When I was in medical school in the 1980s, a surgeon came to my clinical medicine course to talk about how to guide patients in making decisions. He presented a scenario in which a breast cancer patient had to choose between a lumpectomy and a mastectomy. The surgeon suggested we quote statistics and discuss risks, but he advised us not to answer a personal question: tell me, doctor, what would you do if this were your wife? I cringed at the supposed arrangement of a male doctor and a female patient, but his bigger point was clear. Doctors need to listen carefully to the various issues and histories that parents bring to the clinic in order to address their fears. They should be wary of talking about themselves.
But as a pediatrician I sometimes want to say, just so you know, if this was my kid, I’d do this, because that’s what my whole education tells me.
This moment in the pandemic is one of them. When it comes to COVID-19 vaccines, I want to say, if you were my 16-plus, you’d be vaccinated. If you were my child aged 12 to 15, you would have had your first chance now. And if you were younger, I would count down the days until I could give you a vaccine.
Like most pediatricians, I like a vaccinated child. While researching my book on the decline in child mortality over the past century and a half, I tried to imagine what child practice and parenting would be like if you had to accept that a whole host of potentially deadly diseases – polio, diphtheria, tetanus, whooping cough – could not be prevented or treated. Some kids just wouldn’t survive. But by the time I was training, we had vaccines to prevent those diseases, as well as antibiotics to treat bacterial infections. Even more progress has been made in the field of vaccines since the 1980s, when I did my residency. Pediatricians at the time were still hospitalizing many children for rotavirus infection and treating their dehydration with IV fluids (and those kids were lucky, because kids all over the world were dying from that infection and from dehydration). Doctors were doing epidural after epidural on children with high fevers and concerned about bacterial meningitis.
We are now vaccinating against rotavirus. We perform far fewer epidurals. And we vaccinate against diseases that are unpleasant, but usually not fatal. I had a pretty miserable case of chickenpox when I was a kid, in the 60’s, and I still have a few scars from it. My youngest got the chickenpox vaccine. He never had to scratch feverishly, never had to risk skin infections, never had to be sick of this disease. Instead, a vaccine activated all of its intricate defenses.
I love vaccines, but I also understand that parents have every right to think critically about decisions for their children, and that the story of COVID-19 vaccination is evolving rapidly. Some parents question whether the risk of serious illness in younger children is high enough to justify the risks of a new vaccine. Other parents worry that their children are vaccinated primarily to protect more vulnerable adults. Some are afraid of the vaccines because they have heard that they are dangerous in some way that is covered up. And others say they just want to wait until more information is available.
Let me address those concerns one by one. Children ages 12 to 15 and even younger are at a lower risk than the elderly for a severe case of COVID-19, that’s right. The vast majority of people requiring intensive care are adults. But more than 300 children in this country have died in the course of the pandemic, according to the American Academy of Pediatrics. In comparison, the CDC reported 188 flu-related deaths in children during the 2019-20 flu season. And the CDC has now registered more than 3,700 cases of childhood multisystem inflammatory syndrome, or MIS-C, a serious condition linked to COVID-19. Children now account for more than 22 percent of all new cases of COVID-19, and even children who are not very ill can face potential long-term complications. At the very least, those who test positive for the virus but are asymptomatic will still have to go through the hassle of quarantine. Compare all of these factors to what a vaccinated child may experience: brief acute reactions, including injection site pain, fatigue, fever, chills and muscle aches – all signs that the immune system is being activated.
Vaccinations help individuals, but they also help the community. And that’s a good thing. High vaccination rates reduce the amount of virus in circulation, protecting everyone, but especially those who are immunocompromised or have underlying medical problems. We vaccinate all children against chickenpox, although most children recover quickly from the disease, as people with compromised immune systems can have serious complications. We vaccinate all children against rubella, which causes only mild illness in young people but is very dangerous to a developing fetus if a pregnant person is exposed. So we are already vaccinating children for their own good and to protect the most vulnerable.
As for the rumor about the vaccine, even the most sober adults can succumb to anything when they start thinking about their children. We have witnessed a real-time drama of vaccine trials, authorization discussions and safety questions, portrayed in the headlines with an urgency not typical of vaccine development. In an atmosphere of general fear, genuine scientific concerns can be mixed with baseless rumors, and anti-vaccine activists deliberately try to spread misinformation and foment fear.
For example, I’ve read about the persistent rumor that vaccination against COVID-19 could have some effect on a child’s fertility in the long run. This concern is not tied to any biological reality; mRNA vaccines have no effect on DNA and never even enter the nucleus of a cell, where DNA is stored. Many vaccines have been the target of misinformation campaigns, and many of these campaigns have involved fertility issues because they are so effective at instilling fear in parents. In Nigeria, for example, polio vaccination was hampered in the early years by rumors that the vaccine was a plot to sterilize Muslim children. In the US, anti-vaxxers spread false data that the HPV vaccine could cause infertility. The reality is that vaccinations protect the future reproductive health of children because they protect their overall health. A fully vaccinated child is defended by the strongest and most natural defenses: the highest intricacies of immunology.
And finally the waiting argument. Although the vaccines are new, we know a lot about how they work and how people respond to them because so many adults have already received them. We also have data from over 1 million fully vaccinated 16- to 18-year-olds, which apply very well to younger adolescents. Researchers continue to monitor adolescents for any problems, looking for rare reactions and short-term side effects. Messenger RNA is used for these vaccines in part because it doesn’t stay in the body; it is broken down by the cell after it has conveyed its “message”. What survives is the immune response and protection.
Perhaps partly because we are fortunate to live in a world where children are free from so many dangerous diseases of the past, it is difficult to think rationally about risk. And I’ve seen how sometimes making a positive, active decision (let’s vaccinate!) can feel more stressful than inaction (let’s just wait and see). Many years ago, when I was talking to a concerned mother about the measles vaccine, she told me that if her child got measles, at least it wouldn’t be because she consented, whereas if problems would arise after the vaccination. Well, that would be her fault. I tried to explain why that line of thought was wrong, as I remembered another mother who had refused what was then the DTP vaccine, only to have her son fight a nasty whooping cough, which the vaccine would have prevented. That mother was tormented with guilt and self-blame. Making a health decision for yourself is difficult; making it for someone else, especially your child, can be even harder.
It shouldn’t be that hard: Now that we have safe and effective vaccines, COVID-19 is a vaccine-preventable disease in children 12 years and older. Children no longer need to get sick from the coronavirus, nor do they need to get MIS-C or long-term COVID. They should live their lives safe from the virus and no danger to others. What the vaccines give your child is immunity without disease.
If I were you, I would vaccinate my child.