What to Know About COVID-19 Vaccines for Children 5-11

What Early Care and Education Staff Need to Know About COVID-19 Vaccines for Children 5-11

Steve Shuman: And now, we can begin. And it's my privilege to introduce a powerful advocate of children, families, and Head Start staff, the Director of the Office of Head Start, Dr. Futrell. Dr. Futrell?

Dr. Bernadine R. Futrell: Thank you so much, Steve. Hello, everyone. Good afternoon and welcome. I'm so happy that you all have been able to join us today for this webinar, What Early Care Education Staff Need to Know About COVID-19 Vaccines for Children 5 to 11. And I am here opening as the director of Head Start, but also as a mom of a 7 and 9-year-old who were vaccinated two weeks ago. And I am so appreciative of knowing that and really supporting the work of getting more information out to children and families as we continue to move forward.

Before we get started, I want to recognize the National Center on Health, Behavioral Health, and Safety, who's hosting this webinar and who brought together some phenomenal pediatric experts to help us learn more about the COVID-19 vaccines for children ages 5 through 11 and who will provide information about this new way to protect children from serious illness due to COVID-19. This center is jointly administered by the Administration for Children and Families, the Office of Head Start, in partnership with the Office of Child Care, and the Health Resources Services Administration Maternal Child Health Bureau.

While I'm excited for the learning and sharing during this webinar, I do want to take a moment to recognize and pause regarding the position we are in. As the pandemic continues, we know it comes with many challenges. We know that it has taken a toll on many, not just Head Start, but all ECE programs. We understand the increased anxiety that's going into a new year about new information that we continue to learn about the pandemic.

What I do appreciate, like most of you, is that the CDC and others have announced new recommendations for the vaccines as a path out of the pandemic. I'm grateful for that. I'm also grateful because I know the Head Start and early childhood education community has always served and led and partnered with families in the most difficult, challenging times. As we navigate out of these, I commend and thank you for continuing to do that.

We know that the vaccines are safe and effective. But we also know that families who choose vaccines for themselves and their children are critical partners in having healthy, safe communities. That includes many of our Head Start and ECE children who are enrolled in programs. It's a way to protect them, as well as those in their community who are not yet eligible to be vaccinated.

I encourage you all who are on the line today to engage families in supportive and informative conversations about the safety and benefits of vaccinating children ages 5 through 11, and even your own. As I know, as I mentioned, I'm so grateful that my children are vaccinated because I know it's going to protect them and keep them safe. I know also that it takes consistent, honest, and respectful communication with families as a cornerstone towards fostering family engagement around every topic, especially around pediatric vaccines. As many families are trying to decide what is right for them, we want to encourage you to direct anyone seeking additional information to talk to their child's health care provider to get the facts. We appreciate you for being here today. I'm looking forward to a great event. Now please join me as we welcome Dr. Sells.

Dr. Jill R. Sells: Thank you, Dr. Futrell. We really appreciate your leadership and are so glad that you could join us here today for this important webinar. Hello, everyone. On behalf of the National Center on Health, Behavioral Health, and Safety, I'd like to welcome you to this webinar, What Early Care and Education Staff Need to Know About the COVID-19 Vaccines for Children 5-11.

My name is Dr. Jill Sells. I'm a pediatrician, and I serve as a medical advisor for our National Center. One of my roles is to lead our COVID work group for the center and partner with our multidisciplinary team to develop and deliver webinars and other resources around COVID in support of staff and families in the early childhood community.

I'm really delighted that Dr. Lee Atkinson-McEvoy and Dr. Neal Horen are joining us for today's webinar. Their pediatric and mental health expertise will provide important information about COVID-19 vaccines for children. I'll be introducing each of them a bit more before their parts of the presentation. Next slide, please.

Our objectives today are to talk about the 5 through 11 age group so that we can all better understand the recommendations for vaccination for COVID and to understand the benefits of the COVID-19 vaccine. We will learn more about the safety and efficacy of the vaccine from the clinical trials that have been done and gain knowledge and resources to support conversations with staff and families. Next slide, please.

The order in which we're going to do this is the opening and welcome, which you have just heard from Dr. Futrell, then a presentation on the vaccines. Then we'll talk about having conversations with staff and families about vaccines. We'll answer some questions, as many as we have time for today, and then present briefly some of the additional resources that the center has developed to support staff and families. Then we'll close out today's webinar.

I'd like to remind you that we have both the Chat and the Question and Answer feature on the webinar. If you have questions that you hope we might try to answer today, please put them in the Question and Answer section, not in the chat. Next slide, please.

