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Brian Lehrer: It's The Brian Lehrer Show on WNYC. Good morning again, everyone. With the CDC approving COVID vaccines for the youngest among us, the long-awaited vaccines for kids under five have arrived. Parents, we know you have questions. With us now is Dr. Mark Horowitz, a board-certified family physician who has practiced in Manhattan for 32 years and serves as COVID advisor to the City University of New York and the Mark Morris Dance Group. He's here with us today to speak about the tots for shots program as they're calling it and to answer your questions. Dr. Horowitz, thanks for coming on. Welcome back to WNYC.

Dr. Mark Horowitz: Thank you, Brian. Thank you for having me on your show again. Thank you as always for keeping your listeners informed with accurate and timely information about COVID.

Brian: Thank you. Listeners, your questions for Dr. Horowitz about "Shots for Tots," 212-433-WNYC, 212-433-9692, or tweet a question @BrianLehrer. First, can you gauge the demand? So far, this has been available to sign up for, for about a week now. Can you tell if parents of kids six months to five years are rushing to do it or if they're holding back or if there's a lot of ambivalence? How do you read the room?

Dr. Horowitz: How do I read the room? Well, we've done quite a few calls from parents wanting to know if we've received our allocation of the vaccine. That is the only indication that I have, and that is that a good number of parents have called and requested appointments.

Brian: The basic, just the very basic question for parents who've already decided to go for this, where can they find information to schedule a vaccine for their children?

Dr. Horowitz: At the present time, the best source of information and appointments is vaccinefinder.gov, the New York City vaccine portal. Before the program began, I checked that portal and I saw a large number of pharmacies offering the vaccine to infants and children, of course, the five citywide vaccination centers, and then a very, very small number of private practices and clinics.

The one issue that has come up is that pharmacies, by and large, are vaccinating three years and older only, leaving a gap for parents of children six months of age to three years. They're doing this for legal and other reasons. The citywide vaccination centers and the limited number of private practices that are already offering them are giving them to all children and infants six months through six years.

Brian: I see that in New York, state-run mass vaccination sites will not vaccinate kids under five years old. The governor's office is encouraging parents to seek out their pediatricians, family physicians, local county health departments, and the city, that would be the city health department, and federally-qualified health centers at the federal level. Some seeking out that parents are going to have to do in some cases. It sounds like you're saying the pediatricians, which might be the obvious first stop for some families, aren't going to be administering them that much?

Dr. Horowitz: I'm unsure how many practices will. I've read in various places that some practices are choosing not to administer the vaccine because of the storage requirements to have an appropriate freezer and appropriate refrigerator that is not being used for other vaccines and, of course, not being used for food items. There's some expense involved. Our practice has been involved in the vaccine efforts since last March. We've been vaccinating adolescents and adults. At that time, we purchased an appropriate freezer and refrigerator.

There's also electronic temperature monitors that download information to an app that makes sure that the freezers and refrigerators are kept at an appropriate temperature so that the vaccine doesn't go bad. The expense wasn't great, however. I would encourage my colleagues who have initially declined to store and give vaccine to reconsider that because the expense isn't that great. I think you'll see in the next week, a larger number of private practices, both of pediatrics and family doctors, come on board.

I just received an email confirming my order of Pfizer infant and child vaccine. I was waiting on that. I'm going to get 100 doses sometime in the next 48 hours. Haven't received a confirmation of Moderna, but my very able representative at the New York City Department of Health informs me that I should have it by the end of the week. I think other practices that have ordered it or pre-ordered it will be seeing their shipments arrive in the next couple of days.

Brian: All right. Parents, your questions on "Shots for Tots" for Dr. Horowitz, also your stories now that these have actually been available for a number of days. Some of you have probably gotten a shot for your child now eligible six months to five years of age. How did it go? Were there any particular side effects that you want to report? For most of you, a vaccine for a baby or toddler, this is not your first rodeo. This is something you're doing anyway on a whole rash of other shots. Is this any different in any way? You could tell that story, 212-433-WNYC, or ask a question, 212-433-9692. Madeline in Brooklyn, you're on WNYC. Hi, Madeline.

Madeline: Hi, good morning, Brian. Longtime listener. I just wanted to say I got my son vaccinated at the Brooklyn Museum over the weekend. It was a fantastic experience just because we've been dealing with COVID shutdown for the last two years. I have a two-year-old. What this does for my mental health in terms of just knowing that my son will be safe is great. I wanted to say, I have a lot of neighbors and co-workers who are very hesitant about getting their children vaccinated. I was hoping Dr. Horowitz could help me with that. Thank you.

Brian: Thank you. Dr. Horowitz, what do you say to the hesitant neighbors?

Dr. Horowitz: Well, congratulations, Madeline, on making the decision to get your child vaccinated. I'm glad it went so smoothly. Vaccine hesitancy was an issue that we dealt with in adults last year. There were a variety of reasons that our hesitant patients were hesitant to receive the vaccine. The reasons that parents are hesitant are analogous but not identical. The two that I'm hearing most often is, number one, "I don't perceive that COVID is a dangerous disease in infants and children, so why yet another vaccine?"

