Ask a Pediatrician: COVID Shots for Kids Ages 5 to 11

( Rogelio V. Solis / Associated Press )
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Brian Lehrer: Brian Lehrer on WNYC. An FDA panel, as you probably heard, voted on Tuesday to recommend that regulators authorize Pfizer's COVID vaccine for kids ages 5 to 11, an age group that includes 28 million US children. A top CDC vaccine official and an advisor on that panel, Dr. Amanda Cohen, explained her vote this way.
Dr. Amanda Cohen: COVID-19 now is a vaccine preventable disease from my perspective and COVID is also the eighth highest killer of kids in this age group over the past year. The use of this vaccine will prevent deaths, will prevent ICU admissions, and will prevent significant long-term adverse outcomes in children.
Brian Lehrer: COVID is the eighth highest killer of children in this age group, she said. Well, it's good news then that States have already begun to place orders for the pediatric COVID vaccine for children in this 5 to 11 age group. Governor Kathy Hochul says that New York has ordered more than 380,000 doses. Mayor de Blasio says doses will be ready 24 hours after final approval comes in the city, and Pfizer says the Biden administration has ordered more than 50 million pediatric doses.
What does this mean for parents and children and what does it mean in a broader context of the pandemic? With us now is Dr. Judith Flores, pediatrician, fellow at the American Academy of Pediatrics, past chief of ambulatory care at several New York City Health and Hospitals facilities in Brooklyn, and currently working on vaccine engagement as part of the New York City Test and Trace Corps. Hi Dr. Flores, thanks for coming on WNYC again.
Dr. Judith Flores: Thank you for having me. It's a pleasure.
Brian Lehrer: Parents, we will open up the phones right away for your questions about the COVID vaccine for your 5 to 11-year-olds. 212-433-WNYC, 212-433-9692, or tweet @BrianLehrer. We'll look at your questions, go by on our Twitter feed as well. Dr. Flores, what makes these child dosages different from the Pfizer dosages that adults have received?
Dr. Judith Flores: Well, I think the significant difference is they've been tested in children 5 to 11 and found to be effective and safe at one-third the adult dose, so that's very different, small children are just not small adults as we know, and their immune response is significant and they mount a very good response at about one-third the dose, and that's children up to the age of 11.
Brian Lehrer: Now, what would you advise for parents of 11-year-olds? I've already gotten this question off the air. I imagine some might be wondering whether they should have their children vaccinated with a pediatric dose or wait a few months until their child turns 12 and becomes eligible for the full dose.
Dr. Judith Flores: Yes, that's a very, very good question and very important and I would say, please don't wait. Your child obtains significant protection as an 11-year-old with the smaller dose and will be getting a second dose in the three to four weeks after the first dose, so it gives significant protection and actually in some cases we notice that smaller doses can give the long-term immunity that we want from the larger dose in the 12-year-olds, so please don't wait. It puts your child at risk.
Brian Lehrer: We know there's concern among every parent understandably for anything that they're going to put in their children's bodies. We've heard the stories of people who are getting themselves vaccinated with no hesitation but just are unsure about their kids. Along those lines, one question is, is there a difference between the dosage that a small six-year-old would receive compared to a large 11-year-old, for example?
Dr. Judith Flores: The testing has been done between 5 and 11-year-olds, and it proves to be effective even in the 11-year-old. It is not based on size or weight, it really is based on age and immunity, so there is no difference in the dose.
Brian Lehrer: How much do you believe vaccinating children in this age group will change the course of the pandemic overall beyond the health of the individual kids or the people living in their households who might be the immediate concern?
Dr. Judith Flores: I think that is a very key issue with this vaccination of the younger children. I am extremely excited as a pediatrician, I mean my life is dealing at least one-third of the time in preventing disease in children, and key is vaccination. Having this vaccine for younger children, knowing that even though it's rare that they will get very, very sick, it's rare that they will die, we still had a rude awakening this summer with the Delta variant.
