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A Minute with Marschall

PROTECTING OUR YOUNGEST AGAINST COVID-19

July 6th, 2022

As a physician and a grandfather of three young children, I am heartbroken when I look at our daily COVID-19 census numbers and still see two or three children on that list nearly every day. The good news is that parents or guardians can now get children 6 months through 5 years of age vaccinated with the FDA-approved Pfizer-BioNTech or Moderna vaccines to better protect them from COVID-19.

But having available vaccines is only half the battle – the harder part is convincing parents and guardians to use this excellent and necessary protection. To date, vaccination rates for children 13 years old and up are much lower than in the general population and it’s likely there will be even more hesitation among parents to allow their younger children to be vaccinated against COVID-19.

It is normal for parents to be protective of their children and cautious about newly developed and tested vaccines. But let’s look at the science. More than 5.23 billion people worldwide have received at least one dose of a COVID-19 vaccine since they were first approved at the end of 2020. The evidence shows that vaccination carries an extraordinarily low risk, a risk far less than that of being infected by COVID-19.

For children older than 6 months, studies confirm the safety of COVID-19 vaccination. The clinical trials were rigorous; the results analysis by experts at the CDC and Health and Human Services were thorough. No corners were cut. The evidence is clear: vaccination is far, far safer than contracting COVID-19 in the short term, even in children where death and long-term hospitalization is much less common than in adults.

But what about the long-term? It’s too early for data on long-term effects of COVID-19 vaccinations. For many, this fact makes the decision easy.  Because there could be harm in vaccination, why risk it?

Here are some additional reasons parents should vaccinate their young children:.

Consider this: COVID-19 infection is very common in children – children account for about one-fifth of all reported cases.  This could be hard to see because their symptoms were often, but not always, mild. But even asymptomatic children infected with COVID-19 can transmit the disease to their loved ones.

More to the point, long-term adverse effects of viral infections can occur with mild initial illnesses. Numerous illnesses in young adults have been linked to viral illnesses. As a cardiologist, I immediately think of the heart. Several viruses known to infect some children have resulted in inflammation of the heart, or myocarditis. Myocarditis puts a child at risk of developing heart failure as a young adult. Severe heart failure, or cardiomyopathy, in young adults can result in ongoing medication, hospitalization, heart transplants and, in some cases, death.

It is also worth stating that studies have shown that there’s no association between vaccination causing a variety of diseases including asthma, autism, arthritis, diabetes, multiple sclerosis and others.

For children, like adults, vaccination reduces unnecessary hospitalizations in the short term and may prevent more severe illnesses in later years.

Due to all this science-based evidence, as a physician and a grandparent, I am urging that everyone – including children 6 months to age 5 – protect themselves with safe and effective vaccines. 

As members of a world-class health care system, I think we have an additional responsibility to serve as professional advocates for the vaccine. Share what you know about the science. This recent Michigan Medicine blog about the vaccine for kids under 5  provides a lot of common sense information you can share with patients, colleagues, friends or family.

The COVID-19 vaccine should become as routine as the shots children receive to guard against measles, mumps, rubella, chickenpox and other diseases.

Do you agree? What are your concerns about this topic? Share with us in the discussion box below.

28 Comments

  • Currently we offer COVID vaccine at only 2 of our 9 pediatric primary care clinics. So we certainly are not making COVID vaccine as available as MMR or other pediatric vaccines. Requiring that parents take their child to a different location, away from their trusted pediatrician, sends a message that COVID vaccine is not as important as other vaccines. (Not to mention that it completely fails families with transportation challenges.) And the long delay in rolling out COVID vaccine at even this small number of sites was not helpful in countering any parent hesitancy.

    Putting up barriers to necessary services is not world-class care.

    • I understand your frustration. Our current focus is supporting our current vaccine sites but I assure you we are preparing individual clinics to offer the COVID-19 vaccines. We are staffing and training now and will have firm dates soon. I appreciate your patience.

  • Jessica Fealy, MD

    As a pediatrician we strongly recommend and offer vaccines on a daily basis. I’m actively encouraging my patients to get the COVID vaccine every day. And then unable to provide it at that visit. It’s very frustrating for families that they’re unable to get the COVID vaccine at their medical home/primary care clinic. And creates additional barriers, especially for patients with transportation issues, or difficultly navigating the healthcare system. No one wants to take extra time off work to go to an extra visit for a COVID vaccine or booster. Actions speak louder than words and we should be actively minimizing barriers for our patients instead of creating more hurdles for them to overcome. Please push both Pfizer and Moderna vaccines to primary care clinics ASAP.

