host today, Dr. Wanda Montalvo, a senior fellow at the Mac. And I am so pleased to introduce to you today Dr. Lisa Costello.
She is a fellow at the American Academy of Pediatrics and she has a master’s in public health. She’s a lifelong West Virginian. She is an assistant professor in the Department of Pediatrics at West Virginia University and a pediatric hospitalist at West Virginia University Medical Children’s Medicine. I’m sorry. She is a pediatric hospitalist at West Virginia University Medicine Children’s Hospital. Dr. Costello serves as the president-elect of the West Virginia State Medical Association and is the immediate past president of the West Virginia chapter of the American Academy of Pediatrics. A lot of great expertise. She’s also a board advisor, which I think is a really important component of what she does in West Virginia for the Department of Health and Human Services Bureau of Public Health. And she is also a member of the American Academy of Pediatrics Committee on State Government Government Affairs.
Let’s get started with the first question here. So recently, the federal agencies have finally authorized and endorsed the use of the COVID-19 vaccine in our youngest populations six months and older. Can you talk about the process that got us to this point?
Dr. Costello Well, thank you so much for having me. And I’m happy to be talking with you about certainly an area that pediatricians have been working and looking forward to, which is getting access for some of our youngest population to get vaccinated against the virus that causes COVID-19. So there have been trials going on for a long period since pretty early on in the pandemic, looking at COVID 19 vaccination and the way that we see new whether it vaccines or medications or drugs come to market is they’re usually studied in different age groups because many times the dosing may be different depending upon the age of the person. And so these vaccines have been studied in clinical trials there. The data from those clinical trials have been reviewed by both the federal agencies as well as independent advisory committees to those agencies that are made up of experts from across the country when it comes to, in this regard, a vaccine or an immune science. And they consider all of the data that are that’s put forth from these clinical trials and they’re charged with determining, is this a problem that we need to address? I think it’s been well documented that we’ve had challenges in the pandemic, and I think we can certainly talk about that in the context of children. But is this vaccine safe and effective? And what the FDA and the CDC found is that, yes, these vaccines were found to be safe and effective. So now we have two vaccines that are available for individuals six months and older. There’s the Pfizer vaccine, which we’ve seen be available for children of other ages. And then now also the Moderna vaccine that is available for six months and older. So they’re a little bit different in their dosing schedule. The Pfizer vaccine is a three-dose primary series for individuals from six months to four years. The Moderna vaccine is a two-dose primary series for individuals six months through five years. But really, this is the first time that these young children have had access. And the vaccine is really important for those young members of our community. They’ve waited for the longest for this protection. And up until this point, we’ve successfully immunized millions of other children and adolescents to protect them from COVID-19. And now families and infants and toddlers need and deserve that same chance to get their protection against this virus. So that’s kind of how we’ve got here. It’s been a long time coming, but certainly for me, a big area of hope. I have a four-and-a-half-month-old at home, so I’m a new mom. So my daughter is still not eligible to be vaccinated, but I have a lot more hope of knowing that that eligibility is now weeks away rather than years, which I think a lot of parents have been having to deal with during this pandemic of when is my young child going to have the opportunity to get protected against this virus?
Dr. Montalvo As you stated that I remember when we were discussing plans for this webinar and you shared that with me, I was referencing that we can do this campaign and the interview that did with America Ferrera, where she talks about her journey of being pregnant through the pandemic and having a newborn and, you know, the similarity. So as a physician and as a mom, you know, can you and people, I think trying to navigate this sometimes thinking about is it better to vaccinate or am I safe if my child gets COVID? Like, how do people navigate the risk factors in making the decision to vaccinate their child?
