The COVID-19 parent trap: To vax your kids or not?

HEALTH AFFAIRS: Are Israeli moms and dads ready to vaccinate their kids?

A YOUNG GIRL receives a dose of the Pfizer-BioNTech COVID-19 vaccine in Louisville, Kentucky, earlier this week. Will we be seeing similar scenes in Israel soon? (photo credit: Jon Cherr/Reuters)
A YOUNG GIRL receives a dose of the Pfizer-BioNTech COVID-19 vaccine in Louisville, Kentucky, earlier this week. Will we be seeing similar scenes in Israel soon?
(photo credit: Jon Cherr/Reuters)

Donna Rachel Edmunds’s nine-year-old daughter will not be getting jabbed with the Pfizer coronavirus vaccine, even after a near unanimous recommendation by Israel’s COVID-19 Pandemic Response Team and senior Health Ministry vaccination advisers that inoculating the country’s children would help keep them safe.

“My daughter is healthy, unlikely to become seriously ill with COVID, and I don’t think it is worth the risk,” Edmunds said, adding that she is not anti-vaccination and has given her daughter all of the standard children’s vaccines until now.

Her fear, she said, is of the long-term effects of the mRNA vaccine – the first vaccine of its kind on the market – effects that cannot be fully known simply because not enough time has passed.

Health officials on Wednesday night held a three-hour discussion on whether to approve and recommend the Pfizer coronavirus vaccine for children ages five to 11, just weeks after the US Food and Drug Administration approved the jab for American kids.

The children’s version of the vaccine is less potent – only 10 micrograms instead of 30. It received Emergency Use Authorization, as opposed to the first two shots of the Pfizer vaccine for adults, which scored full FDA approval in the fall. A Pfizer clinical trial of a few thousand children showed that the vaccine was both safe and effective – data that was convincing enough for the FDA to give its stamp of approval.

 Empty Pfizer-BioNTech coronavirus disease (COVID-19) vaccine vials for children aged 5-11 are seen in Collegeville, Pennsylvania, US, November 6, 2021. (credit: REUTERS/HANNAH BEIER) Empty Pfizer-BioNTech coronavirus disease (COVID-19) vaccine vials for children aged 5-11 are seen in Collegeville, Pennsylvania, US, November 6, 2021. (credit: REUTERS/HANNAH BEIER)

Israeli health advisers voted 73 to two in favor of approving the vaccine. Some 67 experts voted to recommend the vaccine to parents, compared to six who said they would approve it for parents who want to administer it to their children but not push for inoculation.

The experts also weighed in on whether the country should hold off on giving it even if approved, because of the low level of infection in Israel right now. There are only around 500 new cases per day, and fewer than 150 patients in serious condition in hospitals.

Some 65 experts said to act swiftly, while eight said to wait.

The vaccines are still not fully approved in Israel. To begin a children’s vaccination campaign, Health Ministry Director-General Nachman Ash will need to issue a formal approval and release a detailed policy for administering the shots.

“Everyone agreed that they wanted first and foremost to protect the individual children,” said Dr. Boaz Lev, head of the Advisory Committee for Corona Vaccines and Epidemic Control, who offered a briefing on the committee’s discussion late Wednesday. “Everyone wants what is best for the children.”

According to Lev, the committee was charged with conducting a risk-benefit analysis, comparing the mild short-term and unknown long-term effects of the vaccine on children versus the potential for infection if they are not inoculated.

“The infection is much more dangerous,” he said, highlighting that the majority – between 50% and 60% – of all new infections are of young kids.

While only a marginal percentage of these children develop serious infection, during this Delta wave Israel has seen a marked increase in the number of youth developing long COVID and Pediatric Inflammatory Multisystem Syndrome.

“Long COVID and PIMS are becoming not so rare occurrences,” explained Dr. Itai Pessach, director of the Edmond and Lily Safra Children’s Hospital at Sheba Medical Center, “and they are happening only to [unvaccinated] kids who got sick with coronavirus and not to anyone who took the vaccine.”

PIMS seems to show up about three weeks or a month after children recover from the virus, including in children who did not even know they were infected. The syndrome targets all of the child’s organs, but mainly the heart and lungs.

