- I wanna thank you so much for doing this today.
And just wanna start by asking,
what have you heard from parents, if any,
now that the approval of the COVID-19 vaccine
has come out for kids under five?
- Yeah, as with everything throughout the pandemic,
it's a mixed bag.
There's a large group of parents
that are actually really excited,
have been waiting a long time
and really eager to get their kids signed up
and are a little frustrated
that there isn't enough vaccine yet this week.
There's a group, pretty much the largest group, I think,
that have kind of taken the wait and see attitude
although it's kind of a split group.
One group basically just doesn't wanna deal
with the hassle of it and trying to compete to get slots
and so they're kind of waiting and seeing
mostly just to be able to get it easily.
There's another group that does wanna see
a little bit more data come out
from larger sections of the population.
And then there's a relatively small group
that are fiercely opposed and they're never gonna get it
no matter what we ask them to do.
- Now, if there aren't huge swaths of people
getting the vaccine for their children,
does that make the vaccine less effective?
- Well, I mean, in certain settings it does.
I mean, we really depend on what we used to call
herd immunity or what we now call community immunity.
So if you're in a closed setting, say a school for instance
and only 10 or 20 or 30% of the kids are immunized,
you're really not gonna have much of an impact
if the virus gets introduced and starts to spread.
You really are trying to shoot for at least 70 or 80%,
is where you can sort of diminish
the impact of introduction.
You're really talking about being able to eradicate
or prevent any spread when you get up over 90%.
So that's part of the reason
that as people think about this, if we're all in it together
it really does need to be sort of a collective commitment
to really doing all the same things.
- Are you understanding though of parents
that are taking that wait and see approach?
- Sure, I mean, with everything throughout this pandemic,
it's been a learning process and it's been happening,
pretty much at warp speed, at the speed of light.
And it's a lot to take in.
I think that currently for the pediatrics population,
the one thing that we had to deal with
is that the vaccines were sort of purported
to be coming earlier in the year
and I think people got a little bit excited
and then had their hopes dashed when it became apparent
they just needed more study and we needed to understand
how many doses and what was the right dosing.
And so I think between that, and then the combination
of what was perceived to be a diminishing of the pandemic,
I think sort of softened the eagerness.
But I think as things are kind of moving along
as we're seeing more of these variants,
we're clearly getting a lot more people
that are more interested and asking a lot of questions.
And I think that's really the biggest message we've got
is that it's understandable
that people are gonna have questions,
especially as this is kind of moving
into this newer age group.
And so we really encourage people to talk
to their own providers and make sure
that they've got all the answers
before they make their final decision.
- Now, that's something that surprised me,
a pediatrician on the DHS Media briefing yesterday said
that the most recent Omicron variant,
hospitalized children at a rate five times higher
than previous variants.
Is this because it was more contagious
or more harmful, why was that happening?
And why was it not necessarily known as well to the public?
- Yeah, I think it's actually more complicated
than people realize, I think it was a combination of things.
One, it certainly was more transmissible
and it was transmissible often
before people even really had symptoms.
So I think that there was a little bit of a limitation
in how much people could do to mitigate on their own
because I think when you know you're sick,
most people have been pretty responsible,
but this one was a little tricky
in that people were shedding before they were sick.
I think that was probably one of the larger features.
I think the other though,
is that, compared to where we were earlier in the pandemic
with the alpha, beta and even the delta strains,
society was actually behaving much more
of what we would consider normal.
There was a lot less mitigation.
Certainly masks had been dropped in many communities
including a lot of schools. And then the other piece of it
was that so much of the population had been vaccinated.
The largest unvaccinated portion
of the population was the kids.
And so I think that combination of features
meant that kids got hit a little bit harder with this
when they were a little bit more likely to be exposed
and they were one of the larger portions of the population
that was still vulnerable.
- There's a misconception though
that kids are less vulnerable.
Do children and parents of kids
of this age group feel left behind?
- Well, I think one of the things
we always have to recognize is that the transmissibility
is dependent on so many different things.
And so certainly for the first year of the pandemic
with schools closed and people terrified,
and mostly staying at home, kids were really protected.
We didn't need vaccines for them in most circumstances
because they were protected
by all these other behavioral things.
I think then as things have returned to more normalcy,
we've started to get a better understanding
of really what happens to kids.
And so, compared to flu seasons, for instance,
I mean, we've got hundreds more kids
dying from COVID currently,
tens of thousands being hospitalized.
It's far worse for kids than the influenza viruses are.
And so I think people had kind of mistakenly
either lumped these things together,
or kind of convinced themselves
that these really were milder and less severe illnesses.
I mean, I won't argue the fact that most kids do do fine
and recover from it, but we are seeing now
the same things we see in adults,
we're seeing kids with lung COVID.
