Vaccinating young kids may take time but experts ready to discuss parents' concerns
'Most people never want to be the first in line to do something new,' says medical anthropologist
With provinces and territories now rolling out plans to COVID-19 vaccinate children aged five to 11, many parents eagerly signed their children up to be among the first in line.
But not everyone is pouncing on the opportunity. Some parents have more questions before their kids get the jab.
Nathan Maharaj and his wife were up bright and early Tuesday registering their nine-year-old son for his first dose of a COVID-19 vaccine in Toronto.
He's excited Edmund can feel safer returning to karate classes, for instance, and will feel more comfortable planning visits to Ripley's Aquarium, Ontario Science Centre or the movies.
"It's a threshold we needed to cross to do things that we were comfortable doing before and as things are opening up again," Maharaj said.
"We don't want to be going there and then, you know, for the next 72 hours praying for no symptoms of anything to emerge and then also isolating from others because who knows what we're carrying."
In Coquitlam, B.C., Mike Romaniuk is digging through news sites and studies about how both COVID-19 and the vaccines for it are affecting children. While everyone in his family is up to date with B.C.'s recommended immunizations and received this season's flu shot, he is still unsure about the COVID-19 vaccine for his daughters Harper and Georgia, who are respectively aged four and two.
"There's definitely an aspect of 'I don't want to be first for my kids, I don't want to risk,' but I recognize on both sides there's risk. Not doing it is a risk as well," Romaniuk said.
"The more data, the more confidence, I think, especially if it's tabulated or presented in a way that's easily understandable and comparable."
He would love to be able see the studies Canadian health officials are analyzing to create their recommendations for children, for instance, saying that for him it would help instill more confidence.
"There's a lot of parents that I interact with that have concerns. They're scared to ask [questions], scared to speak out. There's quite a stigma around it," he said.
The drive to vaccinate younger children against COVID-19 could prove tougher and perhaps take longer than earlier age groups, but medical experts say they're ready to answer all questions and meet parents and caregivers where they're at.
Before the pandemic, the term vaccine hesitancy was most often discussed in the context of parental decision-making, according to medical anthropologist Ève Dubé, a researcher at the Quebec National Institute of Public Health who has studied it for more than a decade.
She said before the pandemic about one-third of parents were vaccine hesitant.
"Not all those parents refused vaccines, but some were accepting with concerns, being unsure that this was the right decision," said Dubé, who says education on the issue helps build trust and motivates parents to inoculate their children.
Looking at recent surveys, she says, there appears to be more hesitancy about COVID-19 vaccinations for the five-to-11 age group than for earlier cohorts.
"For COVID, I think the situation is a bit different … because of the fact that children are less at risk of COVID, their direct benefit of vaccination is less clear than for measles or other childhood vaccinations," she said.
'A slower start' predicted
Traditional mass public health campaigns with posters and fact sheets about the importance of vaccination typically work to reach the majority. Those positively discussing vaccines with fellow parents can also help, Dubé said.
However, for those with many more concerns, health officials employing a targeted, one-on-one approach are most effective, she said. She admits it is more resource and time intensive.
"It might be a slower start of the [age 5-11 vaccination] campaign," Dubé said. "But with time … the vaccine hesitancy may decrease. Most people never want to be the first in line to do something new."
According to historian Catherine Carstairs, who has researched health and medicine, many people pointing to when "everyone rushed out to get the polio vaccine" forget that it actually took many years to achieve consistent uptake across different age groups.
"I think we may see something similar with COVID-19," said the University of Guelph history professor.
While many point to a discredited 1990s-era study falsely linking autism and vaccination for increased hesitancy of and opposition to vaccination in recent years, Carstairs believes there have also been many other contributors.
This includes more skepticism of the medical profession, the rise of "natural health" products and non-traditional medicine, a growing feminist health movement and a shift in parenting styles that puts "less reliance on outside expertise and more of a sense of 'I know my child better than anyone,'" she said.
Working to address parent concerns
As a parent of a five-year-old himself, infectious diseases physician Alexander Wong empathizes with fellow parents who, given how fast the COVID-19 vaccines have rolled out, have more questions and simply want to do what's best for their kids.
"We need to really kind of be open-minded and work really hard to address those concerns with parents so that we can get as many kids vaccinated as possible," he said in Regina.
A question Wong hears regularly is that if COVID-19 has caused relatively few kids to become severely ill, hospitalized or die than adult populations, why do we need to vaccinate?
His response: "No kid should get sick or, God forbid, die as a result of a preventable illness.… We vaccinate for things like measles, rubella, mumps, norovirus, all these other things without thinking twice. And the number of deaths caused by those types of disease conditions pre-vaccine were far, far lower than what we're seeing with COVID."
More practically, he added, vaccination will minimize the intense disruptions kids and families have faced throughout the pandemic at school, with extracurricular activities and time spent with extended family and friends.
Another thing he highlights for parents is that real-world data is coming from the U.S., which approved the vaccine for children aged five to 11 in early November. Wong notes that about three million Americans kids have had one dose thus far with no major flags about side effects.
"That's a reassuring safety signal," he said. "Everybody is scrutinizing this vaccine unlike anything else probably in history quite frankly."
Paul Offit, a professor of pediatrics and member of the Advisory Committee on Immunization Practices that authorized the COVID-19 vaccine for children in the United States, empathizes with those who feel there hasn't been enough data gathered on this young cohort.
Offit says contracting COVID-19 is a much riskier proposition than potential vaccine side effects. One risk of natural infection is myocarditis, or an inflammation of the heart muscle.
He said the risk of myocarditis is roughly one in 45 people who contract COVID-19, compared with roughly one in 50,000 among people who get the vaccine.
"And it's much more severe [with infection]," Offit added.
He also pointed out that young kids who contract COVID-19 are at higher risk of a condition called Multisystem Inflammatory Syndrome in Children (MIS-C), "where myocarditis occurs 50 to 75 per cent of the time."
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In the past 200 years, any side effects associated with vaccines invariably arise within six weeks of the dose, says Offit, who is also director of the Vaccine Education Center at the Children's Hospital of Philadelphia.
"It's perfectly reasonable to be skeptical… You should have questions and you should have those questions answered," he said.
"There's a line though between that and someone who [doesn't] trust the pharmaceutical industry, they don't trust the medical community, they don't trust the government and it doesn't matter what you say, they're simply not going to get a vaccine.
"That to me is not a vaccine skeptic. That's a vaccine cynic."
With files from Deana Sumanac-Johnson and Nazima Walji