Dr. Farber’s blog part II

Should your child have a COVID vaccine, and associated boosters, even though it is relatively new?  Categorically, yes.

Most vaccines take years, or even decades, before they can be released onto the market; they have to prove both safety and efficacy.  COVID vaccines, in contrast, have been released under expedited protocols.  Part of the reason for this was the enormity of the pandemic, and the need for a vaccine.  The size of the pandemic, however, also allowed scientists to test enough people, and confirm the vaccine’s value.  For example, we see almost no polio in the world anymore.  It will be almost impossible to show that a new vaccine for polio would be superior to our current one; the disease is so rare you would need to test hundreds of millions of people to find out. Unfortunately, with COVID, we had these sorts of numbers (there have been over 100,000,000 reported cases in the United States alone, and over 1,000,000 associated deaths).

Is the COVID vaccine 100% safe?  No; nothing in life is.  Is it safer than being unvaccinated?  The data here are overwhelming that it is.  This applies even to worrisome side effects, such as the rare risk of teenage boys developing myocarditis after the vaccine.  The chance of this happening is still less than that of an unvaccinated boy getting myocarditis.

In looking at the vaccine, we need to define what we mean by effective.    As with the flu vaccine, many children who are vaccinated can still come down with COVID; protection may be around 50% or so.  While I believe that reducing the COVID burden by half is valuable in and of itself, the real effectiveness of the vaccine lies in its ability to prevent hospitalization and death, and here it is over 75 percent effective.  In this country, with the availability of vaccine, the vast majority of deaths from COIVD nowadays occurs in the unimmunized.

Children, for not well understood reasons, tend not to become that ill with COVID (‘only’ around 2000 deaths in this country so far).  Why immunize them in this case?

First, children do die, or become hospitalized, from the disease.  They can be quite ill and miserable feeling even if not hospitalized, and the chance of that happening is reduced with the vaccine.  We are also just beginning to learn more about ‘long COVID,’ and its sequelae, and preventing COVID will prevent long COVID.  Lastly, children with the illness can pass it on to others who are more likely to have serious consequences (grandparents often fall into this category); being vaccinated reduces this risk.

Why do we keep needing boosters?  Does this mean there is something wrong with the vaccine?  No; immunity seems to persist, but the virus mutates, rendering previous immunity less effective (but not absent), so the vaccine needs to keep up; each new mutation is, in some ways, a new disease.  This is similar to what happens with the flu virus, and vaccine, each year.  It would be great if COVID stopped mutating so rapidly, but that is unlikely.

You may be wondering why we don’t put the COVID vaccine and the flu vaccine in the same dose, so we only need one shot.  I suspect this will happen in the future.  However, it is not a given that you can just merge the two. It is possible that the components in one vaccine counteract the effects of the other, so that combination vaccines need to be carefully studied before doing this.  This takes time.  In a similar fashion, when the COVID vaccine first came out, we were instructed to wait three weeks on either side of it before giving a different vaccine.  We now know that is not necessary, but it had to be proven first.

One last point to go over.  There is a logistic problem with the COVID vaccine for children under age 5.  It is being dispensed in a three-dose vial (most vaccines, by way of comparison, are unit-dosed), and once opened, the other two doses must be used within a narrow time frame, or discarded (and if not used, the practice has to pay the manufacturer for the vaccine anyway).   As such, we will need to co-ordinate doses to make sure we do not waste them; for now, we will need to prebook giving the vaccine, and cannot automatically administer it at a check-up.  The doses for children over age 5 are in unit-dose vials, and do not require prebooking, but there are shortages, and they will not always be in stock in our offices.  As such, it may be more practical to have this done at the local pharmacy, which buys up the bulk of the vaccine

Bottom line, get the COVID vaccine for your children and yourselves.  I don’t care where this is done; if the local pharmacy offers, and is more convenient, go there for it.  All vaccines in the state are registered in the local database, so we will have a record if your child has received it elsewhere.

You can check our website and Facebook pages for updates on our supplies of vaccines.

Next up, RSV prevention.