We're seeing kids with permanent disabilities
related to lung and heart injuries
or even neurologic problems.
So I think we've learned a lot more
with this last Omicron surge,
just because we had a very different dynamic
as far as how behavior was,
but also who was vulnerable in our communities.
- Now let's back up a little bit.
So which brands of the vaccine have been approved
and at what dosages?
- So currently we've got Moderna and Pfizer,
both with emergency use authorization
for these youngest kids.
Pfizer is coming in at 1/10th of the adult dose,
so at three micrograms, the older kids are getting
10 micrograms and adults are getting 30 micrograms.
Moderna is coming in at a quarter of the adult dose.
So they're coming in at 25 micrograms,
their booster dose and their dose for the older kids
is about 50 micrograms, and the initial primary doses
for adults are 100 micrograms.
And the goal with both of those is really to see
how far they could push diminishing the side effects
and still get at least decent immune response
or decent immunogenicity that approximated
what the adults got with those bigger doses.
- So kids are getting how many doses?
- So the Pfizer kids are gonna get three doses.
When they originally seemed to be getting ready
to submit their information back in February and March,
people looked at it and said,
it just doesn't seem to be effective enough with two doses.
And so they continued those studies
and basically extended them and decided on three doses.
Moderna's coming in initially with just two doses
at that 25 micrograms.
I think most of the expectations are that these groups
will eventually need boosters,
the same as we've added boosters now
for all the other age groups,
including most recently the five to 11 year olds.
So I think people have understood now that there's a waning
or a bit of an immune exhaustion that happens over time
that that immunity just basically fades a little bit
and needs to be reminded.
And so I think the expectation is likely
that both the Pfizer and Moderna kids
are ultimately gonna need an additional dose at some point.
- And that's part of why it took so long
for this emergency approval to come out,
is they wanted some more data to understand the dosages.
- Yeah, I think when you look at any new vaccine,
there's really two sides to the coin,
is it safe and is it effective?
And so I think that we've learned a lot over these years
now with hundreds of millions of doses of vaccine
having been provided
at what it is we need to understand and study.
And so for all the studies in kids,
they were primarily focused on the safety
and trying to figure out what's the right dose
that gets you a decent immune response
and then giving it to a lot of kids
to make sure that it was safe
and didn't cause any unexpected side effects.
And at the same time looking at how decent
was that immune response.
And essentially what they've done is what we call
bridging studies, where they basically tried to approximate
what we saw with the adult response
and the older kid response and shoot for a lower dose
that still allowed these younger kids
to get a similar immune response
to what those older individuals got.
- Now you've dealt with vaccines
in younger humans for quite a while.
And what is your message to parents or guardians
that are unsure about vaccinating their child
between six months and five years old?
- Yeah, I think there's a couple things
that are really key to remember.
I mean, one is this virus is unpredictable
and as much as we think we understand it,
it does things and it changes that actually then leads
to unexpected consequences,
some of which are pretty unfortunate.
And so I think that it's a false narrative
to convince ourselves that the virus
is somehow getting milder or less invasive
or less transmissible.
I think what we're seeing is a change in the dynamics
just because more and more the population has some immunity
and so it does change how it behaves
once it gets into the community.
But we really don't wanna leave kids vulnerable
to something that really may surprise us
and cause unnecessary side effects
from those infections themselves.
I think the other thing is that this virus keeps changing
and as it keeps mutating,
unfortunately people are not maintaining their immunity.
And certainly we can't trust that the immunity
from a wild type infection previously
is gonna continue to protect kids.
I think people have seen some of the data that's come out
that suggest that in some areas of the country
and in some age groups, as many as three out of four kids
have actually had a COVID infection at some point,
but we can't let ourselves be fooled by that predicting
that then they're gonna be protected and have a milder case
or have no infection when it comes around.
So we've got a tool now that is extraordinarily safe
in all of these studies that we've done
and while it may not completely protect
against all infections, and I think everybody's gotten used
to the concept of breakthrough infections,
these vaccines do what we need them to do,
they protect against severe disease.
They protect against hospitalization,
intensive care unit admission,
and obviously the worst outcome being death.
And so I think that's really where we're looking at these
as being something that's gonna change
how we think about this is trying to give
essentially equitable protection to all age groups
so that they're protected against the worst outcomes
that can happen as we continue to learn
about this really sort of rapidly changing dynamic
of this pandemic in front of us.
- Now is this kind of the last step in ensuring
that the general population is protected against this virus,
is this last age group of six months to five years old
getting emergency approval for the vaccine?
Is this kind of the last big hurdle we needed to get over
and we'll finally see a little bit of a light
at the end of the tunnel?
- Well, I wish I could say it was.
