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By Anne Blythe

The phones have been ringing more than usual at Chapel Hill Pediatrics and Adolescents as parents eager to get their children vaccinated against COVID-19 call for appointments.

This past Thursday, the office had nearly 100 appointments scheduled. A boy and a girl who came in that day got extra-special attention after rolling up their sleeves for the first jab in a two-dosed series of the Pfizer/BioNTech vaccine approved last week for children aged 5 to 11.

Gov. Roy Cooper and Mandy Cohen, secretary of the state Department of Health and Human Services, were touring the practice and stepped in to congratulate the children.

“This COVID pandemic has been tough on families, and it’s particularly been tough on children,” Cooper told reporters after visiting with some newly vaccinated children who were not expecting a meeting with the governor at their appointments. “I’m so glad that we’ve been able to get our children back in the classroom in person and that we’ve been able to make sure we’ve invested to keep them safe.

“But I know that so many parents, when they’re getting vaccines, when they’re doing things to protect themselves, have remained so worried about their children in this age group who’ve not been able to get a vaccination,” he said. “That worry is just always there.”

Nearly a week has passed since Rochelle Walensky, director of the Centers for Disease Control and Prevention, issued an endorsement that public health care workers say is a potential game-changer for the pandemic.

After favorable reviews from the Food and Drug Administration and the CDC Advisory Committee on Immunization Practices, Walensky endorsed the kid-sized dose of the Pfizer vaccine for children as young as 5 on Nov. 2.

“This week is so important because now these children, 5 through 11, can get vaccinated, and it can give parents peace of mind,” Cooper said at Chapel Hill Pediatrics and Adolescents. “Just to see the two children that we saw get vaccinated, and their parents were just there, it’s relief in their eyes because we know this is an important layer of protection for our children.”

Answering parents’ questions

A Kaiser Family Foundation survey in September found that nearly a third of parents polled would get their child vaccinated as soon as possible. Another third of the parents preferred to take a wait-and-see posture. Twenty-four percent of the parents in that poll said they definitely would not get their child vaccinated.

Mary Braithwaite, a pediatrician at Chapel Hill Pediatrics and Adolescents, said the Chapel Hill office has vaccine appointments booked for at least the next three weeks. She knows some parents will have questions. She says she hopes parents will turn to pediatricians, nurses and others in health care professions instead of focusing on misinformation — online and otherwise — that has been so prevalent throughout the pandemic.

“Vaccinating children against Covid-19 gets us another step closer to the end of this pandemic,” Braithwaite said.   

In North Carolina, the vaccines for the younger children have been distributed to at least 800 sites such as pediatrician offices, pharmacies and other health care sites, Cohen said last week. There is plenty of supply, Cohen added, while stressing what the clinical trials and data submitted to the FDA and CDC show.

“As folks know, I’m a mom of a 7- and 9-year-old. I have two daughters, and we have appointments for Saturday morning to get our vaccines. I could not be more excited,” Cohen said this past Thursday. “I want to make sure I’m doing everything as a parent, and a doctor, to be protecting my own kids. 

“That’s why we want to make sure that everyone knows that we’ve looked at this data, that the data shows that these vaccines are safe, and we want to make sure like we do for all these vaccines for our kids that we are doing things to protect our kids at each and every turn.”

The surge in COVID cases brought on by the Delta variant in late summer hit children particularly hard.

“In the last wave of this Delta surge, we’ve seen almost a 200 percent increase in the number of cases we’re seeing in kids 5 through 11,” Cohen said. “Sadly some of those kids have ended up in the hospital, they’ve had what they call long COVID, where they’ve had inflammatory disease. So kids are vulnerable here and we just want to make sure we’re doing everything here both as doctors and parents to protect our kids.

“I wouldn’t recommend something that I wouldn’t do for my own kids,” Cohen added. “I love them super dearly, as all parents do, so I’m recommending what I would do for my kids and that’s get them vaccinated as soon as possible.”

More than 45 percent of children between the ages of 12 to 17 in North Carolina have had at least one dose of the Pfizer vaccine. They received a larger dose than what the FDA and CDC recommend for children younger than 12. By Monday, according to the DHHS vaccine dashboard, one percent of the children ages 5 to 11 had received a vaccine.

Pfizer’s kid-sized dose, a third of what people older than 11 get, comes in an orange-capped vial and with a smaller needle so it won’t be confused with the purple-capped vials for adults and teens.

The children’s dose of the Pfizer/ BioNTech Comirnaty®COVID vaccine is a smaller dose of only 10 micrograms, and comes in a vial with an orange top that’s easily distinguished from the 12-year-old and up 30 microgram dose that comes in a vial with a purple top. Photo credit: Anne Blythe

What about the holidays?

Now that younger children are eligible for vaccines, many families have been contemplating the holidays ahead in a much different way than they did in 2020.

Thanksgiving and Hanukkah, though, might not be the best times to bring the younger children together with many generations around a big table without precautions.

