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--:-- Host (Halima Shah): It's Today Explained. I'm Halima Shah, filling in for Sean Ramaswaram this week. We are a year into the pandemic, but President Biden says there is hope on the horizon. After this long, hard year, that will make this Independence Day something truly special, where we not only mark our independence as a nation, but we begin to mark our independence from this virus.
--:-- Host (Halima Shah): That's good news for just about everyone, especially for parents. Dad, I don't know how to get in a Google Classroom. But it's too much to read the email. It's too much to read. It's like 50 pages long. Home school. I'm tired of it. I'm tired of home school.
--:-- Host (Halima Shah): Some kids are starting to leave the house with masks and social distancing and staggered school schedules. But to truly get back to normal, we need something we don't have yet. Vaccines for kids. And approving those isn't going to be easy, but it will be worth it because kids can get COVID-19.
--:-- Host (Halima Shah): So at this point in time, about 2.2 million kids in the U.S. have contracted the disease that we know of, which is about 11 percent of the total case count in the U.S. This is according to the CDC.
--:-- Host (Halima Shah): And out of that proportion, very rarely do they get very sick. Caroline Chen is a health care reporter at ProPublica. She laid out the rare but real scenario of what happens to some kids who get COVID-19.
--:-- Guest (Caroline Chen): So a lot of your listeners might have heard of what's known as multisystem inflammatory syndrome in children, MIS-C, which is when basically the immune system kind of freaks out and there's sort of widespread inflammation, which can cause cardiac dysfunction and kidney injury and sort of all sorts of inflammation throughout the body.
--:-- Guest (Caroline Chen): And this type of case, there have only been about 2,000 cases as of early February. All of this to say that kids are not totally spared by coronavirus, even though it much, much more rarely affects them seriously.
--:-- Host (Halima Shah): So around 11% of all the cases that we have seen in the U.S. have impacted kids under 18 that we know of. And then there's this even smaller percent that gets a really scary inflammatory syndrome called MIS-C.
--:-- Host (Halima Shah): But now we do have a vaccine. So who can get it? What is it authorized for by the FDA, i.e. who is allowed to get it? The answer is for children age 16 and up.
--:-- Guest (Caroline Chen): So that's what it's indicated for in the label. And that's what it's been tested for and sort of proven to be safe and effective for. So 16 and up right now.
--:-- Guest (Caroline Chen): And what's the state of vaccine trials for younger children, everyone from age 15 to day one? I'd like to make a distinction here between teens, so this is, you know, 12 to 15, basically, and then younger kids.
--:-- Guest (Caroline Chen): I know when we talk about kids, generally, we often think of kids as, you know, anybody under 18. But both from a biological standpoint and then subsequently how manufacturers in vaccine trials are viewing kids, they really split them into these two categories, which is you can think of like basically high school and elementary and younger.
--:-- Guest (Caroline Chen): So that will be sort of helpful as a framework just to think about what's happening in kids at large. So there are multiple trials ongoing for the teens groups and Pfizer has already finished enrolling its 12 to 15 year old trial and Moderna is in the middle of enrolling as well.
--:-- Guest (Caroline Chen): So that teenage cohort, the trials are well underway. When you start going under the teenagers into the younger kids, that's where the timelines get a little bit squishier because we just don't know when those trials are going to be enrolled in the first place and then completed.
--:-- Guest (Caroline Chen): So oftentimes the timelines that are given by officials or by trial investigators just have to be estimates. So at this point, I think what we can say is that the teenage trials are well underway. The younger children trials will start after the teenage trials are done, and the timeline for those are much squishier.
--:-- Host (Halima Shah): We've heard President Biden really talk about prioritizing getting children back to school and back to school soon. I mean, with that goal in mind, have any officials talked at all about getting younger kids vaccinated so they can return sooner as well? Have they given any projected date that they'd like to have this done by?
