Transcription:
What Parents Need to Know about COVID-19 Vaccines for Young Children

Deborah Howell: After months of rigorous testing and clinical trials, COVID-19 vaccines are now available for children six months and older. We know parents want what's best for their children and have questions about these new vaccines. In this episode of The Peds Pod, we'll speak with Le Bonheur pediatrician, Dr. Jon McCullers, the Senior Executive Associate Dean of Clinical Affairs and Chair of the Department of Pediatrics at the University of Tennessee Health Science Center, to answer questions about the vaccines. Welcome, Dr. McCullers.

Dr. Jon McCullers: Thanks so much great. Great to be with you.

Deborah Howell: It's a beautiful thing. Let's get right into it. What vaccines are now available for children?

Dr. Jon McCullers: Well, fortunately, we now have two vaccines which are available for children over six months of age. One is made by Moderna and one is made by Pfizer.

Deborah Howell: And what is the difference between the Moderna and the Pfizer vaccines for this age group?

Dr. Jon McCullers: Well, they're both the exact same technology using this messenger RNA as we call it to develop immune responses against COVID. The doses of the two vaccines selected by the manufacturers are slightly different. The Moderna has a little bit larger dose and the Pfizer, a little bit smaller dose. And the Pfizer, therefore, you need three shots in order to have the full series. And the Moderna, only two doses is good enough.

Deborah Howell: Got it. And how are these vaccines different from the ones older kids and adults receive?

Dr. Jon McCullers: They're exactly identical to the ones we're giving to older kids and adults, except for that dose. The dose is a little bit smaller, because these are smaller kids. And, as I said, with the Pfizer, you have to get three instead of two, because they went down to a very low dose for that vaccine.

Deborah Howell: Sure. So it's not really diluted. It's just the same. It's just a smaller dose.

Dr. Jon McCullers: That's correct.

Deborah Howell: Okay. And will parents be able to choose which vaccine their kids receive?

Dr. Jon McCullers: I think it depends a little bit on where parents live. These are going to be given out in pediatric offices predominantly as well as health departments and school fairs and places like that. Not at the drug stores mostly as we've seen with the adult vaccinations. So it may depend a little bit on what your pediatrician has. They're probably not going to have both of these in stock. So if you want to choose one or the other, you may have to shop around a little bit. Otherwise you should just take whatever your pediatrician offers.

Deborah Howell: Sure. And doctor, why did it take so long for vaccines to become available for very young children?

Dr. Jon McCullers: Well, the FDA has an approval process that's been in place for many, many years for evaluating drugs and vaccines and biologicals and so on where they start with adults and they evaluate safety in adults. And then, they bring that down to younger and younger ages over time, making sure it's safe for each age group before going to the most vulnerable, the youngest children for whatever that particular vaccine or drug is.

Now, some people might say, "Well, we're in a pandemic. Shouldn't you have just done it for everybody at the same time regardless of the standard process?" But I think from the FDA standpoint, because we weren't seeing as severe disease in kids, most of the severe disease were in older adults, they felt comfortable sticking with their normal process and going through this stepwise testing. So having to do the clinical trials in one group followed by another, followed by another, just kind of built in this length of time before we got around to the smallest kids.

Deborah Howell: Now, you know, I got to drill down for the sake of our audience. Are these vaccines safe? And what, if any, are the side effects?

Dr. Jon McCullers: Yeah, these are exceptionally safe vaccines. As we've seen, we've given them to hundreds of millions of adults in the United States and, you know, many more than that all a world. We do see some mild side effects such as some tenderness of the arm where the injection was, maybe a little bit of soreness and swelling, some systemic symptoms like feeling tired or maybe a little bit of feverishness.

The same thing is seen in kids. It's a little bit less than in adults. I think as we've gone down with the dose for younger and younger kids, we see fewer and fewer side effects. So overall, these are exceptionally safe. We haven't seen significant concerns and the side effects have been minimal, particularly in the smaller kids.

Deborah Howell: That's great news. Now, should children who've already had COVID still get a vaccine?

Dr. Jon McCullers: Yeah, this is a very important point. We do get some immunity, some protection from being infected with COVID. We now have very good data in older children and adults that suggest that if you get COVID, you have about the same immunity that you would've had with the original two doses of the vaccine. But there's very clearly better immunity if you add COVID to a dose of the vaccine or if you get a booster dose with the vaccine. So three doses in adults or older children gives the best immunity and three doses plus infection gives even better immunity than that. So it's kind of additive. So even if you've got COVID, you'll get better protection by adding the vaccine on top of it.

Deborah Howell: Yeah. It's like a multiple choice question. All of the above, answer D.

Dr. Jon McCullers: yes.

Deborah Howell: Okay. So what do you do if your child gets COVID between shots?

