The Perfect Enemy | An emergency doctor and parent sorts through Covid vaccine options for kids under 5
July 1, 2022

An emergency doctor and parent sorts through Covid vaccine options for kids under 5

An emergency doctor and parent sorts through Covid vaccine options for kids under 5  STATView Full Coverage on Google News

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After months of delays and setbacks, there finally appears to be hope that there will be Covid-19 vaccine authorized for children under 5. Next month, the Food and Drug Administration plans to convene its vaccine advisory panel, known as VRBPAC, to review both Moderna and Pfizer-BioNTech’s shots for the youngest kids.

The vaccines are not identical: Moderna’s is two doses of 25 micrograms each, a quarter of Moderna’s adult dose. Its efficacy was between 37% and 51% in a trial against symptomatic Covid during the Omicron wave. Pfizer and BioNTech’s vaccine is three doses of 3 micrograms each, a tenth the adult dose. A preliminary efficacy figure based on only 10 cases seen in the trial was 80%, although that could change once more cases accrue.

So how should parents look at these two potential options in vaccinating young kids against Covid? The hosts of “The Readout LOUD” spoke with Jeremy Faust, an emergency physician at Brigham and Women’s Hospital, instructor at Harvard Medical School, and a dad of a kid under 5 who’s sorting through all of this himself.

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This interview has been edited for length and clarity.

Walk us through how you’re looking at the available information on each of these vaccines and which one, if either, you might choose for your child.

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I think the most important thing is that one of them be available as soon as possible. This has been quite a slog, and I don’t need to say that as a physician. I just say that as a parent.

In terms of deciding between Pfizer and Moderna, for me, it’s really hard, because I actually think that Moderna has a real advantage here. Even though the readouts we have so far indicate that Pfizer would seem to have more efficacy against symptomatic Covid, I’m not really swayed by that. I think that might be a short-term mirage and that in reality, they’re probably both pretty similar.

Given the differences in the vaccines, how do you weigh the potential differences there in efficacy and administration? How do you think physicians are going to look at that versus how parents are going to look at it?

Well, one thing is timing. That’s what’s on my mind. We’ve been through so much for so long that the delayed gratification of a product like Pfizer that could be a little better, but we’re not even sure. With Moderna, we would be able to get the first dose in and then a second dose 28 days later. Then, basically the next week, you can assume that the child is protected against severe disease. With Pfizer, we know that the first two doses, which would be in a similar time frame, would not provide that. And then you’d have to wait two, three months until that third dose, and then another week after that.

I just want my kid to not end up in the hospital the way literally 100,000 kids, 125,000 children in this country have been hospitalized either for or with Covid. I am not interested in adding any more to that. So for me, the immediate gratification of having it done within a month as opposed to two or three months is holding sway. Other people might love that early number that [co-host Meg Tirrell] mentioned, the 80% number from Pfizer and say, well, I’m going to wait two or three months. My hesitation there is that maybe a third dose of Moderna is coming around on the pipeline and would equally do that as well. So that’s why I’m sort of leaning Moderna. But we’ll see what happens as the data come out.

Based on the safety and tolerability of these vaccines, they might have different profiles. How do you weigh what you know about them so far against the fact that a lot of people will point out young kids have much lower risks of bad outcomes from Covid than adults?

One thing is the dosing differences for this particular age group. It really is a lot less [than for adults] — it’s a quarter for Moderna, a tenth for Pfizer. And when you look at the outcomes that have really made the headlines, myocarditis after the vaccine — which is real but rare — that really occurred mostly in young males, 12 and up, 15, 16-year-old-males, 25, 30. We’re talking about teenage adolescent and young adult males had this, who were basically getting the full adult dose, the same as anyone. … And we also know that from from Israel and other studies that spacing out the vaccine in terms of myocarditis is another way to make it even more rare. The only place I’ve really seen even a scintilla of a problem is in a group who got the full adult dose, who might be on the lower side of the male age group. So for the kids, the little ones, I have yet to see anything concerning.

On the aspect of do they really need it — I’ve been looking very closely at the data for two years now. And I see over and over again the downplaying of this virus for kids, which leads to the fact that you’ve had 125,000 kids hospitalized. And look, maybe half of those are incidental. That’s still a really high amount. That’s on a population level, one in a thousand kids. Then you’ve got this awful multi-inflammatory syndrome in children, which has hospitalized thousands and killed some. This virus is one of the worst things I’ve ever seen for a kid. And I’m looking forward to getting my kid absolutely protected from those numbers.

There’s been a lot of debate and outrage from some parents over the timing of all of this. There have been many delays in the clinical trials and the FDA reviews. More recently, there was a suggestion that the FDA would hold back its review of Moderna’s vaccine so that it could simultaneously evaluate Pfizer’s. This frustrated many parents who just wanted any good option as quickly as possible. What’s your take on all that?

It looks bad, right? They claim that they did not do that, that the FDA did not hold anything back to wait for Pfizer. But in reality, the timing between Moderna’s first readout of their data was back in March. Here we are almost in June before a VRBPAC meeting was going to happen. I am led to believe that some of this was administrative mistake or administrative inefficiencies over at Moderna, and that they’re new at this. I’ve heard some of that, but that’s not the whole story. It seems a little too perfect, right? That there was the sense that they’d wait and then it was longer than it usually would be, the interval between the press release readout and the FDA VRBPAC meetings. And then, lo and behold, late May, Pfizer shows up to the party. It’s going to be hard for parents like me to look at the whole timeline and think that it was just completely random that they happened to both line up for the same meeting.

How have you and your family navigated all of this? You know, just thinking about kids’ safety versus wanting to give them a normal life. How do you do that when you’re the last group that doesn’t have access to a vaccine?

We’ve been careful, we’ve been lucky, but we have not been at the extreme. But we’ve really picked our spots. Our 4-year-old has been going to preschool since the fall of 2020. And they did weekly testing at first and then they did weekly testing followed by rapids halfway through. They took this very seriously. They did masks all the time for kids over the age of 2. Then eventually they dropped the masks outdoors. They still do masks indoors. And there have been been cases in the school, in her classroom. We’ve been lucky. We’ve been happy to have her join us on trips across the country to see her grandparents. And, you know, she masks for five hours in the plane and she’s good about it. But we have not done things like take her to something indoors, like indoor dining. At one point last summer, when she was 3, she said, “I want to go to a restaurant some day.” And we were like, “Oh, gosh, oh, geez, OK.”

It was so sad. And so we’re just like, OK, fine, wait a minute. There’s an outdoor restaurant that serves amazing tacos nearby. We literally took her out to dinner the next weekend outdoors, and it was fine. And so we just pick our spots, and we ourselves don’t do a lot of indoor dining just to protect her. We only pulled her out of school for one week, which was the peak of Omicron, when I did the math and realized that it was just statistically almost impossible to justify sending her to school for seven days. As a lot of parents know, it’s just a matter of picking what matters. But the second she’s vaccinated, it’ll be the children’s museum, probably, and it’ll be music lessons with a teacher who hasn’t taken a rapid test. And other than that, though, we’ve doing a lot of rapid testing for people who come in the home.