We saw a situation in which we thought children were-- at some point many of us felt that children were almost immune, they really didn't get sick. Well, they do get sick, and they do end up in ICUs, and younger children are at risk for something called MIS-C, which is a multifactorial immunological condition, very rare but does affect younger children, so that's really important for them. The big picture is that they also are part of the chain of transmission, so having them vaccinated protects the greater community, protects them from missing school, missing activities, protects them from having other illnesses that may be even confused for COVID when they are obtaining their care, and protects their family.
We live with families, so it's protecting their adults who may not be vaccinated around them and definitely the older adult. It's a good way to stop this transmission. It's a good way to halt the new development of other variants, and it's really all around a benefit to all of us.
Brian Lehrer: Let's take a phone call.
Dr. Judith Flores: Sure.
Brian Lehrer: Bonnie in Manhattan, you're on WNYC. Hi Bonnie.
Bonnie: Hi there. Hi. Thank you. I would like to ask the doctor, she states that COVID is the eighth killer of children right now. I have to understand her rationale and what would be before that? I mean, eighth seems way down the line when you're talking about death of children.
Dr. Judith Flores: Yes. It's seventh or eighth, and these are calculations. I actually didn't state that, the previous person stated that, but definitely it is well documented. It's seventh or eighth. Things that go ahead of them are things like, you would look at things like congenital conditions, cancers and such. It is pretty significant to have something like that, as an infectious disease be a cause of death when you compare to other infectious diseases. It is rather alarming.
Brian Lehrer: Right. I guess the skepticism that we hear in the voice of the caller is, "Well, not many children die at all," so if COVID is only the eighth leading cause of death among children, there's not a high death rate there.
Dr. Judith Flores: Exactly.
Brian Lehrer: Therefore not that much of a risk, that's what the skeptics would argue.
Dr. Judith Flores: Exactly. I understand that. I understand that very clearly, but I think that what we've learned over the summer is that death is not the only toll on children. That you're looking at the ability for them to attend school, to attend activities, to not be infected. The infection rate in children has been, as of September, six million cases have been reported in children, so the infection rates are high. We also don't know what COVID does in the long run. Long COVID in children, we've seen about a third of children are reported to have a long COVID.
We don't know what's going to happen to children in the long run who do get infected. Of course they are part of the chain of transmission to the rest of the population, so we shouldn't use death as a marker. We really should use the ability to live a healthy life, to be able to take part in their education and their activities as the marker.
Brian Lehrer: Of course, when we talk about risks to life or quality of life, we have to ask as compared to what. What did these trials on children show with respect to side effects?
Dr. Judith Flores: The immediate side effects of these vaccines are pretty similar to those that we see in adults that have been reported in the trials from the Pfizer trials in particular. They are the usual fatigue, maybe a low-grade fever, and pain at the injection site, which is something we see pretty commonly with many other vaccines in children.
That's important to know. The other thing is that a lot of people, and when I do discussions with parents and with groups, a lot of people are very worried about the long-term side effects of vaccinating their children, "What happens years from now?" It's important to know that vaccines in general, actually there isn't one reported vaccine that I could find or any of us could find, do not have serious side effects beyond two months of the vaccination. Having a vaccine have a serious effect usually is something that we notice within the first to second month after vaccination, not years later. That concern is probably not something we have to worry about too much.
Brian Lehrer: One potential side effect in particular that people talk about, myocarditis. It's very rare, we should say, as a side effect, and usually mild when it does occur. Pfizer's trial of pediatric vaccine doses may have even been too small to pick up on rare side effects like myocarditis, but do we have meaningful numbers? Again, comparatively, is the risk of developing myocarditis from COVID bigger than the risk of developing myocarditis from a vaccine?
Dr. Judith Flores: You are absolutely, absolutely right. You hit the nail on the head, as they say. Myocarditis has been something that we see with other vaccines, but as far as COVID-19, the disease, there's much, much greater risk of a young person, usually an adolescent or young adult, getting myocarditis and pericarditis after the second dose with the illness rather than with vaccine.