Now it is my great pleasure to introduce to you Dr. Lee Atkinson-McEvoy. She is a professor of Pediatrics at the University of California San Francisco School of Medicine. She serves there as the chief of the Division of General Pediatrics and vice chair and executive medical director for Children's Primary Care and Population Health.

She has been instrumental in creating the UCSF collaborative to advise on reopening education safely. This collaborative advises child care and education settings on how to safely provide in-person services during the COVID pandemic. As a primary care pediatrician who's been actively partnering to support both families and early care and education professionals, she really brings both perspectives to our conversation today. Dr. Atkinson-McEvoy, welcome. And thank you so much for joining us today.

Dr. Lee Atkinson-McEvoy: Thank you so much for having me. I'm glad to be part of this webinar. Next slide. As you all probably have heard, the vaccine for COVID-19 for 5 to 11-year-olds made by Pfizer has now been not only approved but recommended.

This vaccine and its dosing is not based on weight but based on age. Children 5 to 11 get a dose which is one third of the dose that was given to everyone 12 years of age and older. And just like those who received Pfizer who are older, children need two doses given three weeks apart. The vaccine doses are in separate vials with separate needles. And we use a smaller needle for the younger children to help them tolerate receiving the vaccine. Next slide.

As we think about giving vaccination, not only COVID-19, but all vaccinations, we really think about it from a risk-benefit approach. The benefits really are that has been shown overwhelmingly, with the same rates in the 90s that we saw in older adolescents and adults, to protect children from getting severe COVID-19 disease. And there are additional benefits I will talk about later. And then the risks are really the mild temporary side effects from vaccines that we see from a variety of vaccines. Next slide.

We know that COVID-19 can cause significant illness in children. We saw in the late summer, early fall with the rise of the Delta variant, as children remained largely unvaccinated population, particularly those under the age of 12, as it was not an approved vaccine, we saw more children getting sick. We actually saw some of those children getting severely ill. Cumulative to date, there have been over 8,000 children who have been hospitalized in the United States. And 35% of children 5 to 11 who were hospitalized had no underlying health problems. We know that even for children who were previously healthy, they can get a more severe case of COVID-19. In the United States, 172 children aged 5 to 11 have died due to COVID-19. Next slide.

As I mentioned earlier, the COVID-19 vaccine is effective. In clinical trials where over 3,000 children were studied, aged 5 to 11, the vaccine was 91% effective in preventing serious illness. In the study, there were no cases of severe COVID-19 that resulted in hospitalization or death. The vaccines worked as well in children as they do in the 12 and older and in the adult population. Next slide.

Part of the clinical trials was also to look for the safety of the vaccine. The children who received the vaccines in clinical trials did well. I just want to add that the children who received the vaccine from the approval, we've also seen overwhelmingly children do well. With the smaller dose of vaccine, we've seen that children have had fewer side effects than older people. The vaccines were safe and effective in children who had never had COVID-19, as well as children who had previously had COVID-19. As I mentioned, vaccine safety is continually being monitored. Next slide.

How did they decide on this smaller dose? This was part of the earlier studies. They're called phase I and II, where they looked to find the right dose. It's very much like the Goldilocks fable. It's wanting to get a dose that if it was too small, it would result in a poor immune response and less protection, and a larger dose might cause more inflammation and side effects. They studied it for the right dose. The current dose that we're giving to the 5 to 11-year-olds seems to be the right dose. Next slide.

Let's talk a little bit more about the benefits of COVID-19 vaccine for children. As I mentioned previously, it has been shown to decrease the severity and the ability to get COVID-19 as an illness. Next slide. However, an important thing is receiving vaccines. As a result of receiving vaccines resulting in differential quarantine needs after exposure and prevention from disease, it really helps children stay in schools. Schools are critical for children in social-emotional skills, safety, reliable nutrition, continuing of PT, OT, and speech services, mental health, and physical activities, as well as education predicting the greatest success for individuals in our society. Next slide.

The other thing that we know is that the impact of COVID-19 has created great inequities with certain parts of our population experiencing more disease due to systemic barriers to care. This slide is really showing the hospitalization rates by race and ethnicity. We see on it that for Black, Hispanic, and American Indian/Alaska Native, a large excess in hospitalization, not because of virus affects people from those backgrounds differently, but because of systemic racism and systemic inequities. The ability to vaccinate children would help to protect against these inequities. Next slide.

Vaccines also help children to be active and social. Besides being able to stay in school, they're able to participate in sports and extracurricular activities, able to be with peers, which is developmentally appropriate, and be able to spend time with extended family, particularly elders in their family who they may have been isolated from through the course of the pandemic. Next slide.