--:-- Guest (Caroline Chen): I want to first acknowledge that there's nothing simple or easy about any conversation about schools. I had the opportunity to interview Dr Fauci and when I originally asked him about this in early February he said that he was hoping to see by the time we get to school opening we will likely get people who come into the first grade.
--:-- Guest (Caroline Chen): Since then, so much more recently, he's sort of changed the timeline and he said that, you know, we'll probably see high schoolers have the opportunity to get the vaccine by fall, but for elementary students, probably not until the first quarter of 2022.
--:-- Guest (Caroline Chen): So the timeline has sort of been pushed back. But I think that when you talk about prioritizing getting kids back into school, it's not just vaccines. Vaccines is one factor that could help kids be more comfortable getting back into school, but it's not sort of like a binary factor here.
--:-- Host (Halima Shah): Well, let's talk about the case for vaccinating kids in the first place. Because if vaccines are one of the many factors that will help kids get back to school, I can imagine there's going to be a lot of mixed emotions about this.
--:-- Guest (Caroline Chen): I mean, on one hand, you want your kid to return to the classroom, but then on the other, you might think kids are already at such low risk for COVID-19. Why should I subject them to a new vaccine whose long-term impacts aren't even clear yet?
--:-- Guest (Caroline Chen): So all of what I'm sharing with you here comes from my reporting by going to pediatricians and going to infectious disease experts. And so what I went to them and said was, look, if these studies pan out, you know, best case scenario, would you want every child to get a vaccine and why?
--:-- Guest (Caroline Chen): And I talked to about five experts who were all pediatricians and some of them were also infectious disease experts. And they all were like, yes, I would want every kid to get a vaccine.
--:-- Guest (Caroline Chen): And it was interesting because there were sort of two levels on which they were thinking. One was the level at which they were saying, for the individual kid, we still want to make sure that they don't run the risk of having, of course, the chance of getting something like MIS-C.
--:-- Guest (Caroline Chen): Because it is still possible, even though it's a super low chance, it is still possible. And then, of course, we have cases that are coming up like long COVID, which has been seen in young adults, in teens, where even if you have potentially mild symptoms, they sort of have long term effects of COVID.
--:-- Guest (Caroline Chen): So you're balancing the individual risk here of obviously almost zero chance of fatality, but there are potential long term side effects of catching COVID for the individual patient.
--:-- Guest (Caroline Chen): So that's sort of an individual question. Every day when I wake up, I have constant migraines, severe headaches, and I'm super dizzy. My stomach hurts, I vomit, my heart races, and I can't read or write.
--:-- Guest (Caroline Chen): But then there was this population level argument that almost everybody was making, which is that children are like 20% of the country. And right now, to get the pandemic under control, there are so many reasons why we want every single person who can get vaccinated to get vaccinated.
--:-- Guest (Caroline Chen): So we need to try to reduce the threat of new variants, for example. Like every case of COVID is a new chance for the virus to mutate and turn into something else. Like the virus doesn't know whether it's in a kid's body or an adult's body.
--:-- Guest (Caroline Chen): And every new case gives the virus a chance to mutate. We don't know the probabilities here, But one of the pediatricians I talked to said, well, you know, there's always a chance that the virus turns into a variant that could be more dangerous for children.
--:-- Guest (Caroline Chen): That's his worst case scenario. He really does not want that to happen. So even though very few kids develop these severe cases of COVID-19 and the inflammatory syndrome that could result from it, we should basically vaccinate them, one, to help us reach herd immunity, and two, because it's going to help us avoid new variants.
--:-- Host (Halima Shah): Yeah, I will say here that at this point in time, I don't know if we are going to, this is a whole other podcast that we could talk about. Are we going to reach herd immunity as a country or a globe or is COVID-19 going to ultimately become endemic?
--:-- Host (Halima Shah): But the goal is, of course, for us to curb this pandemic, end it and make COVID-19, if we can't make it, totally go away. To turn it into something where we really don't have to be scared of it, like basically reducing it to a cold.