Dr. Jon McCullers: Well, the shots are spaced. The first two are spaced either three or four weeks apart. So if your child has a significant illness before the second dose, you may have to delay that based on what the doctor tells you about that. So if you're obviously sick and have fever, you may want to delay it or weak or two. If it's inapparent or mild disease, there's no reason not to just go ahead and get the shot on time. So it really shouldn't change anything, unless the child is ill at the time when they would've got the second shot.

Deborah Howell: Now, this is a biggie. Will the vaccine be a school requirement like many others are?

Dr. Jon McCullers: It won't be a school requirement this year, but I think there will have to be a discussion at some point whether to make this a school requirement. We have many of these respiratory viruses that have been baked into the school requirements for many years, like measles or pertussis, which are significant illnesses that we can prevent by vaccination. We don't know enough. COVID and the need for annual vaccines or multiple vaccines to understand whether we can put it on kind of an annual basis. If we're having to update it every year, like the flu shot, it's probably not going to be practical to require a summer vaccination before getting into school. Then, you start to think about, "Well, Are we going to give it in the fall and require it before they come back for second semester?" I think there's going to be a lot of discussion that needs to be had before it can be incorporated. At some point, you may be four or five years down the line, it may very well be, but I wouldn't expect it right away.

Deborah Howell: All right. And then there's summer school to consider. So we'll just learn more as we go.

Dr. Jon McCullers: Absolutely.

Deborah Howell: Can you get this vaccine with other routine immunizations?

Dr. Jon McCullers: Yes, the COVID shots can be given together with any other routine vaccination. There are no restrictions, either children or adults for that. And in fact, it's recommended that you go ahead and do that because we do know that if you have to come back for a second visit, we see a lot of drop off and we lose a lot of people who just don't have time to get back. So we should give it as soon as we can, and with other vaccines is perfectly fine.

Deborah Howell: What about long-term effects? How can we know what will happen when the vaccine and the virus are still so new?

Dr. Jon McCullers: Well, we can't know exactly a hundred percent, let me just start with that. But we do have two things that tell us, we think this is going to be safe. The first is we have 60 or 70 years of experience with vaccines, and we understand which vaccines cause side effects, why they cause side effects. We understand a lot about the biology. And as an expert in virology and in vaccines, I can tell you that there is no biological reason why we should see side effects. Now, scientists aren't always right. But if we take all the experts and the consensus opinion is this should be safe, most of the time they're going to be correct.

And then the second thing is we've given hundreds of millions of doses of this so far, we don't see side effects appearing. Nobody can rule out the kind of one in a billion or one in a hundred million scenario that we will see some long-term effects down the road, but it seems very unlikely with how safe this has been so far. So we can't rule it out for sure, but everything we know tells us that we think these are very safe. We shouldn't have long-term effects.

Deborah Howell: Yeah, it's really the bright spot in this whole COVID thing, isn't it?

Dr. Jon McCullers: Yeah, this has been just a great vaccine. When the pandemic started, we kind of tempered enthusiasm, said, "It'll take a while. We don't know how effective it'll be," and it's just been so much better than anybody could have predicted from the beginning. So it's been a fantastic vaccine.

Deborah Howell: Such a blessing. Now, if young children don't get as sick from COVID-19, why should they get a vaccine? I'm playing devil's advocate here.

Dr. Jon McCullers: Yeah. Now, we do know that that children don't get as sick as adults, but children do get sick. We do see patients who get into the hospital quite regularly, both with COVID itself and then with that complication of COVID, the MIS-C, the multisystem inflammatory syndrome from COVID. I've had many of my patients in the intensive care unit here at Le Bonheur. I've had children down to one week of age who are very ill in the hospital. So we do know kids can get sick. We want to prevent that even if it's a smaller amount of illness and hospitalization and death than adults see.

The second point is this group -- it's very important -- this group, the kids five and under, they get in the hospital about twice the rate as older children. So if you want to say who really needs it out of kids, it's this group we're talking about right now, the six months to five years of age.

Deborah Howell: Now, the most important question of all, where can children get vaccines and how can parents find appointments for their kids?

Dr. Jon McCullers: Yeah, so the distribution's going to be a little bit different than it was for adults. Most pharmacies you know, your local drug store on the corner aren't going to be giving it to the smaller kids. They just don't feel comfortable with that. They've been giving it to adults, but probably not to younger kids. So most of the distribution will be through your local pediatrician's office, through the health department. We'll have school fairs, we'll have other ways to get it out there to people. Children's hospitals will be giving a lot of it for interest. But the best way to do it is just to call your doctor and say, "Do you have the vaccine? If not, tell me where to go," and that's how you're going to get access to it.

Deborah Howell: That's great advice. Well, Dr. McCullers, thank you so much for talking to us today about vaccines for our young kids. We really appreciate you being here.

Dr. Jon McCullers: It's been great talking to you. And thank you for approaching this very topical and very important conversation.

Deborah Howell: Our pleasure. This is The Peds Pod by Le Bonheur Children's Hospital. I'm Deborah Howell. Thanks for listening and have a great day,