    • I understand your frustration, and how frustrating this must be for your patients. We are currently focused on supporting our current vaccine sites but we are preparing additional clinics to offer the COVID-19 vaccines. We are staffing and training now and will have firm dates very soon. Thank you for your patience, Jessica.

  • Hi Dr. Runge I was going over the trial conducted by the pharmaceutical companies that administer the vaccine, since that was the one used for FDA approval, and it looks like the study was unblinded and the placebo group was vaccinated within 2 months of the studies conception. I’m confused, why they would rush to vaccinate the placebo so quickly? Doesn’t that invalidate the study making it completely useless? I’m considering advocating for vaccine use in small children but since there are no long term efficacy studies I’m very hesitant. Especially since it has been noted in dozens of scientific journals and independent studies that the vaccine completely loses efficacy within a few months, not even considering emergence of more vaccine resistant variants.

    • Simon, thank you for your concern and very thoughtful comments this topic. We need to consider the following when assessing the efficacy of the vaccine. The Moderna and Pfizer COVID vaccines for children 6 months-5 years were approved under emergency use authorization. The FDA and the CDC Advisory Committee on Immunization Practices have carefully reviewed data on vaccine safety and efficacy. The clinical trials provide safety data in nearly 8,000 vaccinated young children and data for vaccine protection against symptomatic infection in this age group. The clinical trials were not powered to detect efficacy against severe disease in young children but similar patterns are expected based on to what is seen in those 5 years and older with higher protection against severe disease. Clinical trials do not yet provide data about long-term efficacy, but considering what we do know and have experienced based on other vaccine effectiveness, I can advocate for these vaccines for younger children. For more information you can refer to the CDC ACIP slide deck: https://www.cdc.gov/vaccines/acip/meetings/downloads/slides-2022-06-17-18/03-COVID-Oliver-508.pdf.

  • Dear Dr. Runge,

    I am certain that all of our pediatric primary physicians agree with you that “The COVID-19 vaccine should become as routine as the shots children receive to guard against measles, mumps, rubella, chickenpox and other diseases.”

    Unfortunately our health system does not allow this to occur. I am not sure if you are aware, but currently COVID vaccine is not “routinely offered” to children (of any age) at 7 of our 9 our primary care sites because of our health system operational strategy.

    From our Mott Health Website (https://www.mottchildren.org/covid-19-vaccines-adolescents-children): “Please do not contact our pediatric primary care clinics to schedule an appointment for the specific purpose of receiving a COVID-19 vaccine. At this time, we cannot schedule appointments specifically for COVID-19 vaccine appointments at any of our primary care clinics or at C.S. Mott Children’s Hospital, nor can we accommodate walk-in appointments at these locations.

    Parents wishing to schedule an appointment specifically for a COVID-19 vaccine should schedule one at our established COVID-19 Vaccine Clinics at Brighton Health Center, Northville Health Center, or the North Campus Research Complex (Building 200) in Ann Arbor.”

    We, the front line primary care health providers, would love to offer the vaccine to all of our patients—-but we need our health system to support us in those efforts. Anything you can do in your role as CEO of the health system to make this happen would be appreciated by parents (and grandparents) and our patient care teams. Currently, most of our families cannot get the vaccine for their children (or grandchildren) at their primary care clinical site or at a convenient location. Your goal of making the COVID vaccine “routine” is not possible in our health system, in contrast to many other health systems in our community and in our state.

    • Gary, I appreciate you bringing up this concern, and for your patience. You are correct that it has been difficult for patients in this age bracket to receive the vaccine at many of our clinical locations. As of the 8th, however, vaccine appointment scheduling for children from 6 months through 4 years of age opened on the MyUofMHealth patient portal. Information will be updated on the pediatric COVID-19 vaccine information page. I am sorry for any confusion this delay may have caused. I appreciate all you do to care for our pediatric patients.

  • I am confused. Since vaccination is so safe and effective then why is the Michigan Medicine roll out of vaccination so delayed?