--:-- Guest (Caroline Chen): And these vaccines can do that because they have been proven and they have incredible efficacy at keeping people out of the hospital, even if they do catch the virus.
--:-- Guest (Caroline Chen): So I guess the additional benefit to keeping kids healthy and also just the broader community healthy is that this is also going to restore some semblance of stability in our worlds again.
--:-- Guest (Caroline Chen): And kids might finally be able to go to karate class or go to school and parents can actually balance their work schedules a little bit more easily.
--:-- Host (Halima Shah): But that also makes me wonder if we should be concerned at all that kids have already started returning to school and they're not vaccinated.
--:-- Guest (Caroline Chen): I think that there are definitely ways that you can go back to school safely with multiple different mitigation measures. And I think that this has sort of been shown that when you sort of stack these different mitigation measures together, that you can provide a safe environment for students.
--:-- Guest (Caroline Chen): However, I think that that still makes it hard in some cases for kids to do maybe things that are like much more intimate. Like you can't keep kids apart when they're doing like a karate class or something which would involve like much more close contact.
--:-- Guest (Caroline Chen): Right. So I think it's not totally normal or in some cases where the classroom infrastructure makes it hard for kids to be separate. And that means that they can only go to school half the week because you have to do half the class, half the class.
--:-- Guest (Caroline Chen): Right. In order to be able to space kids out enough. So to have sort of the total normalcy that everybody really really wants having vaccines as another tool among our set of mitigation measures to be able to just bring us back to where we want to be I think is another argument for the vaccine
--:-- Host (Halima Shah): So what it going to take for kids to get vaccinated Oh my gosh there a lot that we can talk about here, but I would put them into two broad buckets. One is testing, and the other is trust.
--:-- Guest (Caroline Chen): More with Caroline after the break.
--:-- Host (Halima Shah): Support for today's show comes from Adio. What is Adio? Adio is an AI-native customer relationship management system built specifically for the next era of companies.
--:-- Host (Halima Shah): They say it's extremely powerful, adapts to your unique data structures and scales with any business model. According to Adio, Adio takes less than a minute to set up. And within seconds, you will have your email and calendars synced.
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--:-- Host (Halima Shah): Caroline, when we left off, you said that we need two things to get kids vaccinated. One of them is testing and the other is trust. Let's start with testing. Why is it so hard to make a vaccine for kids?
--:-- Guest (Caroline Chen): In the case of the COVID vaccine, after we had done what they call the phase one trials, which is just testing for safety in healthy young adults, the next most urgent pull that we went to was making sure that it worked in the elderly.
--:-- Guest (Caroline Chen): And this is because COVID has such a terrible impact on the elderly. Now, when we're moving on to children, we can't just say because it works in adults, therefore it works in children.
--:-- Guest (Caroline Chen): I've heard so many pediatricians say to me, children are not just little adults. They're their own thing.
--:-- Guest (Caroline Chen): And so remember right at the very start of our conversation, I said, it's helpful to think about this in two buckets, the teens and the younger children.
--:-- Guest (Caroline Chen): So the teens really are more like small adults. And so the trials are giving them the same vaccine as the adults. The younger kids, though, they have to do what they call dose de-escalation trials.
--:-- Guest (Caroline Chen): And what was described to me from a pediatrician was that you're kind of looking here for kind of like a Goldilocks level.
--:-- Guest (Caroline Chen): So he says, as you go down in age, you give the smallest possible dose of vaccine that we think is reasonable. And then you steadily increase until that point where we get that magic level, which it works great and the side effects are tolerable.
--:-- Guest (Caroline Chen): And one thing I want to explain up front is that these trials are not going to be as big as the adult trials. So instead of having about 30,000 people, which was the size of the adult trials, they're going to enroll about 3,000 kids.