Vaccinating children helps to protect families. The more individuals in the household who have protection, it really reduces the chances of COVID-19 being introduced to that household. For children under 5 who can't get vaccinated yet, having their siblings 5 and older vaccinated protects them. It also protects older relatives who may be more vulnerable despite receiving the vaccine and protects family members with health conditions that prohibit them from receiving the vaccine or responding to the vaccine appropriately. Next slide.

COVID vaccines are free. You can go to the vaccines.gov website to find a location near you. Many different types of locations in your community might be providing vaccines – your health care providers, schools, pharmacies, and some large countywide sponsored vaccine sites. Next slide.

I'll just address some of the common questions that people have about the COVID-19 vaccine. Next slide. This particular question isn't unique to COVID-19 vaccine. It's a common question for a lot of vaccines, particularly the flu vaccine. “Can receiving the COVID 19 vaccine cause you to get COVID-19?” And the answer is no. There is no live virus or anything that's reproducible to create the virus in the vaccine. Next slide.

The common side effects – soreness of the arm, feeling tired, some swollen lymph nodes or glands near the area, headache, fever or chills, nausea, or muscle aches. I want to point out that we know that those side effects were less common in children than they were in adults, which we related to the smaller dose being used. Next slide.

Who should not get vaccinated? A lot of people are worried about having specific conditions and concerns about whether that means that they shouldn't get the vaccine. Really, it's only people who have had a severe allergic reaction after a previous dose of the COVID-19 vaccine or a known allergy to a component in the vaccine.

Even if you've had an allergic reaction to another vaccine before does not mean that you cannot receive this vaccine. People who have immune system conditions of concerns were actually amongst the first to be recommended to get the vaccine when we started vaccinating adults. If someone has questions about a specific medical condition, you can speak to your provider. But really, the one common reason to not get it is that you have a severe allergy to a part of the vaccine. Next slide.

Boosters, as you know, it's in the news around who should get boosters. It's coming down the pike that the 16 and older should get boosters of the Pfizer vaccine. Currently for the 5 to 11-year-olds, the only recommendation is that they get their two doses spaced three weeks apart. There isn't currently a recommendation. For children 16 and 17, it just came out in the news in the last couple of days that the FDA has approved 16 and 17-year-olds getting a second dose, sorry, a booster dose, a third dose but that has yet to be fully approved. Additional doses are not approved for 12 to 15-year-olds. Next slide.

The most common question I get is when will there be vaccines for children younger than 5? Clinical trials are happening now for 6-month-olds to 4 years and 364-day-old children really to, again, look at finding the right dose that's not too hot, not too cold, and monitoring the side effects. As information becomes available, we will definitely be providing additional updates. Next slide.

Dr. Sells: Thank you, Dr. Atkinson-McEvoy. We really appreciated all that information. Now, I am happy to introduce to you Dr. Neal Horen. He is the co-PI and co-project director of the National Center on Health, Behavioral Health, and Safety. He's also the director of the Early Childhood Division of the Georgetown University Center for Child and Human Development.

Dr. Horen is considered one of the leading national experts on early childhood mental health and early childhood systems. He's delivered hundreds of trainings across the country and co-led the development of materials addressing trauma, infant mental health, disabilities, and staff wellness, among other things. Dr. Horen has been leading efforts to integrate behavioral health supports into the COVID response work of our National Center since the pandemic began. Dr. Horen, thank you so much for continuing your partnership with us and our COVID-related efforts to support staff and families and for joining us today.

Dr. Neal Horen: Thanks for having me. I listen to that, and it sounds like I know what I'm doing. I realize I'm having that conversation with my 5-year-old. I'm having this specific conversation with my family and my 5-year-old. I think all of what Dr. Atkinson-McEvoy just laid out is so helpful to have all of that in front of me.

I have to think about this is a hard conversation. It's a hard conversation for staff to have with families, for folks to have with children. Let's just spend a little bit of time talking this through. Next slide, please.

I think in the work that we all do in early care and education, we have lots of sensitive conversations. We are talking about very intimate relationships that we form with children and families. That often entails talking about lots of detailed things that we may not share with everyone. This may be even more challenging for some, as people are starting to make decisions that for some felt very good and feel right, for others they've struggled with, and really want to help folks think through, how do we have a successful conversation? What does that look like? Is it always that somebody does what we say? Obviously, the answer to that is not necessarily yes. It's about always working through our relationship and thinking about how that might be helpful.

We have strategies that work, and we'll share those with you. We have some resources that we'll share as well. On the next slide, I just want to talk a little bit here. Whenever you're going to have these kinds of conversations, it really is important to prepare. That may sound – next slide, please – it may sound sort of silly. “Why do I have to prepare to have a conversation?” Anybody who knows me knows I probably should have prepared for any conversation, and I just keep talking anyway.