And I know you were trying to lead me into saying that,
but unfortunately I think there are still a number of steps
that are gonna need to still come forward
before we can really consider ourselves
getting this under control.
I think one is getting full licensure for all these vaccines
so that they can be at least in the younger age groups,
getting into that situation where we may see benefit
from mixing and matching.
So while these are under emergency use authorization
you really need to kind of stick with where you started.
The other big thing though, and I think the thing
we're all really watching most carefully,
is the ability to develop vaccines in a real time,
rather quick response to these new Omicron variants
as they keep coming, and ultimately,
to whatever new variants may come.
A lot of the companies now are working
on these variant boosters and we hope
that those are gonna go forward very quickly
for a review and eventually approval
so that those will ultimately then become the boosters
at least for the high risk populations,
the older individuals and people
with underlying medical and immune conditions.
But I think ultimately, depending on how things turn out,
we very well may end up with a booster program
similar to what we see with influenza
where people periodically get doses of these vaccines,
but they're gonna have to be better and more responsive
to what is currently circulating and not continue
to go back to the original strains
that started this whole thing out.
- Do you foresee kids getting this regularly like they would
when they're six months on getting other immunizations,
is it gonna be normalized?
- I mean, I'm still an optimist at heart,
and so I do still hope that we will be able
to get this under control in a way that doesn't mean
that this is gonna be an inevitable persistent thing,
but I also won't be surprised if we end up in that setting.
I mean, this is clearly starting to look more
like an endemic virus that's gonna hang around
and continue to circulate for quite some time.
So I do foresee that we're gonna end up continuing
to add boosters as we have a second booster
for all these high risk populations.
We're on first boosters for the healthy,
younger populations, but I think ultimately we'll add
probably a booster for these younger kids,
especially if the Omicron variants continue to circulate.
And then I think time will tell,
I think we're really gonna need to understand,
does this virus continue to mutate and require updates
the way we have to update the flu vaccines
or is this something that we only give
to select populations?
I think we're gathering that information,
we've got the right people sort of thinking about this
and I think from a regulatory and policy standpoint,
I think everybody's kind of looking at that.
I think we've gotten really good at looking in real time
at data as it emerges now, processing that
and even messaging it better than we did early on.
And so I think ultimately we're gonna be able
to make pretty clear decisions and get people
to understand what it is we all need to be doing.
- So if a parent or a guardian is out there
listening to this and they are really eager
to get their child vaccinated,
can they just go to the pharmacy,
like so many of us have to get our COVID shot
or is there a different procedure
for this really younger group?
- Yeah, not quite yet.
I think that currently the supplies
are just starting to roll out and they're just shipping
from the federal government to the state government
and then being allocated out.
So at this point,
I think everybody's gonna have to be looking
for appointments, whether it's through pharmacies,
whether it's through public health
or whether it's through health systems
until there is much more supply available.
I think most of us learned our lesson early on
in this pandemic, that we didn't wanna offer
appointment slots until we actually had vaccine in hand.
So I think that people are gonna have to play
that game a little bit until there's more supply available.
I think ultimately once we have plenty of supply,
then it'll be more like it's been for the adults
where you can basically just show up and get them.
But I think for the time being,
at least certainly for the next couple weeks
and probably even the next month or two.
The other thing I think we're gonna see though,
is that we've probably at some level,
depended on the centralization of delivery of these vaccines
for quite some time where we've instead of giving them
in people's routine, medical offices and places like that,
have sort of kind of channeled people into select places,
just to be able to manage the supply and the workforce.
But I do think that there's gonna be more of an effort
now to move the vaccines now out into primary care offices
to make it both easier for people,
but also to do it in a place where they're more familiar
and comfortable and where they can actually talk to people
and get their answers that people
that they've been working with
and have dealt with for many, many years.
So I think that's gonna be the biggest change
that we're gonna see probably
over the next three to four months, but at least initially
I think it's still gonna be an appointment only thing
until we get a lot more supply.
- And does Wisconsin law say that children three and under
do have to get it from a physician or need a prescription?
I thought I heard something about that.
- Yeah, it's been complicated.
Basically the state legislature has gradually moved
the age down for when pharmacies can provide vaccine,
but between the emergency use authorization statutes
as well as the state statutes, underage three kids
do need a prescription from a provider.
And so most of the providers are gearing up
to be able to do that, but that's another reason
and I'm glad you reminded me,
why people need to make an appointment
because then the pharmacy can reach out
to your primary care provider,
and we're working on pretty nimble ways
to provide those electronically over the phone
so that people don't actually have to go seek
and get a written prescription.
But yeah, under age three, people do need something
that's been provided to the pharmacy
that a provider has prescribed it.
- All right, Dr. James Conway,
thank you so much for this information.
- Thanks for having me.