In the latest installment of our occasional conversations with Fort Worth newsmakers, Dr. Laura Romano, a hospitalist at Cook Children’s Health Care System, discusses the upcoming COVID-19 vaccines for kids under 5. 

This conversation has been edited for length and clarity. For more, please listen to the audio file attached to this article.

Alexis Allison: Dr. Romano, we know that a committee of advisers to the Food and Drug Administration voted (this week) to recommend that the FDA authorize COVID-19 vaccines for children as young as six months. Can we just start with some basics? What makes a COVID vaccine a child vaccine?

Dr. Laura Romano: It is a smaller dose than what an adult vaccine is. So, for both Moderna and Pfizer, you’re talking about much smaller doses. The Moderna is going to be 25 micrograms for the little kids compared to the adult dose of 100 micrograms. With Pfizer, it’s a little bit different, because between six months and five years, it’s a much smaller dose — it’s only three micrograms, which is a 10th of an adult dose. But (Pfizer is) also going to be three separate doses, as opposed to the two separate doses an adult will receive and that’s to help bolster the immunity and give an extra bridge.

Allison: I know that the older age groups have been able to get these vaccines for a while now. Can you talk a little bit about why this process took an extended time?

Romano: I have wondered that myself. I have a daughter who just turned 4 yesterday, and a baby boy who will be 2 in October, and I have been waiting to get them vaccinated for almost a year now. But whenever you do any clinical trial or any trial involving a child population, there are extra ethical concerns that you have to worry about. There are extra hoops that you have to jump through, extra regulation. So those trials just take longer to establish. And then, throughout the process, the FDA actually asked Moderna to increase their sample size to make sure that it’s been safe. So Moderna hasn’t been able to present their data until recently.

Allison: Thanks for sharing. When I hear people hesitate about getting the vaccine for their children, I hear, ‘Oh, you know, the risk for serious illness or death is lower for children than in other age groups.’ What would you say to (those caregivers)? 

Romano: So it is true — there is less of a risk of death. Only 442 children (under 4) have died from COVID since 2020. But that’s still 442 kids that are no longer with us. 

And if you look at the deaths of vaccine-preventable diseases, COVID, even though it’s not killing as many kids as adults, proportionally, it’s actually affecting kids more as a vaccine-preventable illness than something like the flu or chickenpox. 

There are also many other reasons to get vaccinated: It’s what’s going to allow society to return to as normal pre-pandemic levels as possible. 

(The vaccine) does prevent against serious illness and death. We’ve seen that in adults and in kids. It decreases your risk for hospitalization for COVID respiratory infections, and it decreases your rate of ICU admissions and also deaths as well. We’ve seen that in adults. We’ve actually seen that here at Cook Children’s, especially during the omicron surge when vaccines were available for older age groups. 

(Between Dec. 19, 2021, and Jan. 15, 2022), we had 14,000 kids test positive for COVID. Only 320 needed to be admitted, but of that 320 patients that needed to be admitted, 37 of them were fully vaccinated. So the vast majority of patients that we are seeing who are symptomatic from COVID are the unvaccinated. 

COVID, unfortunately, just doesn’t stop with a respiratory illness, with a fever. We do see something called MIS-C a lot in the pediatric population, that is Multi-System Inflammatory Syndrome in Children. It’s a very serious complication that occurs about four to six weeks after a COVID exposure or a COVID illness. These children are very sick, are usually hospitalized — sometimes in our ICUs for a couple of days. They need high doses of steroids, high doses of immunomodulators to bring their immune system and their inflammatory system back under control. 

But to date, we’ve only seen 21 cases out of 21 million kids who are fully vaccinated develop MIS-C. So getting the vaccine drastically reduces the risk of getting MIS-C. 

It decreases the rate of long haul symptoms in pediatrics. We do see kids with COVID long haul now. That can be new, daily persistent headaches, that can be persistent fatigue. We’re also seeing something called dysautonomia, which is a dysregulation of your autonomic nervous system. So your fight-or-flight, your rest or digest. One is too activated, the other is underactivated and there’s no telling which one. So these kids can have persistent fatigue, they can have a sense that their heart is beating erratically, they can have fainting, they can have issues with constipation and diarrhea. Getting a COVID vaccine decreases that risk by 50%

And then, just from a practical standpoint, as someone who has survived, now, 10 days of quarantine with my kids, if they were fully vaccinated, that 10-day quarantine can be decreased, so you are not stuck in the house for 10 days with your kids with nothing to do. And then, if you want to travel, a lot of foreign countries do have a vaccination requirement before you’re allowed to enter. So, this is a way for you to travel again, this is a way for you to make new memories with your family while keeping everyone safe and healthy.

Allison: Have you heard any other concerns or questions from caregivers that you’d like to address?

Romano: I have. I’ve heard a lot of parents, especially with daughters, mention that they’re concerned about the effects on fertility. So a COVID vaccine does not affect a woman’s fertility. The American College of Obstetricians and Gynecology, the American Society of Reproductive Medicine and the American Society for Maternal-Fetal Medicine have all recommended that all women, regardless of what stage they are in life — pregnant, trying to become pregnant, not thinking about getting pregnant, breastfeeding — get the vaccine as soon as possible. 

There was concern initially because there’s a protein that’s in the vaccine mixture that does look like a protein that’s secreted by a pregnant woman while they’re pregnant. And they were actually concerned that it would create an immune response to that protein and that the immune system and then attack the baby and the pregnancy. That is not true. 

Yes, the proteins look similar, but that would be like asking your husband to go into the closet and get a pair of shoes, and he brings you back an umbrella. Yes, they’re both in the closet. Yes, they might be something that you need on a rainy day, but you asked for shoes and your husband should know the difference between an umbrella and a pair of shoes. And that’s what your immune system can do. It can tell the difference between, this is something that I need to respond to, and this is something that the body is supposed to be making.

Allison: Thank you. That’s a great comparison. Just practically speaking, once everything is finalized for these child vaccines, where can parents and caregivers find them? 

Romano: A great place to start is always your pediatrician’s office. Most outpatient pediatricians’ offices weren’t able to carry the Pfizer vaccine because of the special requirements — the temperature needed to be kept extremely cold. Most pediatricians’ offices did not have that capability. Moderna is different. So a lot of pediatricians’ offices are expecting to be able to carry the Moderna vaccine. 

They can also go to www.vaccines.gov. That’s where I direct a lot of my parents to. You type in your zip code and your age and it tells you every single pharmacy (near you) handing out vaccines that day.

Allison: How would you recommend that parents or caregivers approach that conversation (about the vaccine) with their child?

Romano: So, the best way is just to prep them for it and to be honest: “We’re getting you a shot today because we’re trying to prevent a disease that can make you and can make others very sick. There might be a little pinch, there might be a little burning, but that’s it, you’ll be done.”

Alexis Allison is the health reporter at the Fort Worth Report. Her position is supported by a grant from Texas Health Resources. Contact her by email or via Twitter. At the Fort Worth Report, news decisions are made independently of our board members and financial supporters. Read more about our editorial independence policy here.

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Alexis Allison

Alexis Allison covers health for the Fort Worth Report. When she can, she'll slip in an illustration or two. Allison is a former high school English teacher and hopes her journalism is likewise educational....