It's very clear that myocarditis is a higher risk with the disease than with any of the vaccinations. The other thing to note is that in children 5 to 11, we have seen apparently no cases of myocarditis reactions in the trial so far. They also are not in the age group that usually has myocarditis. It's something to watch, it's something to take into account when you're making these decisions, but the decision should be the risk that your young child or your adolescent has for being affected by myocarditis by the disease rather than the vaccine.
Brian Lehrer: Dr. Judith Flores with us, pediatrician, fellow at the American Academy of Pediatrics, past chief of ambulatory care at several New York City Health and Hospitals facilities, now working on vaccine engagement as part of the New York City Test and Trace Corps, as we talk about the impending approval of COVID vaccines for 5 to 11-year-olds. Here is Jason, a dad in Manhattan, he says, calling in. Hi Jason, you're on WNYC.
Jason: Good morning. Thanks for taking my call. I have two kids that are going to be eligible, they're between 5 and 11. I'm so happy and grateful, I cannot wait to get them the shot. My only question is do you feel that there's a difference in where I should go to get the shot? There's the pediatrician, there's the hospitals, there's the local CVSs, there's even the vans that are on the sidewalks. I'm just curious if you feel like there's any nuance or skill or anything like that that we should be aware of and where we should go.
Dr. Judith Flores: I think from what I've seen during this implementation for adolescents and for adults, this city is very well equipped to handle the 5 to 11-year-old. I don't think there's a preference. I would go wherever it's easier for you. It's always good to have conversations with your pediatric provider, to let them know what you're doing and to engage them, but it might be harder for you to get an appointment at that point.
You can get an appointment for this once this is eligible at mobile vans, at popup centers, at hospitals, at your pediatrician's office if that's available in the clinics. They can even be delivered to your home. Also remember that all children are eligible for the $100 incentive, which might come in handy coming Christmas time or holiday time.
Brian Lehrer: Oh, that's good to know.
Jason: To summarize, you feel that they're all equal, all the different process[crosstalk]?
Dr. Judith Flores: Yes. I would say that they're all equal. The standards have to be the same. When we have immunizations in different sites, the standards by the State Department of Health for us are all the same. In the practice that I work, it will be the same as in one of the city popup centers [crosstalk] or in your home.
Brian Lehrer: Do you think-- Go ahead.
Dr. Judith Flores: No, that's it.
Brian Lehrer: Jason, thank you very much.
Dr. Judith Flores: Thank you.
Brian Lehrer: I hope that answers your question. Do you think there's going to be a rush on these once they do become available? I've noticed, for example, that with the booster doses for people over 65 and others who now qualify, it's like back to January, you can't get an appointment at your local pharmacy for like six weeks.
Dr. Judith Flores: Well, I'm hoping that's the case. I would love to see more and more children vaccinated to get us to the state where COVID is endemic and not a pandemic. I would say I don't see a rush, I think we have enough capacity in the city to meet it. I just read an [unintelligible 00:14:38] study and that's national, that says and it's always in my feeling that a third of people will actually run out and get it, a third will think about it a little bit and watch other people kind of dip their toe in the water, and then there's a third that will take a longer time and maybe be very hesitant.
I think that initially there may be a rush, but then it may die down. We need to, as pediatricians and as pediatric providers and primary care, we have to be ready to really listen to address the concerns of parents and to give them the best information we have so that they can feel comfortable. I'm a parent also, we need to feel comfortable about what we do with our children. I don't imagine a rush that we can't meet. I think the city can definitely meet the need.
Brian Lehrer: I don't know if what I said is the case about long waits for booster doses at every pharmacy or doctor's office or whatever. I know there are a number of-- that I've seen where that's the case, but what you just said about the rush to get it and then a lot of people don't get it, as a pediatrician and as someone working on vaccine engagement in particular, how do you make sure that parents who have doubts or concerns at least feel heard?