--:-- Guest (Caroline Chen): This is for the adolescent trials. And instead of waiting for the kids to get sick and tracking who goes in the hospital, which is basically what they did for the adult trials, which is, can this vaccine stop people from getting sick and being hospitalized, which was the main question for the adults.
--:-- Guest (Caroline Chen): Because as you remember, so few kids get hospitalized anyways. If they wanted to track that kind of effect, they'd have to enroll so many kids. It'd kind of be impossible.
--:-- Guest (Caroline Chen): What they're doing is they are tracking the immune response in kids' bloods, which is like, what antibody response do you produce? And say this vaccine is safe and effective for kids.
--:-- Host (Halima Shah): What will the rollout be like, especially when not all seniors have even gotten theirs? This is going to take a little while.
--:-- Guest (Caroline Chen): But I think by the time we get the data from these clinical trials in teens and then in younger kids, I don't think supply is going to be as big an issue by then.
--:-- Guest (Caroline Chen): Because we already know that based on the projections of what the U.S. has contracted by Pfizer, Moderna, and then Johnson & Johnson, that we should have enough vaccine for any American adult that wants them by the end of July, at least if not earlier.
--:-- Guest (Caroline Chen): So I'm not too concerned about there being enough supply. I do think that if they end up with a different dosage for kids, you know, it might take a little while to sort of re-ramp up making the kiddie dosage.
--:-- Guest (Caroline Chen): What I am curious about though is where will the kids get their vaccines? And by that, I mean, will there by then, say in September and going on, be the ability for kids to get their vaccines at the pediatrician's office?
--:-- Guest (Caroline Chen): Right now, what we've seen so far in the US is mainly people getting vaccines at max vaccination sites.
--:-- Guest (Caroline Chen): And that made a lot of sense early on because there just weren't that many vaccines and particularly Pfizer's vaccine needed ultra cold storage.
--:-- Guest (Caroline Chen): And so it was difficult to handle and you couldn't just sort of like sprinkle a handful here and a handful there at primary care doctors' sites because they couldn't store them.
--:-- Guest (Caroline Chen): But as we get more and more vaccine available, I really hope there will be a way for it to be able to be administered, ideally, you know, in my dream world at pediatricians' offices, because that's where people are used to getting their shots.
--:-- Guest (Caroline Chen): And I do think that at the end of the day, this is going to be a very personal choice for every parent. And being able to discuss the data that's available from these trials with a pediatrician and ask all your questions to your family doctor about the vaccine it would just make so much sense then to be able to get the vaccine right there and not then have to have like this whole discussion with your family doctor or with your pediatrician and then have to go to a mass vaccination site to get your shot
--:-- Host (Halima Shah): So let's talk about the other factor you mentioned, which is trust. What are you hearing from parents so far regarding giving their kids the COVID vaccine?
--:-- Guest (Caroline Chen): Every parent I've heard from, you know, has just a lot of feelings about the vaccine. And I think that makes a lot of sense.
--:-- Guest (Caroline Chen): There's a huge spectrum. I've heard from parents who are incredibly eager for their kid to get the vaccine and who have some of them who have kids who are at who have high risk conditions, who they're really scared, will get COVID.
--:-- Guest (Caroline Chen): And so they see the vaccine as a way for their kid to be able to get back to normal life. So they're on the end of, you know, I want my kid to get the vaccine like yesterday. Why has this not been authorized yet? Why aren't the trials moving faster?
--:-- Guest (Caroline Chen): On the flip side, I've heard from parents who say, the risk to my kid from COVID is so low. Why would I ever give them a vaccine? Like, this is absurd.
--:-- Guest (Caroline Chen): The foremost concern is about the side effects. We are not sure if it's going to be fever or pain and whatnot.
--:-- Guest (Caroline Chen): I think that the risk, the side effects from a vaccine are way higher than the risk from COVID. And so I can empathize with all these emotions coming from parents.