    • Thank you for your question. It has been difficult for young children to receive the vaccine at many of our clinical locations. As of the 8th, however, vaccine appointment scheduling for children from 6 months through 4 years of age opened on the MyUofMHealth patient portal. Information will be updated on the pediatric COVID-19 vaccine information page. I am sorry for any inconvenience due to this delay

    • Thanks for your note. You are correct, pateints can now make a special appointment to get a COVID vaccine. However, they are still only available at 2 of our 9 pediatric primary care sites. If we cannot give the COVID vaccine to our patients, we will not be able to make the COVID vaccine “routine” as you suggest in your blog. We, pediatric primary care providers, want to give this vaccine to our patients—-but our health system does not allow us to do so. We have to send them to clinical sites far from their homes and require additional visits to get their kids vaccinated. Can you please work to fix the situation and prioritize the ability for our health systemt to provide COVID vaccine to our pateints in all of our primary care clinics?

      The current Michigan Medicine strategy is creating barriers for our youngest patients to receive the COVID vaccin e.

      • Thank you, Gary, for responding again to this concern. We are continuing to work on this situation. Our current focus is supporting our current vaccine sites but I assure you we are preparing individual clinics to offer the COVID-19 vaccines. We are staffing and training now. I know this is not what you were hoping to hear, but I appreciate your patience.

  • I appreciate this blog post because I agree that this is so important, especially as a parent of a young child who is now finally eligible for COVID 19 vaccination. However, what has been very challenging is the lack of information about the plan for the vaccine to be available at U of M. There is so little information about the plan for roll out and scheduling/availability you’d almost wonder if U of M is even recommending it. Our U of M pediatrician office has very little information about the availability, but do know that they will not be administering at their location. As described in the recent U of M Blog post “Parents split on whether to vaccinate younger kids against COVID” will polling data showing parents may be more open to vaccination if it was offered at their pediatrician office, the location where they get all of the many other vaccinations young children receive in the first two years. As a health care provider myself and a parent I don’t see that as best patient and family centered care. I understand that there could be some vaccine dose wasting at sites with low numbers, but is the missed opportunity to vaccinate worth it? If you are advocating for this vaccine to be as routine as vaccines for other childhood disease, make it as available as those vaccines!

    • I appreciate your support of vaccines for these children and I understand your frustration about the availability at your clinic’s site. However, we have opened vaccine appointment scheduling for children from 6 months through 4 years of age on the MyUofMHealth patient portal. Information will be updated on the pediatric COVID-19 vaccine information page. I am sorry for any inconvenience this delay may have caused you.

  • Dear Dr. Runge,

    Are you aware, that as of today Michigan Medicine has neither communicated a plan or implemented a plan to deliver coronavirus vaccines to children under 5?

    As a mother of a young child who has spent time in our own PICU for respiratory illness, and a physician who has desperately worked to keep my family well throughout the pandemic, I find it embarrassing that Michigan has yet to provide communication, care, or access to resources that would allow us to care for our youngest children and support our working parents. The Washtenaw Health Department, The Corner Health Center, and most local pharmacies have been able to do this – why can I still not schedule a vaccine for my daughter through our health system? I have the resources to drive 40 miles away to obtain a vaccine for her: how is it equitable to not provide accessible vaccinations to our patients who cannot do that?

    I am glad to finally see an endorsement of these vaccines, but actionable steps speak much louder. I hope that Michigan Medicine finds the means to answer the demand for these vaccines before more of our patients are ill.

    • Thank you, Ketti, for supporting vaccines for younger children. I understand your frustration about our availability. However, we are now open to vaccine appointment scheduling for children from 6 months through 4 years of age on the MyUofMHealth patient portal. Information will be updated on the pediatric COVID-19 vaccine information page. I am sorry for this delay. Thank you for all you do to support patient care at Michigan Medicine.

  • Charlotte O'Connor

    Dr. Runge,
    Can you please include citations or links to the data produced by the rigorous studies you reference? As a grandparent myself, I think it’s important to read primary sources prior to making important decisions.
    Thank you in advance.

    • Charlotte, I can relate to your concerns as a grandparent. Here is some additional information that I hope will help you with your decision. The Moderna and Pfizer COVID vaccines for children 6 months-5 years were approved under emergency use authorization. The FDA and the CDC Advisory Committee on Immunization Practices have carefully reviewed data on vaccine safety and efficacy. The clinical trials provide safety data in nearly 8,000 vaccinated young children and data for vaccine protection against symptomatic infection in this age group. The clinical trials were not powered to detect efficacy against severe disease in young children but similar patterns are expected based on to what is seen in those 5 years and older with higher protection against severe disease. Clinical trials do not yet provide data about long-term efficacy, but considering what we do know and have experienced based on other vaccine effectiveness, I recommend these vaccines for my grandchildren. You can find more information on this CDC ACIP slide deck: https://www.cdc.gov/vaccines/acip/meetings/downloads/slides-2022-06-17-18/03-COVID-Oliver-508.pdf.