For this, we really want folks to think about this. Hopefully, you've taken that time to develop that relationship that you have with a family. It's even more important here. Start to think before you even have the conversation about what questions may come up. Think about how that's going to be done in a way that really is reflective of the values and opinions and cultural beliefs and familial beliefs that that family has and that you have that may or may not be the same. That's a hard thing to do, because we all have our own feelings. In a conversation that we're having that we want to have some success about, we really need to think about the other person just as much.

Think about even where we're going to have that conversation, how it's going to be private in a warm, inviting sort of place. Think about maybe even using some of the mindfulness practices. We have resources here. Our Center's developed a number of resources on challenging conversations or around sensitive topics and encourage you, you'll see them here towards the end, but really encourage folks to look at those.

This is really, it may not – it may feel like, “Wow, that's a lot to do to have a conversation,” but this is a sensitive conversation. The more that you're prepared and the more that you've thought through the kinds of things that may come up, the more likely you are to have a successful conversation about that. Next slide, please.

Really start to think – and we've talked, I'm sure, if you're in early care and education, this is sort of your bread and butter. I like to use – Dr. Atkinson-McEvoy talked about Goldilocks. I'll use bread and butter instead of porridge – I think this is your bread and butter. You know that arriving at this conversation with a strength-based attitude is critical. We know that our families are our partners in all of this. They've entrusted all of us with the care of their children. That's a bond that we've established.

When we think of them as our partners and them having the expertise about their children, then in our relationship we're really focused on that. We're focused on our relationship. We're focused on the relationship that they have – the family has with their children. Then we start to think about them in terms of as a unique family with their own cultural beliefs, with their own perspectives on this. We honor that. We have a conversation that is not about right and wrong, but about we're in a conversation where we're talking about our perspectives and really thinking about how this might be a conversation that's helpful and understanding that people are very passionate.

This is a topic, I don't think it's a surprise to anyone, people are very passionate about this topic. Remembering that, remembering that you may feel passionately, as is the person that you're speaking with. When we approach it in this way, we have a much better chance of success in that kind of a conversation.

To that end, we've actually really thought about how you can think about where a family is coming from, where you're coming from, and how you have that conversation. We have a number of strategies and resources on our next slide. A number of these on ECLKC, and Preparing for Challenging Conversations with Families. It's really about this piece of not just going in and saying, we're going to have a conversation, without thinking through this particular family, this particular child. What is it that may come up? What is it that they've oftentimes talked about in the past?

Engaging Families in Conversations about Sensitive Topics and having those sensitive conversations, there are resources here that sort of have a number of tips and strategies for all of you to think about in those conversations. I say this in a way that is to encourage you all to think carefully about this kind of a conversation, not to make it more dramatic than need be. If you are feeling like this is going to be a tough conversation, to really spend that time preparing.

We talked about strengths-based, starting with strength during challenging times. Using motivational interviewing techniques, sounds really fancy. I'm not a fancy guy. This is really about how do we have a conversation where we may or may not exactly be on the same page, but there are strategies we can use so that we have a conversation that moves forward. It may not be at the end where either of us wanted it to be, but it's moving forward.

I think these are important sorts of resources, because oftentimes many of us feel – I know I have felt this way over the last year and a half, that at times I'm not exactly sure what I should be saying. I have to measure my words and really think about where the other person is. I just had this this weekend, sitting with folks and thinking about I'm not sure where everyone sits where they feel about things. I'm not just going to say something without thinking about what do I want to say, what am I trying to accomplish here, and what's this conversation really about? These are some great resources for you to take a look at. Next slide, please.

If you thought that was challenging, how about having the conversation with children? And in some ways maybe this feels easier for folks. But I really want you to start to think about, what's developmentally appropriate? And that's a big range.

How you would talk to a 5 or a 6-year-old versus a 10 or 11-year-old is a very different level that you would pitch. I oftentimes think about conversations with children about the level at which I'm – developmental level at which I'm pitching something. Then thinking about that conversation that the child and family are having, right? There's a lot of differences. It's really important that for some children, this may be anxiety producing. We want to start to think about, what might we do that might be helpful?

On the next slide just a couple of things to keep in mind, that children can often be, again, developmentally, it can be for a 5-year-old very different, what comforts a 5-year-old versus an 11-year-old. Or for young children, 5 or 6-year-olds, having one of those favored possessions may be super helpful to have before, during, after. We thought about this carefully, as Dr. Futrell mentioned – I didn't go with Dr. Futrell, but as Dr. Futrell mentioned her children, my daughter was vaccinated. And we thought carefully about what are we bringing for her to have before we go in, during this vaccination, and afterwards?