The second reason is that, "My child had COVID or tested positive for COVID. It was a mild illness. Why does he or she need another dose of the vaccine?" I'll address each of those individually. First of all, you made a very good point about this not being the first rodeo. If you count the number of diseases we immunize children in adolescents against, it totals 15 and we give them a total of 31 shots in their first 18 years of life.

Another two or three, two in the case of Moderna or three doses in the case of Pfizer, is not an extraordinary addition to that already large number of vaccines that we give. We've abolished some very serious diseases, some fatal diseases, and some not so serious and fatal diseases in our lifetime. Answering the question, is it a dangerous disease in kids? The truth is for the overwhelming majority of kids, it isn't a dangerous disease.

However, it remains a disease that does kill some kids. In the United States, there have been 1,086 deaths among children 13 years of age and younger from COVID. In New York City, there have been 28 deaths. Those are 28 deaths too much. If we can prevent even one more death by giving the vaccine, I think we're achieving a lot. The vaccine is safe. It's effective. We can talk a little bit more about the effectiveness subsequently. I think that in the spectrum of diseases that we prevent with vaccinations, this falls sort of in the middle.

We have some diseases that we prevent with vaccinations that are more nuisance diseases than lethal. We have some diseases that we prevent with vaccination that are lethal and deadly and very dangerous. This falls right in the middle. I would choose to vaccinate my children if they were that age. They're grown now, but I would choose to vaccinate my children without any hesitancy if they were of age to receive the COVID vaccine.

Brian: Can you imagine the stat that you gave a minute ago if 28 children under 5 had died from, I don't know, contaminated infant formula or almost anything? We'd be turning the world upside down to prevent another 28 deaths, and yet people look at this and they're like, "I don't know."

Dr. Horowitz: Well put, Brian. Absolutely. Addressing the second hesitancy issue, and that is, "My child had COVID." During the Omicron wave in December and January in the more recent BA1, 2 in four waves in the last 8 to 12 weeks, lots and lots and lots of kids tested positive and lots and lots of families tested positive. The overwhelming majority of those kids recovered very quickly.

Some parents pose the question, "Well, if my kid had COVID, isn't he or she immune?" The answer is the same as for adults. Number one, yes, they're immune for a transient period of time as yet undefined. Number two, we know that what's called "natural immunity," that is the immunity that develops in response to a vaccine or this vaccine in particular, is temporary and wanes with time. The combination of infection with the disease and the vaccine gives extraordinarily strong and durable protection. We all know people.

As a physician, I've taken care of people who have had COVID twice or three times or even more. A child with COVID, even a mild infection, is a real disruption to family life. As Madeline said, it's a disruption to everybody's mental health and the child's social development. Wouldn't it be great if the majority of children in the city were vaccinated and could have playdates and play and gather together without any parental apprehensions or any other restrictions? I think that's a tremendously strong reason to get the majority of kids in the city vaccinated.

Brian: Joseph in Wyckoff, you're on WNYC with Dr. Horowitz. Hi, Joseph.

Joseph: Hi, thank you. I have a five-month-old son. He was actually born during the Omicron wave. We were in a hospital room for a week and we had Brian on every day. He'll be a lifetime listener, hopefully. I'm wondering, is there a preference that we should have between the shots? I think Moderna is two, Pfizer is three, and is one preferable? When we got vaccinated, we have this fully-vaccinated phase and then the boosted phase. Does it make sense to talk about that or think about it like that anymore or is that not helpful at this point? I'll hang up and take the answer off the air.

Brian: Thanks, Joseph, and congratulations on your newborn. Dr. Horowitz?

Dr. Horowitz: Joseph's question was an extraordinarily good question. I'll start with my answer. My answer is whichever vaccine goes into your child's arm is the correct vaccine. It matters not whether it's Moderna or Pfizer. He was correct in saying that Pfizer is a three-dose vaccine and the Moderna, two. I'll add the words "so far." It seems likely that additional doses will be necessary to maintain immunity and also to maintain immunity to emerging variants.

Same thing will happen for adults. There will be tweaked versions of the vaccine. Moderna has already announced preliminary results of their Omicron-based adult vaccine as being highly effective. I think you'll see additional doses necessary in the future. The distinction between two doses and three doses is not meaningful to me at the present time. I think that parents should take whatever vaccine that their provider or the center they go to provides.

Now, the efficacy data is a little bit hard to interpret. Moderna published data that showed an approximately 50% reduction of serious illness, hospitalization, and death in young children who received their vaccine. Pfizer's number was a little bit higher, but it was based on a very, very, very small sample size. I suspect that when push comes to shove, both vaccines, since they both utilized the same mRNA technology, will have the same efficacy and will be tremendously effective in avoiding serious illness, hospitalization, and death.

Brian: Kylie in Northern Virginia, you're on WNYC with Dr. Horowitz. Hi, Kylie.