The dosing schedule for the pediatric vaccine requires two shots three weeks apart. The children are not considered fully vaccinated until two weeks after their second shot, according to the CDC.

David Wohl, a physician at UNC Health who specializes in infectious diseases, described what his family plans to do for Thanksgiving during a recent briefing with reporters.

“In my household, we are going to get together with another family and we’re all going to do rapid tests the day of the event that we’re going to get together,” Wohl said. “These are all vaccinated people. In fact, some of us are boosted. But we’ll all be fully vaccinated.”

“We’ll all get a rapid test that day and that lowers the risk that anyone who has a viral burden in their nose or throat that’s going to spread the virus to any of us,” Wohl added. “Those are the kinds of measures I’d like to see, but those tests cost money. If you have 10 people coming to dinner, that’s a lot of tests. I know this is not as feasible as we would like, but I think we have to take those kind of measures now.”

Wohl worries that holiday travel might bring another surge in infection. Despite dropping numbers in the U.S., Europe is seeing yet another surge in infections in the past week. 

“Right now, we travel and we do things and there’s little kids, right there in the store… and you know that they’re not all vaccinated because they’re not eligible,” Wohl said. “They’re potentially vectors for the infection.”

Dr. Kathy Merritt vaccinates 9 year-old Josie Murdoch with the Pfizer COVID-19 child vaccination at Chapel Hill Pediatrics and Adolescents in Chapel Hill, N.C., Thursday, Nov. 4, 2021. Photo credit: Gerry Broome/ AP (pool)

The United Kingdom lifted many of its restrictions in July and has seen a steady wave of COVID infections since then, much of which is believed to be driven by school children, asymptomatic or symptomatic, who then interact with older people and further spread the virus.

“I think the same thing is happening here and will happen until we get more people vaccinated,” Wohl said. “I do think we just have to be careful around unvaccinated people because not only can they get infection more readily, but if they have infection, they have a higher viral burden that they’re shedding to the rest of us. So I think you have to keep your distance from little kids.”

That’s why public health advocates hope parents will gravitate toward vaccinating their children as quickly as possible while also recognizing that even if their children are in the early wave of those getting shots that Christmas, Kwanzaa and the New Year holidays might be the earliest for larger family gatherings.

“The challenges are that there are a lot of folks who are kind of just tired of distancing and not getting together,” Wohl said, acknowledging that vaccines have given people a sense that they’re not at as great of a risk for infection as they were a year ago. “But I do worry that there’s going to be some infections that are going to spread with the holiday travel and the get-togethers.”

Will vaccines be required?

It’s unclear whether North Carolina will see the same leveling of interest in COVID vaccines for children as the state did with adults. Initially, it was difficult for adults to get a vaccine because of more demand than supply.

That waned by May, though, and the governor used financial incentives to try to entice more North Carolinians to get vaccinated. Cooper also ordered state employees in his cabinet and administration to show proof of vaccination starting in September or get tested regularly to increase the ranks of the vaccinated in this state.

9 year-old Josie Murdoch holds her vaccination card at Chapel Hill Pediatrics and Adolescents after being innoculated with the Pfizer child COVID-19 vaccination in Chapel Hill, N.C., Thursday, Nov. 4, 2021. Photo credit: Gerry Broome/ AP (Pool)

Cooper and Cohen were asked last week whether they anticipated a COVID vaccine mandate for school children. The N.C. Commission for Public Health, as The Assembly reported in October, is the group that has the power by state law to issue such mandates for students.

“We need to continue this effort to get people vaccinated because it has proven to be very effective against the Delta variant,” Cooper said last week. “What we want to do is prevent any kind of future surge. The process of vaccination for children and whether they’re required is going to be decided by the Public Health Commission.”

Cohen said she would rather start with an approach that lets parents find out more about the vaccines. Data from clinical trials show that they’re 90 percent effective at protecting children from getting COVID and serious illness related to the virus.

“As we think about whether this should be a mandate, I think that’s premature,” Cohen said this past Thursday. “We’re day two here, getting folks vaccinated. I think our message here is making sure folks understand what the science and data is. And really important, I think it’s OK to have questions. I think that is right, as a parent, that you want to understand this deeply.”

Do you have questions about the COVID vaccine for 5- to 11-year olds?

Mandy Cohen, secretary of the state Department of Health and Human Services, will lead a virtual fireside chat and tele-town hall online from 6:30 to 7:30 p.m. Tuesday, Nov. 9.

Rasheeda Monroe, a pediatrician and medical director of primary care pediatrics at WakeMed, will join Cohen in a discussion moderated by WBTV news anchor Molly Grantham, an author, speaker and mother of three.

The discussion will be livestreamed from DHHS and WBTV social media accounts. People can also dial into the event by calling (855)-756-7520 Ext.76807#.

Tune in through Facebook, YouTube or Twitter.

Republish our articles for free, online or in print, under a Creative Commons license.

Anne Blythe

Anne Blythe, a reporter in North Carolina for more than three decades, writes about oral health care, children's health and other topics for North Carolina Health News.