--:-- Host (Halima Shah): I think at the end of the day, as I said, this is a conversation between parents and their pediatrician. And I think really rest on the data that needs to come out from these trials, which is why it's going to be really, really important that these trials be done transparently.
--:-- Host (Halima Shah): You know, Caroline, anytime we talk about kids and vaccines, the name that comes to my mind is Jenny McCarthy.
--:-- Host (Halima Shah): We do not need that many vaccines that we need. The chickenpox, I think, can be a parent's choice. The rotavirus, the flu shot that still contains mercury.
--:-- Host (Halima Shah): Who is the celebrity who's gotten really famous for creating a lot of suspicion around vaccinating children and claiming it has links to autism.
--:-- Guest (Caroline Chen): And I think when you have these kind of high profile people talking about it like this, people do start to buy into that, regardless of whether or not there's much grounding in science.
--:-- Guest (Caroline Chen): Is there going to have to be a huge public outreach effort to get kids to take this new vaccine when there are already parents out there who are skeptical of getting their child vaccinated for measles or rubella?
--:-- Guest (Caroline Chen): Well, first, I think it's really important for us to state for the record that there is no link between any childhood vaccination and autism.
--:-- Guest (Caroline Chen): And that has been proved over and over and over again by now in the science and data. So I want to make that very, very, very clear first.
--:-- Guest (Caroline Chen): Great. And foremost.
--:-- Guest (Caroline Chen): So with regards to vaccine skepticism or vaccine hesitancy, I think what's most important here is really listening to people's concerns.
--:-- Guest (Caroline Chen): I think that it's unhelpful to lump together people who have questions, very legitimate questions about, you know, what are the side effects? You know, how well has efficacy been proven? You know, people who I would call vaccine questioning or people who have very well thought out questions as to why or why not should I get the vaccine with people who are anti-vax.
--:-- Guest (Caroline Chen): I think there is a small, very vocal anti-vax crowd that will never change their mind no matter how much data they see.
--:-- Guest (Caroline Chen): And I think that that's very, very different from a parent who has questions and wants to see the data.
--:-- Guest (Caroline Chen): And I think that that's why I'm such an advocate for like seeing evidence and talking it through with someone who really knows what they're talking about.
--:-- Guest (Caroline Chen): And I think it's important to separate those two and not just be like, oh, like you're asking questions. Are you anti-vax?
--:-- Guest (Caroline Chen): But I do think that the flip side is to recognize that a lot of pediatricians, infectious disease experts, and immunologists are closely scrutinizing this data and also want the best for kids.
--:-- Guest (Caroline Chen): And so I think there's a point where one does need to recognize the expertise of people who actually study this and sort of pay heed to their word.
--:-- Guest (Caroline Chen): I would say that these vaccines are incredibly closely scrutinized right now by the scientific community.
--:-- Guest (Caroline Chen): And that also gives me some comfort knowing the number of eyeballs that are on this data, because I feel like it would be really hard for anything to get by right now if there were any questions about the way the trials were set up or about any of the data.
--:-- Guest (Caroline Chen): The fact that the FDA is having public advisory committee meetings I think was a really good call for them because the data can be discussed publicly by an independent panel of experts that are not employed by the FDA and can come and independently ask questions.
--:-- Guest (Caroline Chen): And in fact, many of the people on the advisory committee, like Dr. Paul Offit, are pediatricians themselves.
--:-- Guest (Caroline Chen): So I think they will probably have a lot to say about the pediatric data. And I'm really looking forward to hearing them discuss the data when it becomes available.
--:-- Guest (Caroline Chen): And as a health reporter, I'm going to be doing my best to share it with the world as it comes up.
--:-- Host (Halima Shah): Caroline Chen, thank you so much for joining us today.
--:-- Guest (Caroline Chen): Thanks for having me.
--:-- Host (Halima Shah): Caroline Chen is a healthcare reporter for ProPublica. I'm Halima Shah, filling in for Sean Ramoswaram. It's Today Explained. Thank you.