Dr. Judith Flores: I think that, this is something that we traditionally do as pediatricians and primary care physicians. We have to listen. We have to listen, we listen to people's concerns and be very respectful. It also helps that a lot of us have the facility to give the message in different language and to listen to people's cultural and ethnic concerns around how healthcare has been distributed and how access has impacted our general population health. I think now the fact that the Department of Health looks at issues of racism and equity as a public health feature and factor, is very motivating to many of us.
I think you've got to listen first and you have to keep working with families to get them where they need to be, to get them to be comfortable because most parents want their children to be safe and they want to be the parent that says, "I made the decision for this child that will keep them safe and keep them growing and developing."
Brian Lehrer: Few more minutes with Dr. Judith Flores, pediatrician and engagement practitioner with the New York City Test and Trace Corps, as we discuss the impending approval of a COVID vaccine for 5 to 11-year-olds, it did get preliminary approval from an FDA Advisory Committee this week. Gwen in East Harlem, you're on WNYC. Hi Gwen.
Gwen: Hey, I can't believe I got on. I am really disturbed listening to the conversation. There is a lot of other points of view out there besides what's going on in the mainstream media, and I'm really shocked listening to this doctor. If I had a child, the last thing I would do is put this vaccine in them. This vaccine is still in the experimental stages, you don't know what it's actually going to do long-term. It's not a regular vaccine because it's messenger RNA, which is different from every other vaccine we have ever had. It's the first vaccine we've had which is messenger RNA.
There were no animal studies that were done on this, so we don't know-- What we do know, in the beginning, they were done and all the animals died, so they stopped doing it. To me, to say that this is perfectly safe, don't worry about it, take your most precious little baby and stick them in the arm with something that basically is still in the experimental phases, you have to ask yourself when companies like Pfizer and Moderna get blanket immunity from lawsuits if there are vaccine injuries, what's going on here? I think--
Brian Lehrer: Gwen, I want to ask you one question and then Dr. Flores can answer your questions.
Gwen: Sure.
Brian Lehrer: I don't know if you have kids of your own, but did you or would you get them vaccinated for the other childhood immunizations?
Gwen: My niece got vaccinated twice, got COVID, and gave it to her little premature baby which got COVID. Everyone in my family, by the way, who's gotten vaccinated so far has gotten COVID. This is [crosstalk]
Brian Lehrer: I'm asking you if you get other vaccinations or talk against other vaccinations for children, the childhood vaccinations that every child gets?
Gwen: I've gotten all my vaccinations. I've had all my vaccinations, but I tell you that I have a nephew who is autistic and the severity of autism on the entire family has been devastating and it didn't happen until he had these shots. That's when I began to be more careful, but myself, I am a regular Bloomer Baby, I had all the shots, but shots have changed and the formulas have changed, and this is still in the experimental stages, and we don't know what it's going to do two months out because it's not a regular vaccine.
It's only 8[inaudible 00:19:48] not a huge figure of children that die from this. Very few children will die from this. You're asking us to put this into their body and let's not forget about-- [crosstalk]
Brian Lehrer: Gwen, I hear, I hear. [crosstalk] I'm going to leave it there. All right, last thing--
Gwen: [crosstalk] Heart problem or heart inflammation and--
Brian Lehrer: Well, we did just talk about the heart inflammation and the real data on that.
Dr. Judith Flores: Yes.
Brian Lehrer: Gwen, thank you very much. Obviously, Gwen is a general anti-Vaxxer, she was repeating the debunked, alleged connection between autism and other childhood immunizations, but the central argument that she was making is one that we will hear over and over again, which is that this is experimental, we don't have enough time yet under our belts to know whether there are going to be long-term effects or not. She brings up the newness of the mRNA technology. What would you say to Gwen?
Dr. Judith Flores: I say two things. First of all, I say you have to listen when people talk. Gwen has a right to say how she feels, and I think that our role is really to try to find scientific, verified information that we can share. As far as the duration and not knowing whether this is experimental and cases were very small in children, we've already vaccinated with this vaccine millions of people throughout the world, and a long time has passed. We started vaccinating pretty much in great numbers in January. We're sitting here in October, almost a year later, and we have not seen a lot of the issues that people were concerned about. That's important.