Dr. Costello People have questions. I think it’s just inherent for us as individuals. We had questions when I was pregnant, I had those questions. I received my primary series before I was able to get pregnant. My husband was the same way and we were able to get pregnant. And then my husband and I both got boosted during our pregnancy. So I already had that one decision point to make in regards to should I choose vaccination. And I’ve been so encouraged since I made that decision, there’s been even more data that we’ve found that by a pregnant person getting vaccinated, they can pass immunity on to their newborn, their little one. And so for me, I already had to make a little bit of that decision. And I chose that for protecting myself and also protecting my now little girl. And I think parents have a lot of different factors to consider when they’re deciding if they should choose vaccination or not. Anything we do in life is risk-benefit. As a new parent, I’m trying to do everything I can to protect my daughter. So I did all the research I could on car seats. I have looked at what compared car seats and tried to pick which one would be best for our needs and for keeping my child safe. I made sure that it was properly installed. My husband did the same thing. We always make sure it’s properly installed, so we take those steps to ensure the safety that we can and how I can best protect her. And so I think when we’re talking about the vaccine people, what I frequently get asked is, do kids even get COVID? I work in a hospital. I care for children in a hospital. And I’ve cared for children who have had COVID-19, children who have gotten really sick from COVID-19 of all ages, from very newborn to teenagers. And so we know that children get severe diseases. There have been millions of children who tested positive for COVID. There’s been tens of thousands of them hospitalized. And unfortunately, we’ve seen hundreds of children die from COVID. COVID-19 is actually a leading cause of death in children. And so it is important to offer protection to children to prevent that really severe disease that ends up landing people in the hospital or even worse, taking their life. And that’s what these vaccines have shown to be able to do. And we’re also learning about what COVID is going to do long-term. We’re still learning about what are the long-term consequences of this long COVID. And we’re going to continue to have to learn about that. So I think when a parent, including myself, is considering should I take the opportunity to vaccinate my child or should I take the chance of them getting COVID? I think from what I’ve read in my experience choosing vaccination is the safest path for that protection and gives children and really everyone the best opportunity they have to be able to fight off the virus that causes COVID-19 if they should come in contact with it. So I certainly ask and maybe people have asked questions. I know we’ve worked very closely with the Primary Care Association in my state of West Virginia and just the incredible work that’s happened through community health centers and school-based health centers of not only offering and administering vaccines but really also answering questions people have. And so I always encourage individuals to reach out, get there, ask their questions and get answers so that they can make an informed decision for themselves and their families.
Dr. Montalvo, I want to kind of really highlight that point about the work and the kind of collaboration coalition that occurs. I think at the local level, it’s important that is to have those types of partnerships. Based on interviews we did with health centers and patients, often we heard over and over again that they are the most trusted source. And I think for parents and caregivers listening to this podcast today, I encourage you to please reach out to your pediatricians and our community health centers, and other trusted sources for information. Another kind of I want to go back to something you said earlier, and I think sometimes people don’t quite understand the approach of things like long, long COVID. And so when we think of children in this age group, what does that mean?
Dr. Costello, We’re still learning a lot about how long COVID is considered a symptom that people may experience. That’s believed to be attributed due to COVID-19 weeks and months after having that diagnosis. And it impacts multiple different systems. So common symptoms that we’ve heard are being really tired, headaches, and trouble concentrating, but there can be other impacts. And then another thing that is a little wooden, I would say as long, but for a few weeks after someone has COVID three to 4 to 5 weeks after children can get what we call MISC or multisystem inflammatory syndrome in children. I’ve cared for children in the hospital. This is a disease that it’s multisystem and is in the name but gets a really high fever. It can have an impact on their heart. It can also have an impact on seeing blood clots. And in others you have a rash. We’ve also seen the impact on the liver. And so multiple systems are being impacted. It’s really that MISC is a big inflammatory reaction. We’ve even had children that have been very sick that needed to be in the ICU from that. So there are consequences from getting COVID, whether there’s that MISC or this long COVID like you talked about. You know, we’re still learning about what that actually looks like, but we’re seeing more and more people be diagnosed with that. And we’re going to have to continue to study and see what the long-term impact is, particularly on children who if they got it early in their life, how is that going to impact them for the years to come.
