It’s here. The COVID vaccine parents of the very young have all been waiting for is here. And parents — the burnt-out, bedraggled bunch of us — are ready for it. We think. It might be the fact that the vaccine has come out a good 18 months after the first adult vaccine was authorized and eight months after the 5- to 11-year-old vaccines. Or that it’s been 66 days since the public transportation and airport mask mandate from the Centers for Disease Control and Prevention was struck down. Or that summer is upon us, and getting child care to help us through is as difficult as it's ever been — a full-time job in itself. But, no doubt about it, there’s vaccine hesitancy.
Dr. Anthony Fauci, the most senior public health official in the nation, gets it. “Hesitancy in parents is certainly understandable, because parents are very concerned about their children,” he tells Fatherly. There’s a “but” on the tail of this statement — one that’s backed by scientific evidence and careful epidemiological logic, and an earnest want to protect the lives of young kids, 442 of whom have died due to a COVID-19 infection.
In an interview five days after the federal government authorized both the Moderna and Pfizer vaccine for all children under 5, we spoke to Dr. Fauci, who does not seem as world-wearied as so many of us feel. As he methodically laid out the arguments for vaccines and predicted the course the virus could go from here, he wore his worries on his crisp white sleeves, complimenting his signature red tie. Dr. Fauci is hopeful. But, as ever, he begs the American public to do its part. Namely, get vaccinated, get boosted, and think about your neighbors. We’re nearly there.
Even when presented with the facts, a lot of parents are still hesitant about getting their young kids the COVID vaccine. What do you say to those vaccine-hesitant parents?
Hesitancy in parents is certainly understandable, because parents are very concerned about their children. So you shouldn't brush aside a hesitancy, but try to explain to the parents the scientific basis for the importance of vaccinating children in that age group. The decision of authorization by the FDA through their advisory committee, and the CDC recommendation through their advisory committee, is based on a randomized placebo-controlled trial, which unequivocally showed clear safety and efficacy of the vaccine.
That's the thing you want to get people to understand: Look at the facts, look at the data, discuss with your pediatrician, who should have all the information, and make a decision. Know also about the history of this virus in children. It's true that children generally do much better in the sense of severe illness compared to adults, particularly elderly adults and those with underlying conditions. But it is not a trivial disease in children. Over 400 children in that age group have died. Thousands have been hospitalized. And we have a very, very effective vaccine that can prevent that.
If you wait too long and your child gets infected and gets a serious complication, you will have wished that you didn't wait and see.
What about the wait-and-see parents who are open to getting the vaccine eventually, but want to wait a few weeks or months to see how it plays out in the other children under 5 who are getting the vaccine?
Again, it's understandable when parents want to wait and see, but there's a potentially negative consequence to a wait-and-see [approach]. If you wait too long and your child gets infected and gets a serious complication, you will have wished that you didn't wait and see, but that you got something for your child at the time that it was available.
What are you hearing about the rollout and uptake of the COVID vaccine for these young kids so far?
I think it's too early to make any definitive statement about uptake, but I can tell you that the government is doing an awful lot to try and make this as convenient as possible. Pre-stocking pharmacies, clinics, pediatricians’ offices, and others so that the vaccine would be made available in a very easy, logistic way to the parents who want to vaccinate their children. Certainly the ability to get vaccinated is being facilitated to the extent possible by the government.
What are your expectations for uptake?
I hope it will be better than what we've seen in other pediatric populations. If you look at the 5 to 11 group, I believe there's less than 50% uptake. We would like to see 80% to 90% uptake in all of the pediatric groups, very similar to what we see in the uptake of children's vaccines for other infections.
So the realistic, best-case scenario for the under-5 vaccine, is that 80% to 90% uptake?
It depends on what you mean by “realistic.” I'm a cautious optimist, and I would like very much to see a very, very high uptake. The more children that get vaccinated, the more are being protected against infection and against severe disease.
How should parents think about the efficacy data of the vaccine, which is in regard to antibodies, not necessarily in terms of preventing infection or severe disease?