Having folks in the family, maybe their older brothers or sisters, cousins, other family members who can actually talk with that child about how the vaccine keeps them healthy, protects them, protects other people, that could be really helpful as long as it's done in developmentally appropriate terms. Oftentimes the messenger is just as critical as the message.

We have to be honest with children. The vaccine may pinch or sting. It doesn't last very long. It sort of goes away. You heard Dr. Atkinson-McEvoy talk about some of what might happen after in terms of swelling or things like that.

Oftentimes, we have to – we're to wait for 15 minutes. Think about, are we just going to have a child sit for 15 minutes and just sit? Or are we going to actually be prepared about for young children listening to music, coloring, reading a favorite story. For older children there may be other things. I've heard there's these things called video games that children like. I'm not promoting them, but I've heard they like them, but things that may be of interest that may be much more helpful than just sitting there for 15 minutes.

Lastly, I'm going to say what I oftentimes say, and I know that some people think it's just brief, but it's not. On the next slide, this is all about relationships. If we are being consistent and predictable, if we are developing that relationship and we have that in place, children who have these big feelings and need some support, we are there because we have that relationship. That relationship that we have with the children, with our coworkers, with families, that's what's going to help us move through this in a way that is supportive to families and children wherever they're at, however they're feeling about this. Those relationships that we've established, as I said when I started, are going to be super helpful.

I know I ran a little bit long, but I do feel pretty strongly about this. I got all excited when I saw bowls of porridge. Dr. Sells?

Dr. Sells: Thank you, Dr. Horen. It was great. Really appreciated all the information and specific resources that you shared that folks will be able to turn to as they think about all of this.

Now, we're going to do some open-ended questions here a bit. The first one I'll have is for Dr. Atkinson-McEvoy. I know a lot of people are curious about this, because we are in a position to be interacting with more families than average around this conversation. Can you share with us a little bit about what you've heard or what you've seen about how both children and parents feel about this vaccination for 5 to 11-year-olds?

Dr. Atkinson-McEvoy: Sure. I'm happy to answer that question. I think there's three categories. I can't tell you the numbers in them.

There was the category of the people who were so anxious to get the vaccine that on day one they were crashing everybody's system to schedule their kids to get the vaccine and really relieved around the vaccine being a path for us as a country to recover and for their children to return to the developmentally appropriate state of being that they needed to be in. There was another group who were just concerned about what the effects would be, and the number of kids studied weren't enough, who wanted to get it, but maybe wanted a few other people to be the early adopters, sort of see what happens. Those are the people who are scheduling their kids now that all of those early adopters have gotten their second doses to do it.

And then there's a group who remain questioning or want more information, where the perception that the impact on kids 5 to 11-year-olds isn't actually serious, and that they would wait a little bit longer. What I would say to the latter group is sometimes it seems like not doing something is safe, meaning once the vaccine is in my child, it's in my child, and I can't take it out. But if I wait, I'm keeping them safe.

We know and we continue to learn, besides the statistics I gave you around hospitalizations, where they were otherwise healthy children who were hospitalized, there were otherwise healthy children without underlying health conditions who have died from COVID. We as a society have really decided that between 5 and 11, there's not many good reasons that you should die, including if you have a chronic condition. We develop medicines and treatments to improve health. The goal is to have that number of kids who die go down to the smallest possible number. 172 children dying from a previously unknown illness is significant, and we pay attention to it.

All of the social-emotional effects of having been in the pandemic and social isolation, we are starting to see. You all might be starting to see it as educators for the early childhood group. Schools are seeing it in all of the K through 12. Those social-emotional effects are important, and they do have consequences for children.

Dr. Sells: Thank you. So many things to think about. It's really helpful to hear how you're sharing those perspectives. This one's for you, Dr. Horen. What if I encourage a family to get the vaccine and then someone has a bad reaction? Won't the family hold that against me?

Dr. Horen: If I'm being honest, they may hold it against you, but my guess would be that you've probably had a more extensive conversation, in which you've sort of laid out there are potential side effects and things like that, as we've talked about. I think part of this is not about do we hold it against me, but it's about in your relationship, have you had a discussion in which you said here's what we know? Here's all the information about the benefits of this, as you've heard today.

Here are the kinds of things that we know are potential side effects. When you make that decision, understand that those things may happen. I'm here for you to follow up, to support you if the child is having difficulty, not in the sense of anything but what you've already been doing. You support social-emotional development. You support the relationship.

It's not something you have control over. We oftentimes talk about what you have control over. What you have control over is sharing information and then dealing with a family who may be having difficulty. Whether it was about side effects from a vaccine or any other topic that came up, our role in early care and education is that we are supporting our families. There is support that you can offer that is not about what happened here, but more about as you made that decision, I hopefully provided you with information that helped you make that decision.