Kylie: Good morning. My question, so I have a four-year-old. He's turning five in September. He's starting kindergarten in September and my husband and I are both vaccinated. We are not boosted, which is another conversation because of an interaction that I had from my vaccine. We are not boosted, but my question is I understand that the result of these studies have not yet been peer-reviewed.

My thinking is that I would like for them to be peer-reviewed, particularly since the United States is the first country that's having vaccinations for kids this young. We have a mixed reputation with vaccinations that fall in this country. I just wanted to know, what would be the logic to waiting for these results to be peer-reviewed? What could we learn from having other trusted professionals review these findings and offer some commentary before we begin?

Brian: Kylie, thank you. Well, is the premise accurate, Dr. Horowitz? Were these studies on the Pfizer and Moderna vaccines for little ones not peer-reviewed?

Dr. Horowitz: They haven't been published yet, but I would hesitate to say that they're not peer-reviewed because they both presented their data through both the FDA and the CDC. Both agencies approved the vaccines for use in those age groups. They had to go before a pretty distinguished panel of experts at both agencies with their data, but I do understand this caller's hesitancy. I just want to emphasize that we've waited this long for the child vaccine.

I want to say this to all your listeners. A parent should not be considered negligent of their child if they are a bit hesitant and want to wait for more information to come in. It does necessitate continuing to take stronger precautions against your child contracting COVID, but I would not term anyone who's delaying the vaccine in their child in any way negligent if they're trying to gather more information. I hope I could help this caller by saying that the FDA and CDC panels consisted of highly-distinguished scientists who I would consider peer reviewers.

Brian: How are the side effects in babies and toddlers? What's the experience compared to the range of what we know from adults who've gotten the shots?

Dr. Horowitz: The dosage being used is quite small as compared to the adult doses. The range of side effects has been much smaller, much lower. Of course, soreness at the injection site is still very common, but things like fever and brain fog and headache and more systemic and durable symptoms have not been reported to any great degree. Certainly, it's going to happen in some kids. With the existing 15 vaccines that we give for other diseases in adolescents, some of these side effects are seen in those vaccines as well. It doesn't differ greatly from existing vaccines that we give. They're much milder because the dose is so small.

Brian: Listener asked via Twitter, or it's really a statement, "I think it's important to also discuss that there are still concerns about long COVID for kids." He or she or they wrote a hashtag #LongCOVIDKids and not just the tragedy of death with COVID and children. What do you have on long COVID in kids?

Dr. Horowitz: Extremely good question. I just sat on an airplane next to a pediatric ear, nose, and throat specialist yesterday. I asked her that very question. She is seeing kids who have had COVID with a variety of post-COVID symptoms, including persistent loss of smell and taste and various ear and hearing abnormalities. Long COVID is very much a reality in children. It may not be as common as in adults. I haven't seen any prevalence rates published. I'm sure that information is available, but the vaccine will prevent, to a great degree, long COVID just like they do in adults.

Brian: Andrea in Park Slope, you're on WNYC. Hi, Andrea.

Andrea: Hi, so we have a 14-month-old daughter. I have a strong family history of autoimmune disease. I have an autoimmune condition. My sister does, my mom does. We've been really, really careful in just not exposing our daughter to COVID and taking as many precautions as we can. We've avoided plane travel. She doesn't go to daycare just because we know that COVID could trigger, in the long run, an autoimmune condition for her.

She's eligible for a pediatrician to get the COVID vaccine. It would be Pfizer next week and we are really excited for her to get that. I am curious if it's part of any of the studies that they've done. They've looked at whether the vaccine itself could trigger an autoimmune response for kids that are this small and their immune system is still developing.

Dr. Horowitz: My answer is an unqualified no, that there's no connection between the vaccine and the subsequent development of autoimmune conditions. This has come up for me in my capacity as a COVID advisor to a university. I've been asked to review requests for exemptions from the vaccine mandate. In that capacity, a number of people have raised the issue of having an autoimmune disease and being concerned that the vaccine may trigger or worsen their own immune disease. We've done some extensive research on this subject. We've found no evidence that it does so.

In fact, people with autoimmune diseases are more susceptible to severe COVID, whether or not they're being treated with immunomodulators. If any of your listeners out there have an autoimmune disease that has necessitated treatment, the treatments are immune-based, whether it be steroids or what they call biologics. Those certainly interfere with your immune system and can make you more susceptible to more severe infection with COVID. I say without any qualification that there's been no evidence that the vaccine triggers autoimmune diseases or makes them worse.

Brian: Parents, thank you for your questions. Hopefully, we've provided some decent answers now that the shots for kids six months to five years are available to prevent COVID-19. We thank Dr. Mark Horowitz, a board-certified family physician who has practiced in Manhattan for 32 years and serves as COVID advisor to the City University of New York and the Mark Morris Dance Group. Dr. Horowitz, thanks for coming on again.

Dr. Horowitz: Thank you so much, Brian. It's been my pleasure.

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