Although only around 200 Israeli children out of some 300,000 who caught COVID developed the syndrome, Pessach said that there were youth who died from PIMS in Israel and around the world, and there are those who required intubation, ventilation and even to be hooked up to heart-lung ECMO machines.

In contrast, he said, there are few vaccine side effects – mainly pain at the site of injection and mild fatigue or fever.

“Some 200 to 250 kids are getting infected with COVID each day,” Pessach said.

He added that the additional negative health and psychological impact of the last 18 months on kids who missed school or spent time in isolation should also be considered.

“This has had a very negative impact on our children, and vaccinating them would of course help,” he said. “Kids who are vaccinated would not have to worry what happens if they get infected or others around them get infected.”

The ministry is expected to make a final ruling on the vaccines sometime in the coming days, likely before the first children’s vaccines arrive in the country around November 15. But regardless of how the ministry ultimately rules, Lev stressed that getting one’s child vaccinated would remain “a private decision for each family,” even as experts hope for high turnout because “vaccinating children is the opinion of the majority of health experts.”

IN CONTRAST to the experts, the majority of Israeli parents might not be ready to put their children’s shoulder to the cause.

PROF. MICHAL Grinstein-Weiss, director of the Social Policy Institute at Washington University: When it comes to children, it seems all parents feel the same. I don’t think parents are going to jump into this so quickly. (credit: Courtesy)PROF. MICHAL Grinstein-Weiss, director of the Social Policy Institute at Washington University: When it comes to children, it seems all parents feel the same. I don’t think parents are going to jump into this so quickly. (credit: Courtesy)

A new, still unpublished survey by Prof. Michal Grinstein-Weiss, director of the Social Policy Institute at Washington University, showed that only 17% of Israeli parents were “sure” that they would vaccinate their five- to 11-year-old children. Some 20% said that they were likely to vaccinate them, 23% said they were wavering, 18% said they were not likely to vaccinate, and 22% said they were sure that they were not going to vaccinate their kids.

Parents with younger children are even less likely to do so than parents with older children within the targeted age cohort.

While 46% of parents said they would vaccinate their 11-year-old children, only around 30% said they would vaccinate their five- and six-year-olds. An average of 40% said they would vaccinate children between the ages of seven and 10.

Those parents who will vaccinate had three main reasons: to protect them against COVID-19 (88%), to protect them against long COVID (69%) and to help the country eradicate the pandemic (67%).

Only some 42% of parents who said they would vaccinate their children said they were doing it to get their children a Green Pass.

There are differences among parents based on their socioeconomic status. Parents in the highest income bracket were more likely (60%) to say they would vaccinate their children, compared to 25% of parents in the lowest socioeconomic bracket.

What Grinstein-Weiss found different in this survey than in her previous vaccination surveys is that there was no gap between the opinions of the different sectors.

Only 40% of secular parents said they were sure or likely to inoculate their young children. Similarly, only 34% of traditional parents, 37% of religious parents, 34% of haredi (ultra-Orthodox) parents and 35% of Arab parents said that they were sure.

“When it comes to children, it seems all parents feel the same,” Grinstein-Weiss said. “I don’t think parents are going to jump into this so quickly.”

THE SURVEY found that the main concern for parents is that the vaccine could harm their kids (71%), or that it could have unknown long-term effects (70%).

Others said that they would not vaccinate because COVID is not fatal for children (56%), or because they do not trust the safety data presented by Pfizer (53%) or by the government (49%).

“The short-term effects of the vaccine we know, and there is not much risk,” Pessach stressed. “The bigger issue is what will be the long-term effect of the vaccine... what will happen in 20 or 30 or 50 years. But the answer to that question we will not know in another year or three years – only in 50 years.

“Someone who says he is going to wait 50 years to vaccinate his children is making a mistake,” he said. “I think we need to protect our children now.”

IT SEEMS that what would help parents make the decision to get their kids the shot is increased transparency, Grinstein-Weiss’s survey found.

Some 45% of parents said there was not enough transparency around vaccine side effects, 59% said there was not enough around the country’s agreement with Pfizer, and 55% said there was not enough insight into how decisions were being made by the ministry and other officials.

The less transparent parents feel the situation is, the less likely they are to vaccinate.