The antibody data is very highly predictive of protection. There was enough data in the Moderna study to show that, in fact — particularly in the younger group from 6 months to 2 years, but to a certain extent in the 2 years to 5 years old — it was quite effective. Not 100% by any means, but certainly effective.
There weren't enough cases in the Pfizer study to show a clinical efficacy, but our experience now over more than two years tells us that the level of antibodies is quite predictive of what the protection is. And the antibody levels were very comparable to the antibody levels in the adults who received the higher dose and who were protected. So parents should have every reason to believe that even though much of it is based on antibody data, that that is a very good predictor of protection.
I'm not talking about shutting down. I'm not talking about total restriction. I'm just talking about being careful.
Once kids under 5 get the vaccine, how should their parents approach COVID risk-taking? How should they feel after their kids get vaccinated?
I don't think that they should throw caution to the wind. Because remember, even vaccinated people can get infected. That's for sure. The good thing about vaccines is that they protect somewhat against infection, but they're very good in protecting against severe disease.
But you don't want to put your child or yourself at a significant risk, for example, when you're in an area — a region, a city, a county — where there's a very high dynamic of infection and then go into an indoor, closed space where there's a lot of people, many of who may be unvaccinated or infected.
It doesn't mean you should put all caution to the wind, but you should feel more comfortable and confident that you've dramatically diminished your risk of getting severe disease.
Let's say there's a successful implementation of the children's vaccine. What's the next big pandemic hurdle?
As we approach the fall season, there are going to be many people, predominantly adults, who have been vaccinated and whose vaccination effect is waning, and you'd want them to get boosted.
Remember, we've vaccinated 210 million people in this country, but only about half of them have received their boosters. So you want those who have not received their booster to receive their third shot of an mRNA [vaccine], if that's the vaccine they received. And those who are 50 years of age or older should have gotten their fourth shot.
By the time we get to the fall, we would hope that people are up to date on their vaccines as we approach the potential for a fall surge.
At this point, two years in, how would you characterize the current phase of the pandemic? How should parents be thinking about it?
We've learned from this painful experience that this virus is quite unpredictable. You might remember last year at this time, we thought we were in very good shape. Then we had Delta that surprised us. We had Omicron that surprised us. The more people who get vaccinated, the more risk you've diminished to have a surge like what we saw last summer when we had Delta and then in the winter when we had Omicron.
As a public health official, what can you infer about people's reactions from here on out?
People all over the world, including the United States, are rather fatigued with COVID. I mean, we've been going through an extraordinary ordeal for the last two and a half years. So the tendency for people is to let their guard down and think it's over. It isn't.
I'm not talking about shutting down. I'm not talking about total restriction. I'm just talking about being careful so that when you have a high degree of dynamic virus in your community, you're careful. And if your particular area of the country goes into a yellow or an orange or a red zone, that you go back to wearing masks indoors in a congregate setting, and that you get vaccinated and you keep up to date on your boosters.
If we do that, we can do pretty well in keeping the virus at a low enough level that it doesn't disrupt society the way it has over the past two and a half years.
How can parents remain vigilant without getting to that fatigued state?
First of all, you don't want to go to extremes. You don't want to shove caution to the wind and just not care about it. On the other hand, you don't want to be so obsessed with not getting exposed that you dramatically influence your lifestyle.
The best thing to do, as I'll say over and over again, is to get vaccinated. And when you do, to get boosted. If you do that, you can return to a degree of normality in your life with much less of a risk of getting infected.
What do you want to see happen in regards to long COVID?
Long COVID certainly is a serious problem. We don't fully understand it. We've invested a substantial amount of money in it at the NIH. $1.15 billion has been invested in long-term and intermediate studies on what the cause is, what the pathogenesis is, what the extent is, and how we can do things once we understand it better to mitigate some of the effects of long COVID. And it's a serious problem given the fact that we have so many, many millions of people in this country who've been infected and who are at risk for long COVID.