Pick Your Battles
My 15-year-old daughter is due for her second Pfizer-BioNTech COVID shot this week, but I’m not sure she’ll get it. At least not today.
She’s miffed. “Let’s just get it DONE, mom!”
This isn’t my first rodeo with teen angst, but unlike other instances of looks-to-kill pointed in my direction, this time I completely get it. Like all of us, my daughter desperately wants COVID-19 in the rear-view mirror.
In my almost 20 years of parenting, I’ve tried to make rational decisions when it comes to my kids’ health and well-being. When my kids were infants, I immersed myself in baby books and instructional videos on swaddling and sleep training. I prepped preschool lunch boxes with every food group. Now with three teens, I’ve learned to swap lengthy inquisitions for open-ended quasi-questions (my kids can smell an agenda from a mile away).
But let’s face it: sometimes raising kids isn’t scientific — or particularly pretty. My parenting style is akin to my T-shirt drawer: loosely organized, easily rumpled, and scattered with stabs at humor.
When it comes to the COVID vaccine, however, a careful consideration of science is in order. To be clear: I’m pro-vaccine. I never miss the chance to vaccinate myself, my kids, or my patients. Vaccines prevent communicable diseases and save lives.
That said, remember that science is ever-evolving. There’s a reason many of us in medicine sing the refrain “Follow the Science!” and not its lyrical cousin, “Inflexibly Stake your Scientific Claim, and Never Look Back!” In fact, the essence of practicing medicine is understanding nuance, marrying science and the patient in front of you, and adjusting medical advice as the data or clinical picture evolves.
So here we are, looking at a vaccine that’s been authorized for Emergency Use by the FDA for the young, with loads of emerging data and food for thought. Here are the reasons we might decide to wait on my daughter’s second COVID shot:
Her risk for COVID-19 already has dropped significantly with a single dose of the vaccine. The clinical trial studies have actually found stronger immune responses to the vaccine in the 12-15-year-olds than in young adults (who had already been shown to be protected in the original trial).
Her risk for COVID (even without the vaccine) is already low and dropping daily as community case rates fall and more and more people around her are vaccinated and therefore unlikely to transmit the virus to others. Moreover, kids this age are generally at low risk for severe disease in the first place.
There’s strong evidence that, in older people, delaying the second COVID vaccine dose actually improves the immune response to the shot. In fact, most vaccines work better — not worse — when the booster shot is given later. The minimum interval on vaccines is typically 28 days for this reason. Just because the “cook book” for the Pfizer vaccine says that the doses should be three weeks apart doesn’t mean that this interval is necessarily optimal. Recall that when conducting trials, the FDA and pharmaceutical companies understandably chose a close interval between shots to be able to study efficacy and then get vaccine doses out to the public ASAP.
There is a tiny risk of a phenomenon called myocarditis (inflammation in the heart) that’s being reported in males ages 16-24 after the second dose of the Pfizer vaccine — at 5-25 times the background rate. The incidence is estimated to be between 1 in 3000 and 1 in 6000 among 16-24-year-old males, with an even higher incidence among 16-19-year-olds. A causal relationship has not been established but certainly warrants ongoing investigation. It’s important to note that viruses themselves can cause myocarditis — as can COVID-19 — and that this phenomenon is usually mild and treatable.
On the flip side, here are the reasons we likely will proceed with vaccine dose #2 now:
The COVID vaccines are stunningly effective and safe. (Click here for an excellent summary — today’s vaccine "101" of sorts — by pediatric infectious disease expert Alasdair Munro.)
According to the studies in kids ages 12-15, getting both doses yields close to 100% protection against COVID-19. As immunologist Andrew Croxford explains, the “second dose results in a massive boost in the production of neutralising high-affinity antibodies created in germinal centers (transiently-formed cell clusters in lymph nodes of your armpit under the arm you got jabbed in).”
Full vaccination further drops the chance of transmitting the virus to other people — like unvaccinated kids and other vulnerable people — which is arguably the main reason to vaccinate kids at all, since they don’t tend to get very sick themselves. (How much further does two doses reduce transmission compared to one? We don’t know yet.)
I’m not really worried about long-term safety given the tens of millions of people around the world who are already vaccinated and doing beautifully without any safety issues.
There’s no biologically plausible reason that the vaccine would have adverse long-term risks, though of course this is being studied in real time. So far, so good! (The infertility myth is just that — a myth.)
Getting both doses is a requirement for the camp my daughter is attending. (Many camps require both shots for all kids ages 12 and up.)
I’m not thrilled about an ongoing battle of wits with my smart, savvy, and straight-talking daughter. I love a good debate; I also love peace at the dinner table.
At the end of the day, I’m pretty sure we’ll get shot #2 sometime this month. The benefits largely outweigh the risks — for her.
The “right” decision for you may be different. Making an informed decision about your family’s health is personal and requires translating public health guidance to your particular situation. After all, we each have unique medical vulnerabilities, risk tolerances, and social structures. For example, a child who is high-risk or who lives with a high-risk parent may be more inclined to get vaccinated than a teen who is generally healthy and has the luxury of living in an area with low COVID incidence.
Whatever we do, let’s make sure we’re using the available science and facts — not fear, misinformation, or “groupthink” — to guide our decision-making process. It’s so easy to get swept up in a popular narrative that isn’t rooted in reality. I can be guilty of this, too.
Let’s also recognize the anxiety of the moment. We’re in a period of transition where many parents are naturally feeling vulnerable as we re-enter life and make everyday decisions for our kids — about daycare, camp, and social situations. At least for me, there’s nothing like uncertainty to rev my engine of parental worries. What’s worse is that kids age 11 and under won’t even be eligible for the vaccine for many more months, and we’re well aware that unvaccinated folks are at increased risk for infection.
Here’s my toolkit to help parents of younger kids squash endless loops of “what if” thinking: First, we remember that COVID-19 case rates, death rates, and hospitalizations are falling fast and that kids are indirectly protected from COVID-19 as adults in their midst are vaccinated. In other words, as more adults become immune, kids’ infection rates drop, too. Widespread vaccination has dropped COVID-19 cases in kids over 50% in the 4 weeks. In other words, every single day we’re choking off the virus’ ability to spread — even to unvaccinated people.
Second, we remember that the risk of outdoor transmission is exceedingly low, and that unvaccinated kids are generally safe to play unrestricted outdoors — for example at camp or at the playground. And last, I direct my patients to their pediatrician to give more specific advice based on that child’s unique medical issues. At the end of the day, it takes a village — plus a heavy dose of humility and humor — to raise a child!
I will see you next week. Until then, be well.