Dr. Montalvo So that is still the other thing is, as a pediatrician, how do you frame the conversation with parents? You know, this kind of refers to them as the simple, movable middle. You know, some people clearly have decided, I’m going to get my child vaccinated. They’ve lined up, made appointments, and then others are on the fence. So how do you engage them in a conversation and what type of tips do you have for other clinicians and nurses and others that are speaking with parents?
Dr. Costello Great question. I always try to start conversations from a place of empathy I get. It’s tiring. We’ve been doing this for a long time and having conversations and with people who cared for children, you know, we’ve talked about vaccines for a long period of time. This is what we do in providing vaccine counseling. And when it comes specifically to COVID-19, I think starting from a place of empathy and really listening and hearing what the concerns the parent or caregiver may have is an important place to start. Next, you have to acknowledge as the health care provider that it might take more than one conversation to improve someone’s confidence to get vaccinated. I heard this analogy and I’ve been using it when I talk about kind of how do you have discussions with and how do I have discussions? I think of it as planting a seed. If you start having that conversation with someone, you plant a seed, somebody else comes along and they add a little bit of water to that seed. Maybe the individual themselves goes and looks up one of the resources that you provided. And over time the hope is that that seed starts to blossom. And so in the analogy is that over time, as we continue to provide this clear, consistent, and really unbiased information for people to make a decision, I believe that their confidence improves. If you open up that space and keep that open dialog and then give them resources and give a call to action. If you’re having that discussion with them and they may not make that decision right in that visit or right in that moment, provide them with resources that they can get more information from. So the American Academy of Pediatrics has many different resources. You reference that we can do this campaign. There are many resources out there also available in different languages, but they can get information from their own state. In my state of West Virginia, we put out information based upon what we hear West Virginians want to hear about and have answers to. And so pointing your patients and families to those trusted sources of information, there’s a lot of information out there. But pointing them to those trusted sources, I think is a way to help. So I always try to start with empathy and make sure that I’m listening, knowing myself that it might take more than one conversation to move someone’s confidence to get vaccinated and then really leave it to a place where we can have conversations in the future, but give them resources to address whatever questions they may have and then to keep bringing it up. I think there are also a lot of things not to do which sometimes we don’t talk about. Like I really don’t try to shame someone because we know that shame and guilt don’t work. And so I really try to again be open in my conversation, give the facts that I have based upon my experience and I share my experience of I plan to vaccinate my daughter when she turns six months old and how I’m getting that decision and also know why I chose to get vaccinated when I was pregnant. So I think those are some of the tips to try to help those people. As you said, minimal middle fence sitters, whatever you kind of refer to them as, who really want information. They want information so that they can make a decision for themselves and their families to get vaccinated. We know that there are people who like to wait and see. They like to kind of take their time and wait. You know, I’m very I’m like what you said, I’m high on the vaccine confidence. As soon as my daughter’s eligible, I’m choosing to get her vaccinated. There are other people that need a little bit more time to make that decision. And I think as health care providers working in our communities, they trust us. As you said, they trust our community health centers. They trust their local health care provider. And so if we can provide those resources to them, we really can do a great deal in regards to improving vaccine confidence.
Dr. Montalvo, I still agree with you. I do like the emphasis on making sure that we listen. We heard this over and over again during our own interviews that people just want the time to process. At the end of the day, there is a decision-making burden we’re putting on people to navigate this, and they’re not epidemiologists, overall ages, and we’re asking them to trust that we have done all the work and the science and following the research and making them healthy to partner with them in making an informed decision to vaccinate. So now I have decided I’m vaccinated. I’m vaccinating my little ones. So are there any things I should look for after vaccination? Anything I should be kind of alerted to that I should report.