For instance, 54% of parents who thought there was transparency around side effects said they would jab their kids, versus 15% of those who thought that there was not. Similarly, 58% of parents who thought there was enough transparency around the Pfizer deal said they would inoculate their kids, versus 22% of those who didn’t.

At the same time, among those parents who were still wavering whether to vaccinate their children or not, some 64% of them said that if there were more transparency around the vaccine’s side effects, they would be more likely to move forward with inoculation. Some 61% said the same would be true with increased transparency about the effectiveness of the vaccine, and 52% if there were more transparency around the decision-making processes.

The Wednesday night discussion of the expert panel was not streamed live as originally intended, according to top ministry officials, because of fears by committee members of violent backlash by the anti-vaccination community.

A preliminary discussion on the subject of children’s vaccines was aired live the week before.

“The idea of livestreaming the conversation did not happen, not only because of violent threats but to maintain the professionalism of the conversation,” Lev said. “There was a feeling that some of the staff would not want to express their opinions openly and fully, and that they would talk to the cameras and not to the matter at hand.”

But Grinstein-Weiss said this decision might have harmed the first stages of vaccine uptake by parents of kids five- to 11-years-old.

“It is really important to give as much information as possible to parents so that they do not feel like something is being hidden,” she said. “Transparency is what we need to increase the vaccination rate – this is critical.

“The more we share the full picture... the more likely people will feel secure with the process and get their kids the shot,” she said.

JUST ASK S., who splits her time between Jerusalem and Florida. Like most parents who are against vaccination, she asked to keep her full name anonymous for fear of being targeted or attacked by the pro-vaccination community.

“I don’t like the suppression of information,” she said in a phone call.

S. said that after watching a good friend have a negative reaction to the Pfizer vaccine, she is nervous about inoculating her son.

She said she believes that young kids don’t suffer too much from COVID and “what they tell you in the media is crap. The vaccine is definitely not needed for kids – heck no.”

Ari from Jerusalem will also not vaccinate his children, because “the likelihood that corona has any serious effects on children” is low.

“Why vaccinate them against something that is not dangerous to them?” he asked. “I don’t necessarily think vaccinating is dangerous, and I am not opposed to it. I just don’t see any reason to do it.”

He added that he has been turned off by the feeling that the government is forcing vaccines on the population rather than allowing people to make the best decision for themselves.

Ari said the only way he would bring his kids to the vaccine complex is if his wife makes him; she is more inclined to do it if the country makes not vaccinating youth a “logistical headache.”

IN CONTRAST, Nitza Raymond said that she will get her youngest daughter vaccinated right away “because it’s important for her health and the health of the family. It will protect her and the people around her.”

Another mother, Lydia, said she, too, will get her kids the shot.

“I want the pandemic to end,” she wrote in response to a Facebook question posed by The Jerusalem Post. “I see vaccines as a privilege, not a problem. I don’t think there are any major risks to vaccinating kids. And the virus has been finding its way into younger and younger unvaccinated people as this pandemic drags on.”

And Debbie Finkelstein from Modi’in said that she will also be getting her kids the shot.

“I believe that vaccines offer the most effective long-term protection against COVID, and there is the added benefit of avoiding the negative mental health issues caused by quarantine or the fear of quarantine,” she said.

Pessach, too, said he will be vaccinating his youngest child.

“It is not just that I am sending my kid to go get vaccinated, but that he wants to go and get it and put the challenges of the last year behind him,” Pessach said. “He is very happy to do it, and I am sure the vaccine will protect him.”

He added that he hopes many other parents will choose like him and get their children jabbed.

“We have a responsibility to one another,” Pessach said, “to the children and the rest of the community.”

“We do not know when there will be another coronavirus wave,” said Prof. Eli Somekh, head of the pediatric wing at Mayanei Hayeshua Medical Center in Bnei Brak. “We don’t know if this wave will start to spread again or if there will be another variant.

“People who are vaccinated will be in a much better place against serious infection,” he stressed. “It is much better to enter any new wave vaccinated than unvaccinated.”

But both groups of parents said what they really hope is that whatever decision they make for their children, there will not be a stigma around it.

“I am not an anti-vaxxer or a crazy conspiracy theorist,” Edmunds said. “I just looked at the data and felt it did not work. I wish other people would respect that decision.

“It would be nice to have respect for people who take the vaccine as well as for those who don’t,” she said.