Dr. Sells: Thank you. Here's one for Dr. Atkinson-McEvoy. Do some kids have symptoms of long COVID?

Dr. Atkinson-McEvoy: I assume you mean not in the context of having received the vaccine. We are seeing children who have prolonged symptoms after having COVID infection. That phenomenon has not been described post the vaccine.

Dr. Sells: Great. Let me just say that what I think I heard. Yes, for children who've been infected and gotten sick, there have been some cases of long COVID that we continue to see. And no, if someone was inquiring about whether the vaccine could cause that, the answer is no …

Dr. Atkinson-McEvoy: Is no.

Dr. Sells: … because it doesn't lead to infection.

Dr. Atkinson-McEvoy: Absolutely.

Dr. Sells: And another one for you. What about children who have already had COVID? How do they benefit from the vaccine or do they?

Dr. Atkinson-McEvoy: What we know is if you have had COVID vaccine, the disease, you do make an immune response. But that wears off, and you can be infected again. That's one of the things that's coming up as we are trying to understand a micron as it goes across the globe. The idea is if you get vaccinated, your protection lasts longer. Even if you've had COVID, it is recommended that you get the COVID vaccine once you have recovered from your illness.

Dr. Sells: Thank you. Here's one for – that I'll get to Dr. Horen to start. Why do early education workers need to discuss medical treatment with families? Why wouldn't we direct them to their doctors?

Dr. Horen: You absolutely should direct them to their doctor. That's the first stop. Why should early care and education folks discuss anything? Because you are the people that we look to. As somebody who's had their child in child care, who do I want caring about my child? I want you to. It's not about you are the only person to discuss it. It's about being prepared that families may come to you with questions, concerns, thoughts. You need to be prepared to have that conversation as best you can.

I don't think – I hope that no one's taking away from this that you're the only one. We certainly want – you're right, if there's a medical question, that should be – it should be going to medical experts. Your role in this is being that supportive relationship piece that may say, “Boy, here's what I think I'm hearing. Any of those kinds of concerns or that particular question, you certainly should be talking to your primary care physician.”

Did I get that right, Dr. Atkinson-McEvoy? OK, good. I just wanted to make sure.

Dr. Sells: I'll just add in, so much of the early childhood community and certainly within Head Start, we're really trying to connect all these dots and build this supportive system around children and families for all kinds of reasons. This is just one of those. Thanks for sharing that perspective.

Let's see, Dr. Atkinson-McEvoy, are there any known long-term effects of the vaccine? How can we reassure parents if we can't answer that question?

Dr. Atkinson-McEvoy: Yeah, as everybody knows, the vaccines really first became available a year ago now. A year ago now was when they were first being approved and the first health care workers were receiving it. We only have a year's worth of data to talk about long term. We know that's not a long time. As we get into children, the time that we've been following it is shorter.

One of the things we can rely on, however, is a vaccine isn't – the vaccine wasn't the entire piece created from new. The vaccine is almost like a platter with something on top that's being presented to your body to respond to. The something on top that's new is the little piece of information that's specific to COVID – the COVID crown pieces – for our bodies to make antibodies and other immune reactions to the crown.

The platter of the vaccine has been studied for almost 30 years. We know that the platter, the core part of it, is well-established in terms of what effects we would expect long-term from that. It is just really how our immune system is responding to the little bit of COVID information and whether long term – because we know we react to that vaccine – whether we would expect anything to happen long term.

Dr. Sells: Thank you. This is another one for you. Have some children had a severe reaction to the vaccine?

Dr. Atkinson-McEvoy: I'm sorry, can you say that one more time?

Dr. Sells: Yes. Have any children had severe reactions to the vaccine?

Dr. Atkinson-McEvoy: I'm assuming it's the 5 to 11-year-olds we're talking about. I don't know if we're talking about the entire population of children. In the 5 to 11-year-olds, there were three people in those studies who were categorized as having a severe reaction. Some of them, there wasn't really a plausible explanation. Somebody sustained a fracture after an injury, but it was categorized like we were watching you after your vaccine, you had this fracture, so we're going to categorize it.

We continue to monitor it to see. We were particularly interested in after the second dose. It takes a while before we get that information because, again, they categorize everything that happens after the vaccine, even if there's not an explanation related to the vaccine to cause it, and then we get the information.

As of yet, there hasn't been anything, obviously, , but we will continue to look to see what the severe side effects are. There's a national reporting system that we track all vaccines, actually, not just the COVID vaccine. We rely on that. Anybody can report anything. A parent can report. A physician can report. We're looking for the data to come out in the next couple of weeks.

