Angela Markert is vaccinated against COVID-19, but when it comes to vaccinating her 5-year-old, Tygen, she’s hesitant.
“As a guardian, it is my job to keep him safe and do what is in his best interest,” she said. “How do I know which choice that is, if there isn’t enough anecdotal evidence for his age group?”
Markert isn’t alone. A study of nearly 2,000 American parents published this month in the journal Pediatrics found that 42 percent were somewhat or very unlikely to vaccinate their children, compared to 46 percent of parents who were somewhat or very likely to vaccinate. Twelve percent of parents said they were unsure. The FDA is expected to give emergency use authorization for the Pfizer vaccine for children ages 5 and older soon, but many parents are still wary of signing their children up when the vaccine becomes available. That has left health-care workers scrambling to address the most common concerns from parents.
“Vaccination is the best way to protect your child and family,” said Dr. Erik Shessler, a pediatrician at the Children’s Hospital at Dartmouth in Lebanon, where Tygen sees specialists.
The pressure Markert feels over the vaccine decision is amplified by the fact that Tygen is her biological grandson. She worries about making a wrong decision and having that impact her custody.
“Add that to the societal pressures on either side of the vaccine debate, and it’s a bit overwhelming over here,” said Markert.
It’s normal for parents to feel especially cautious when making medical decisions for their children, said Shessler. “Naturally, families are often most protective of the youngest members of the family,” he said.
That can lead some parents to delay the decision to vaccinate, Dr. Christine Arsnow, New Hampshire vice president for the N.H. chapter of the American Academy of Pediatrics and a pediatrician with Concord Hospital said on a recent episode of The State We’re In.
“We have a bias that it feels harder to do something than to sit back and see what happens, whereas in reality that in and of itself is a risk,” Arsnow said.
The Collaborative spoke with Shessler, Arsnow and other health workers to address concerns that parents have and prevalent myths about vaccinating children.
Myth: Kids don’t get COVID.
According to the Centers for Disease Control and Prevention, kids are less likely to get COVID-19 than adults, but there have still been cases of serious illness and death. Last month, children made up nearly 25 percent of new COVID cases in New Hampshire. Children can also pass COVID, even when they are asymptomatic.
“The surest way to protect children and our communities from the harmful effects of COVID-19 is to get the vaccination,” Shessler said.
Dr. Holly Mintz, a pediatrician and chief medical officer for ambulatory care services at Elliot Health System in Manchester, said that getting kids vaccinated helps ensure that schools and extracurricular activities can stay open. That, in turn, supports children’s well-being.
“It’s imperative for [kids’] mental health and functioning to attend school and do the things they normally would do to affect their health and development,” Mintz said.
Concern: It’s a case of the government impacting medical decisions.
Many people, particularly in communities of color, have a distrust of the government and medical system. Dr. Deborah Opramolla, a member of N.H. Public Health Association’s COVID-19 task force, has heard people compare the vaccine to the abusive Tuskegee syphilis study, where Black men were denied treatment by federal researchers.
“That, to me, is a misunderstanding of history,” Opramolla said.
Past medical abuses have been about denying care, she said; the COVID vaccine makes health-care justice available to everyone.
“Social justice work is about accessibility: making sure that vaccines are available to everyone — documented, undocumented, poor, Black, BIPOC, white …,” she said.
Myth: mRNA technology is new.
The COVID vaccine is the first vaccine to use messenger RNA, or mRNA. However, mRNA technology has been around for decades and is proven safe, Mintz said. Before being used for the COVID vaccine, this technology was studied for other vaccines and cancer treatments.
“It’s been studied for a very long time and there’s a lot that is known about it,” she said.
Concern: We don’t know the long-term side effects.
mRNA never enters the nucleus of a cell, where our DNA is, so there’s no scientific basis for potential long-term side effects, said Mintz. The vaccine doesn’t interact with DNA in any way. Within hours of getting the vaccine, the mRNA is destroyed and leaves your body.
This makes long-term side effects extremely unlikely. Data from millions of administered vaccine doses confirm this. Parents should be more concerned about the lasting effects of COVID-19 in kids, Shessler said.
“The long-term effects of COVID-19 can be much more problematic, and we continue to learn more every day,” he said.