Dr. Costello These vaccines, what we’ve seen in the clinical trials as well as now because we’ve been vaccinating down to age five and now for the past week, we’ve been able to vaccinate children under five as well. These things we see after the vaccine are pretty typical of other vaccines. So they may have redness at the injection site. I know my daughter has had redness at her injection sites since she was two and four months old. She does well with them. They might have some soreness there at the injection site. We do sometimes see a fever so they could have a fever afterward. And for other children that are able to kind of maybe say what they feel, you know, my daughter’s cooing a lot, but she’s not. She’s babbling a lot. And it’s really cute. But it’s not any formed words which we in pediatrics know our patients can’t really tell us how they feel until they get to a certain age. But other children may report feeling tired or they might have some kind of muscle aches. So the side effects have been pretty similar to what we’ve seen in older patients. But I will say, because of the pediatric doses, smaller children can still mount an immune response with a lower dose. The side effects have been somewhat less than we’ve seen sometimes comparatively to adults. And so those are the things to be on the lookout for. And I think if you ever have questions, call your healthcare provider, whether you call the community health center. And I think it’s important for those who work in that area, too, to be able to provide the guidance that, okay, this is what we would typically see or expect from a vaccine. The one thing that I would mention that I think there’s been a lot of questions that I’ve thought about is this issue of myocarditis or pericarditis, which is inflammation in and around the heart. That has been a very rare side effect we’ve seen with COVID-19 vaccination. I would remind everyone that we see myocarditis and pericarditis in people who actually get COVID, so people who didn’t get vaccinated. The risk is actually higher if you get that type of condition in your heart, get COVID-19, then get vaccinated. But in those situations, people have reported shortness of breath or chest pain. And so if your child reports experiencing those symptoms, you certainly want to call your pediatrician and make sure that they get checked out again. That side effect has been very rare, but it is something that certain people see out there in different conversations. And I think it’s a question that I get and one to make sure we discuss with families.
Dr. Montalvo So, I mean, I think once you decide to get the child vaccinated and I know it’s almost like you’re coming back into the introducing our little ones back into the world of daycare, you know, playing out in the yard and kind of family gatherings and protecting our extended family as well. Right. So are there any kind of final key takeaways you’d like to share with us before I close out?
Dr. Costello For me, obviously, I’m speaking as a pediatrician, but also as a new mom. This is a time for me to be hopeful. I mean, people that have children in this age group have waited a long time. And, you know, you can do all the precautions and certainly still recommend using as many of the toolbar tools in the toolbox. We have, you know, wearing a mask, washing our hands. If you’re sick, get tested, and stay at home. But we have seen time and time again that vaccination is our strongest tool in the toolbox. So I remember back two years ago, well, back in December of 2020, when the vaccines were first authorized and how hopeful I, I, and my colleagues and so many people were to finally have that protection. And as we’ve seen since that time, different age groups have had that opportunity and now we have it eligible for people who are six months and older. So for me, I think this is a time to be hopeful. And as a parent and I think a pediatrician, we always want to do what’s going to protect your child and be in the best interest of your child. And when it comes to protecting against the virus that causes COVID-19, vaccination really is our strongest tool. And so I hope people ask questions and talk to their pediatrician, talk to their community health center, their school-based health center, and to talk to people and get answers to questions they have and make an informed decision for themselves and their families that hopefully will lead to choosing vaccination because we do know that it’s safe and effective and our children need this protection. So I’m hopeful to see that we now have this protection to offer for children. And I think that we’re all going to work together. As you said, I think community partnerships are key. I’m so grateful. And really that’s been a silver lining of the pandemic for me to get to work with so many community health centers. My parents go to the community health center in my community. So for all those listening, thank you for all that you do. I know it’s been a long journey and we’re still continuing to do the important work to keep our communities safe and healthy.
Dr. Montalvo It’s great. And I think one of the again, I’m going to reference the We Can Do This campaign and the materials that will provide links to, I think in preparation for going to meet with your pediatrician, there’s things, a list of questions you can ask. It’s available in multiple languages. There’s a lot of good information for clinicians, so you’re not having to reinvent the wheel that’s already vetted. So use those resources so you can focus on the task at hand of meeting with parents and answering their questions. At this point, I want to thank everyone for joining us today, and I’d like to thank and ask a favor of those that are listening once our podcast goes live, please retweet it, share it with colleagues, and help us get the word out. And I want to thank everyone for joining us. Stay safe. Get your child vaccinated.