Dr. Sells: I'll just add here, we did a webinar earlier in the year, where Dr. Sean O'Leary talked through the whole process of, in general, of vaccine developments, specifically this vaccine –these vaccines as well, but the ongoing safety and monitoring processes that we have for all vaccines across the country. There's a very robust system in place intended to try to cast a broad net and make sure we don't miss anything and try to figure out if it's something that could actually be related to the vaccine or not and whether it's something that needs to be addressed. That webinar is on ECLKC if folks didn't hear it or would like to revisit that. I just thought I would add that. Thank you for those comments.

Let's see. Dr. Atkinson-McEvoy, you're getting your work cut out for you. This one looks like it's for you, too. What evidence is used to determine that the immune response to the vaccine is more prolonged than what you get through natural COVID exposure? How do we know that?

Dr. Atkinson-McEvoy: Thanks for that question. I'll try to answer it without getting into – being too technical. One of the obvious ways is observational studies, to really look at people who test positive for COVID, certainly the ones who are more serious, who are hospitalized, and looking at their history to see, did they receive a vaccine, or did they not receive a vaccine?

An example is the first case of omicron in the United States that was publicly spoken about, although other cases came out that may have predated it within San Francisco. And for that individual, they did a careful history. Did he get vaccinated, had he been sick, et cetera. That's one of the ways that we know, is from that observation. With people who don't get the vaccine but have had the disease, we see them getting reinfected at a slightly higher rate than people who have been vaccinated.

The other things that we track are the antibody immune response. There's lots of studies. I actually just recently participated in a study. I was randomly selected based upon my zip code for me and a child. One of my kids and I did it, to submit blood data. We had to put in when we last got our vaccine, where they monitor antibody levels.

That's how – and part of the questions was have we had COVID, which we had not, but if we had what date we were diagnosed. They really used that to track that information. Studies are ongoing on the natural history of COVID and what happens postvaccine across the globe, not only in the United States.

Dr. Sells: Thank you. I see a question that I think will be maybe interesting for both of you to consider. I'll start with you, Dr. Horen. What if kids wanted to get vaccinated but parents are not?

Dr. Horen: Sorry, is there an easier question? I'm just joking. I think that yeah, this is – obviously, the first answer is their legal guardian is who is going to ultimately make decisions. That said, it is an interesting question in the sense of how do you have – that's a sensitive, difficult conversation.

I've seen a couple of questions or comments here about convincing people. I'm not sure if that's the exact word I would use. I think the word I'd use is to have a conversation. I'm not sure that our job is we have to force somebody, convince them. It's about hearing people's perspectives, and in that case, maybe helping parents hear their child's perspective.

What would cause a child to feel differently than their parents? Lots of things. There's lots of reasons, lots of times that that comes up. Is there a reason to maybe help foster the conversation where a child says, “Here's what I'm thinking,” have a parent lay out here's what we're thinking, and you be the party who's helping them have that conversation. It feels like a lot of pressure for you.

That said, again, I think that there are times where if we change this into – let me try and think – parents want a child to play a sport, child doesn't or vice versa, you'd be probably OK at least participating in that conversation and saying, “Well, I wonder what it feels like for them. I wonder what it feels like for you,” and using some of these strategies that we've laid out here and some of those resources. This is, obviously, a very different type of conversation. And it's not your role to convince the parents, but to maybe allow them to have a healthy, good conversation, and demonstrate ways in which people can have a difference of opinion and come to some good conclusion where people feel good about it. I think it's a tough one, because there are going to be instances not just related to vaccination, but there will be instances over the course of a child's lifetime where they don't agree with their parents.

Dr. Atkinson-McEvoy: I love some of those analogies. It's a big part of what I do when I see families. There's plenty of differences of opinions once children become verbal and even preverbal, where their parent wants them to do something, and they want to do it a different way.

I see my role as it's part of a relationship. I have families who haven't received some of the already other approved vaccines that many of us consider standard. My role is to provide information and to help people in their decision making. And I come from a place of assuming the best intention. That parent is worried about their child and trying to protect them. That's how I feel about my children. The more information I have, the better the decisions I can make.

Your children are part of the decision making, right? We are preparing children to become independent adults. I encourage parents, even if their child would want them would want to receive the vaccine and the parents say no, for that to be a space of having a discussion. Even if the decision by the parent remains to not do the vaccine, speaking specifically with your child around understanding why they want it and being specific around what your concerns are. It's just an important part of how we raise a society that is comfortable engaging in difficult discussions and being able to agree to disagree respectfully.