  • Let’s get them available for administration in our clinics as soon as possible then!

    • Sarah, I understand your frustration. Initially there was a delay in vaccinating this younger age group. As of the 8th, however, vaccine appointment scheduling for children from 6 months through 4 years of age opened on the MyUofMHealth patient portal. Information will be updated on the pediatric COVID-19 vaccine information page. I am sorry for this delay. I appreciate all you do to care for our patients.

  • Marschall, with all due respect, your concern for “protecting our youngest” rings a little hollow in light of your recent support of so-called “abortion care.” It is certainly admirable to want to protect young children from illness, but it seems inconsistent to simultaneously advocate for Michigan Medicine being able to kill them in the womb, in some cases just months earlier. I hope I’m wrong, but the conclusion seems to be that you believe we should only protect SOME of our youngest—those who are “wanted.” I simply cannot accept this logic. History shows how dangerous it is to define others’ worth by age, sex, race, or any other characteristic besides simply being human, which the child in the womb is. If Michigan Medicine truly wants to be inclusive, we should condemn abortion as the ultimate ageism. And if children aren’t protected from being killed in the womb, how to protect them from COVID-19 becomes a moot point indeed.

    • Both abortion and vaccinations are complex and controversial topics, but they remain two separate issues. I will reiterate, and stand by, our policies on women’s health: Michigan Medicine is dedicated to providing the full spectrum of women’s health services, including abortion care. Many of the patients we see are diagnosed with fetal anomalies or experience other complications that make ongoing pregnancy and giving birth dangerous. We will continue to care for women across all of their reproductive health needs. This includes abortion care, which, at least for now, remains legal in Michigan.

  • Thank you Dr. Runge! I agree 100%! It is heartbreaking to see children suffer when there is a safe and effective vaccine available. Let’s continue to educate parents and caregivers!

    • Thank you, Casey, for your comments and your support of this issue. And thank you for all you do to care for our patients.

  • What in your opinion is the reason for twice as many vaccinated patients being in the hospital vs unvaccinated patients?
    Data for June 30 showing 15 patients hospitalized with COVID-19, 10 vaccinated and 5 unvaccinated.

    • Steve, you are asking a very legitimate question, and it is true we are seeing a higher number of vaccinated patients admitted to the hospital. However, the results you may see on a certain day and any patterns they suggest are best interpreted over time and compared to population-based, time-dependent health care measures, which include masking and vaccines. The data we report on the patients who are hospitalized at Michigan Medicine with COVID includes those who are hospitalized as a direct result of COVID infection and those who are hospitalized for other reasons and also found to have COVID infection because of routine testing on admission (with or without symptoms). At the current time, the large majority of patients with COVID are hospitalized for other non-COVID reasons. Given this, the reported COVID hospitalization numbers should not be used to reflect efficacy of vaccination against severe disease. COVID vaccines do remain highly effective at preventing severe disease but are less effective than in the past at preventing asymptomatic or symptomatic mild infection due to the advent of new variants and waning efficacy of vaccines over time. We anticipate the FDA will authorize a new Covid booster vaccine to target these new variants in the near future.

  • I don’t understand how or why it is taking michigan medicine so long to offer the vaccine for this age group. Not even starting sign ups until this Friday (7/8) is sad for an organization of this magnitude. There was over a month’s notice of when the FDA would meet to in all probability, approve the vaccine and yet it seems like there was no plan in place or urgency to actually get the shots to those who have been so desperately wanting it for so long. Even trying to find a sign up through the CDC was stressful because only a couple places in Michigan were offering to under 3 year olds. As a parent of a child who has been too young to get vaccinated until now I see it as a severe let down and feel like everyone gave up on us because we were the last group.

    • I assure you we did not give up on this age group. I strongly believe this group needs the vaccination as urgently as others. However, because they are so young and parents are so hesitant, it has required some additional effort and planning to begin this process. As you mention, these appointments can now get scheduled on the MyUofMHealth patient portal, and we will keep information updated on the pediatric COVID-19 vaccine information page. I am sorry for this delay. Thank you for your concern and for reading the blog.

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