Myth: The science was rushed and not studied in kids.
It’s true that the COVID vaccines were approved faster than any other vaccines, but the science was not compromised.
“Vaccines became available faster because of cutting red tape, not cutting corners,” Shessler said. Scientists benefited from existing coronavirus and mRNA research to get the vaccines to market quickly.
The fact that we’re still waiting for FDA approval to vaccinate kids demonstrates that health-care officials are not compromising safety.
“When developing the COVID-19 vaccines for younger children, the scientists were mindful of the fact that children are unique and not just little adults,” Shessler said.
In addition, more than 7 million people ages 12 through 17 have received the vaccine, Arsnow pointed out.
“We have a lot of information on it,” she said.
Concern: The FDA will give emergency-use authorization but not full approval.
The FDA will likely give an emergency-use authorization for vaccinating children ages 5 through 11 prior to full approval. The FDA fully approved the vaccine for adults in August, and use in people ages 12 through 16 is allowed under an emergency authorization.
The emergency authorization is only issued once a vaccine’s safety has been established, Mintz said.
“The FDA is not going to give an emergency authorization review without significant data to show that it is safe and effective,” she said.
Despite the fact that life is returning to normal, the pandemic is still killing thousands of Americans every week.
“A lot of people forget that we really are still in an emergency situation,” Mintz said.
Myth: The vaccine can affect fertility.
There’s no plausible biological mechanism that could explain how the vaccine affects fertility, Mintz said. This is purely a myth, a case of online misinformation. Data from adults show that vaccinated females conceive at similar rates as unvaccinated females and have similar risk for miscarriage. Research has also shown that the vaccine does not impact sperm quality in males.
Concern: There’s the potential for cardiac issues.
Markert is particularly concerned about cardiac issues that have been reported in males under the age of 30 who have received the vaccine. Out of 186 million fully vaccinated Americans, the CDC has confirmed 892 cases of myocarditis or pericarditis, inflammation of the heart muscle or the surrounding lining, after the vaccine. Most of these patients recovered quickly.
Despite that, Finland, Denmark and Sweden have paused the use of the Moderna vaccine in young males due to cardiac side effects. Mintz pointed out that the U.S. government had previously paused, then reinstated, the Johnson and Johnson vaccine, due to concern over side effects, and would do that again if the cardiac risk were that significant. So far, data have shown it’s not, she said.
Researchers are still studying the risk for myocarditis, but it’s believed to be about 1 in 50,000, with the greatest risk in young males, Arsnow said.
“That’s scary, as a parent,” she said. “Anything with your child’s heart is alarm bells.”
However, she pointed out that COVID-19 also carries a risk for myocarditis. About 1 in 3,200 children who get COVID will develop multisystem inflammatory syndrome in children (MIS-C), which includes inflammation of the heart. Sixty to 70 percent of those children will be admitted to the intensive-care unit. For comparison, 95 percent of vaccine-linked myocarditis cases were mild, according to one study.
“For me, it’s much more scary to leave it to chance and have potentially severe myocarditis from COVID than to get the vaccination,” Arsnow said. “The illness remains scarier and the benefit of the vaccine still outweighs the risk.”
Myth: All hesitant parents are anti-vaxxers.
When Opramolla talks to parents who are hesitant about vaccination, a more nuanced reason for hesitancy often emerges. Some people are afraid of needles or concerned that their child might spike a fever after that vaccine, forcing them to miss school or work. In other cases, people have heard the prevalent false rumors about the vaccine.
“Getting a person through that misinformation can be daunting,” she said.
Opramolla recommends opening a factual and non-judgmental conversation with people who are hesitant about vaccinating their kids, directing them to easy-to-digest information, like Dartmouth-Hitchcock’s Pediatric and Adolescent Vaccine FAQ or the CDC website.
Mintz has two daughters, 22 and 17, who were vaccinated as soon as they were eligible. She urges parents to talk to their child’s pediatrician and trust those with the medical training to understand the vaccine.
“I hope people will have faith in the science and their physicians, who have undergone the training regarding these issues,” she said.
American parents will likely be the first in the world to be able to vaccinate their children.
“We take that for granted,” Mintz said. “We’re fortunate in this country because we have access to care. We know we have the tools to prevent this virus.”