Dr. Sells: Thank you both. Really helpful thoughts. Dr. Atkinson-McEvoy, one of the things that's often confusing is understanding the word "quarantine" and what it means, what it's used for, and how that might vary with vaccination status. Could you try to explain that in simple terms?

Dr. Atkinson-McEvoy: Sure. And my Wi-fi is a little slow, so if I’m glitchy, I apologize. The two things are quarantine and isolation that gets a little bit confused. It's helpful specifically to talk about isolation first and then back into quarantine.

We have used isolation as a strategy for people who have COVID. Isolation is as it sounds, that I am alone and not in contact with others. It's because I have the virus, and I am shedding the virus.

Quarantine is typically for people who were exposed, and the exposure is concerning, but we don't know yet whether they have the vaccine. They might be in their home with family members, et cetera. We ask them to not leave the house unless it's absolutely necessary and stay at home. Necessary, like a doctor's visit because now I think I'm getting sick, or I need to get a COVID test. That's sort of the difference. Quarantine is you're exposed. We're not sure if you're sick. We want to watch you. Isolation is you do have the virus. You're shedding it. You should not come in contact with anybody else because you risk exposing them.

Dr. Sells: And can tell us for if you're exposed, right, and you're vaccinated, are things different for you than if you're not vaccinated?

Dr. Atkinson-McEvoy: Yeah, in the vaccinated population, quarantine, meaning we're observing you to see if you turn positive, you might be able to go to school and participate in your daily life wearing a mask with some specific sort of testing timing, which is normally five to seven days after the exposure, as opposed to if you're unvaccinated, your quarantine oftentimes requires you to not remain in social settings. You couldn't go to school. You couldn't go to work.

Dr. Sells: Great. The big picture of that is that vaccinations are one strategy that will continue to help people be able to stay at work, stay active, stay at school. That's another reason why that might be the case.

Dr. Atkinson-McEvoy: Yes, because the vaccine makes it less likely after an exposure that you're going to get sick. That's why it's safe for you to still be at school because your risk of getting sick is significantly less.

Dr. Sells: Great, thank you so much to both of you for all of those great answers and to our audience for submitting so many great questions for us. All of the questions have been captured behind the scenes. We will be going through them and we'll use them to inform future technical assistance and training efforts. It's really helpful to know what people are thinking and asking about. Go ahead and go to the next slide, please. Next slide, please.

One of the resources that folks have been very excited about during the pandemic that the Center has developed is a number of different series of posters that people can use to post in their early care and education programs. The latest round of those relate to these vaccines for children in this age group. These are some screenshots. There's a variety of them. They're all available for you to download and look at it and see which might be useful in your setting. We encourage you to go to the link to do that and to share it with others. Next, please.

We shared earlier places where you can think about getting vaccines. One of the things that might be particularly helpful for staff in early care and education programs to do is to know what's available locally. We always want to encourage families to connect with their regular primary care provider wherever that may be, a pediatrician, family physician, nurse practitioner, an FQHC, or other kind of clinic.

There are quite variable in different communities what's actually accessible. The last thing that we want is for people to want to get a vaccine and then get really frustrated when they can't figure out where to go. This may be something that you can help with by just being aware of what's available in your local community and sharing that with your staff and families. Next slide, please.

As was pointed out earlier, we have a series of resources that have been developed, some of which we've talked about here today. And your handout from today's webinar list all of those with the links where you can find them. Next slide, please.

Thank you, again, so much for joining us today. Your participation and your comments on the evaluation are very helpful to us. I'll turn this over to Steve to close us out.

Steve: Thank you so much, everyone. What incredible responses, making very difficult topics so much more accessible and hopefully helpful to all of our participants today. Thank you to the participants, great questions. If your question didn't get answered, please consider sending it to health@ecetta.info. That address was put into the chat a number of times and is on the handout, as is the link to the evaluation. The same link will pop up shortly after the webinar ends. Don't close out the Zoom yourself. That will be handled by folks behind the scenes here. Then the evaluation will pop up. If you don't get it, you can write to health@ecetta.info or look on your handout. Next slide, please.

Thank you very, very much, Dr. Sells, Dr. Futrell, Dr. Lee Atkinson-McEvoy, and Dr. Neal Horen. Thank you all very, very much. We do have a mailing list. That link is also on your handout if you'd like to subscribe.

And the final slide. Thank you. This is our phone number, our email address, and the website where you'll find all of our materials on the ECLKC. Thank you very, very much, everybody. Stay safe. Stay well. This is hard for everyone. But we are beginning to see the light. We do have vaccines for so many people to take advantage of. Thank you. In just a few seconds, Kate will close the Zoom platform and open up the evaluation.

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