As I said once before, vaccines generally, if they're going to show something, they will show it in the next two months. That speaks to people that want to wait a couple of months, and that's their choice. I think the thing is always, always to be very careful when you look at information. We've looked at the issue of disinformation the surgeon general came out on this several months ago, and a lot of us deal with this on a daily basis.
I always ask people, "Look at what you're reading, look at what you're seeing on the media, check it out, don't share it unless you feel comfortable that this is coming from a good source." Really, it's something that we have to go on, and it's our job, it's our job to try to give people the most updated, accurate information and to make them feel comfortable with decisions about themselves and their family's health.
Brian Lehrer: Do you want to debunk one more time since it was implied in the caller's question that mRNA as a new kind of vaccine, relatively new, does not affect your DNA?
Dr. Judith Flores: MRNA has no influence and no impact on your DNA, it is really a copy of a spike protein that goes in, your body recognizes this protein, it doesn't go into your DNA in the nucleus of your cell, it's in the cytoplasm, and your body really does get rid of it very quickly and allows your body to recognize this protein and prevent severe illness, death in the future. That's why we some-- We do see breakthrough infections because you can still get exposed to the virus and hopefully and in most cases, the vaccine works to even fight off symptomatic infection. No, it does not go into your DNA.
One other thing is if you are-- I want to shout out to people that are pregnant and lactating, it's very important that you speak to your provider because COVID in pregnancy is very serious to both the mother and the child, so we do encourage women now, and the CDC has come out with having them vaccinated against COVID. It's important again to get the information and feel comfortable about it.
Brian Lehrer: One more call.
Dr. Judith Flores: Sure.
Brian Lehrer: Bill in Rego Park, Queens, you are on WNYC. Hi Bill.
Bill: Hi Brian. I'd like to ask the doctor whether there's the possibility of a vaccine for children under the age of five, and if not, why?
Dr. Judith Flores: That's a very good question, and actually, I was just reading about that today. Moderna is one of the companies that's looking at children six months and older. Yes, there is a possibility, it is still in very early stages. They really need, just like with every one of these vaccines, you really have to have good numbers and you really have to have enough data to have the FDA and other agencies analyze. It's not ready yet. Yes, there is a possibility. We vaccinate most infants for flu at six months. It's not out of the box that we're going to be doing this with COVID. It's going to take a while. Again, we have to be very careful and we have to have enough data so not yet.
Brian Lehrer: Last question, Dr. Flores.
Dr. Judith Flores: Yes.
Brian Lehrer: We're going to be doing a segment later this hour on the vaccine mandate for New York City workers, that enough workers are resisting, at least so far, that it may cause an ambulance shortage and a firefighter shortage and NYPD shortage and a sanitation collection shortage come Monday when they would start their suspensions.
Do you have a position about mandating COVID vaccines for school kids? Like almost every school system does for other vaccines considered vital to eradicating deadly diseases? Mayor de Blasio on this one says no, because he doesn't want to do anything that would be a barrier to children attending school. Eric Adams, the likely next mayor, seems more open to a vaccine mandate. Do you, as a pediatrician, have an opinion?
Dr. Judith Flores: I think that we've done a very good job and we can do a very good job right now in schools without the mandates, that as long as we reduce some of those barriers and we make access available and we continue to work with parents and others, we should be able to get to where we need to get for vaccination and for safety. At this point, I don't see us-- I agree with the mayor. I don't see us using mandates right now for school-aged children.
Brian Lehrer: Listeners, we will talk about that vaccine mandate for city workers and the implications after the deadline hits later today, later this hour. For now, we thank Dr. Judith Flores, pediatrician, fellow at the American Academy of Pediatrics, past chief of ambulatory care at several New York City Health and Hospitals facilities and now working on vaccine engagement as part of the New York City Test and Trace Corps. Dr. Flores, thank you so much.
Dr. Judith Flores: Oh, thank you. It's been my pleasure.
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