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Handling hesitancy: How to help uncertain families decide about their kids’ COVID-19 vaccine

Brian L. Simmerman, MD, FAAP

Brian L. Simmerman, MD, FAAP
Providence Medical Park Pediatrics

As expected, the FDA authorized COVID-19 vaccine for children aged 5-11 and the CDC added its recommendation, making kids in our community eligible for the shot. This expansion in eligibility offers us the chance to make continued inroads toward broad immunity and to help return our community to pre-COVID routines and quality of life. But – also as expected – not every parent is eager to have their kids receive the COVID-19 vaccine.

Pediatricians and family practice physicians are used to having conversations with vaccine-hesitant parents. But since the COVID vaccines are new, politically fraught and surrounded by misinformation, this dialogue has taken on a thorny new angle. In my practice, I’m definitely finding a mix of those who are super-excited for their kids to get vaccinated versus those who are opposed.

Navigating these conversations can be difficult, but I believe that encouraging parents to vaccinate is an essential responsibility in our role as caregivers and advocates for public health. In anticipation of the authorization announcement, I’ve had some preparatory conversations with hesitant parents and patients. I’ve found that adopting a slow, open and personal approach offers the best chance for persuading people who are open to, but hesitant about, the vaccine.  

Research and experience show us that data and science don’t always persuade most people to vaccinate, but anecdotes and personal stories do. During these conversations, I share that my own children got the vaccine, and I believe that sharing is more persuasive than percentages and statistics. If you are a family pediatric health care provider, you have likely guided your families about other big decisions – this is another opportunity and I find that lending a personal touch can really help.

Some notes for your consideration, as you engage families in the decision-making process:

1. First: Slow down, listen, and ask questions without assuming anything.

Some families are eager to share their reasons for being hesitant – most often it comes down to the “newness” of the vaccine or safety questions. But at other times, they share cultural, religious or political objections. I allow time and ask questions, trying to engage their concerns in a fair and honest way, without wading into the controversial aspects and opinions.

2. Offer accurate information.

Many parents express concern about the potential medical impacts of the vaccine, and we do have data to share. You can find some key points here. In a nutshell:

Effectiveness:  The Pfizer vaccine was studied in approximately 4,700 patients age 5 through 11; it was determined to be 91 percent effective at preventing COVID disease. (Source)

Safety: The Pfizer vaccine’s safety was studied in approximately 3,100 children, age 5 through 11, who received the vaccine. No serious side effects have been detected in the ongoing study. (Source)

Side effects: Commonly reported side effects are similar to those in older teens and adults. Side effects included injection site pain (sore arm), redness and swelling, fatigue, headache, muscle and/or joint pain, chills, fever, swollen lymph nodes, nausea and decreased appetite. Side effects were generally mild to moderate in severity and occurred within two days after vaccination; most went away within one to two days. (Source)

Myocarditis: Many parents ask me about the possibility that their child – especially boys – could develop myocarditis. The first thing to know is that a COVID-19 infection presents much greater risk for severe myocarditis than the vaccine. The FDA and CDC safety surveillance systems previously identified increased risks of myocarditis and pericarditis following vaccination with the Pfizer vaccine, particularly following the second dose, and with the observed risk highest in males 12 through 17 years of age. Clinical trial data reviewed by the FDA showed no cases in the 5-11 age group. It is generally believed that we still may see myocarditis following vaccination in the 5-11 ages with expanded vaccination. But when it does very rarely occur in older teens, the mild conditions usually improve quickly. (Source)

Dosing: Some parents express concern that a full dose of vaccine could overwhelm a small child’s immune system. The Pfizer vaccine for children 5 through 11 years of age is administered as a two-dose primary series, three weeks apart, but is one third the dose (10 micrograms) than that used for individuals 12 years of age and older (30 micrograms). (Source)

Long-term effects: We don’t yet have data available to address these concerns, but I am able to answer with confidence when these questions arise. Literally all other vaccines we use today show zero latent effect years later. If someone has an allergic reaction, it occurs very shortly after the vaccine and can be treated at the time.

3. Remind parents about the secondary implications – social, educational and mental-health.

We’ve got some good data in hand about the global limitations of home-learning throughout the pandemic; kids didn’t learn much when they were stuck learning at home, even in the best cases.

Students benefit from in-person learning, and we need to do all we can to maintain a conventional school experience, as well as sports and other extracurricular activities. Widespread vaccination of younger children will go a long way toward keeping in-person classes safely in session and reducing quarantine requirements after exposures – not to mention resuming worry-free family gatherings, celebrations, travel and other activities that lead to a well-rounded life.

Some final thoughts: Parents who are uncertain about the vaccine have myriad reasons; what they have in common is a desire to make the best possible judgements in their child’s best interest. I believe that our most effective approach to combating hesitancy is by listening, acknowledging concerns, and speaking plainly and respectfully to help bridge the gap between myths and facts.   

Additional resources
How to Talk with Parents about COVID-19 Vaccination (CDC)
COVID-19 Vaccine Toolkit (American Academy of Pediatrics)