By Jennifer Reich and Douglas Opel / Special To The Washington Post
Even before the coronavirus pandemic, some parents felt vaccine decisions for their children were challenging and fraught with uncertainties.
As researchers who have spent more than a decade examining vaccine decision-making, we have heard this small but growing group of parents describe their concerns time and again. The fears vary, but they almost always pertain to safety, such as whether a child might be one of the unlucky ones to suffer an adverse reaction or whether there are long-term effects of vaccines that are not yet understood.
As we watch coronavirus vaccination become widely available to young children in the coming days, weeks and months, we will inevitably see some parents struggle to decide whether to vaccinate their children. Most of these parents are neither virus deniers nor anti-science. Rather, they are part of a group of parents that has had a different relationship with vaccines than did their own parents, viewing vaccines not as one of public health’s top achievements but as something to use as rarely as possible and only when it seemed to them to be totally necessary.
Before the coronavirus, about one-quarter of American parents struggled with the decision to accept routine vaccines such as influenza or measles-mumps-rubella shots for their children. Uncertainty regarding the safety and necessity of these vaccines featured prominently, despite overwhelming evidence for both. Vaccination rates have remained high, but this is the context in which coronavirus vaccination for young children has arrived. Many — like a mother one of us spoke to who worried that “there’ll never be a clear answer” — point to the uncertainty they feel in rejecting vaccines, and also in consenting to them. When in doubt they too often opt for omission, instead of commission, imagining that delaying vaccination is the safer option.
These parents overestimate the risks of vaccines and underestimate their benefits. Nevertheless, their views are instructive, providing an opportunity for us to acknowledge that we all must make health decisions with imperfect and incomplete knowledge. But even as we recognize the role that uncertainty plays, it’s worth reminding parents that we know far less about the long-term effects of covid-19 on their children than we do about the shots that keep it at bay. And what we do know makes clear that vaccination is by far the safer choice.
While routine vaccines have reached a level of certainty built upon decades worth of data, the novelty of the coronavirus vaccines is top of mind for many parents. This is not surprising. Coronavirus vaccines have been developed faster than other vaccines. And we are still learning some things about them, such as how long their protection lasts and how well they prevent transmission. It is understandable that some parents are hesitant to be among the first to jump in line with their young children for the newly authorized shots.
But as it turns out, there are also still many things that are uncertain about the disease caused by the virus; and those uncertainties should weigh far more heavily than those about vaccines. We are still learning how to predict who will have a mild case of covid and who will require hospitalization. We don’t even really know what recovery means yet. New evidence suggests that one-half of people who survived covid still experience symptoms six months later.
For children, there are additional considerations. Almost 700 children have died of covid-related illness since the pandemic began. More than 5,000 in the United States who seemingly recovered from coronavirus infection experienced multisystem inflammation syndrome in children (MIS-C), a condition in which youngsters experience two or more organ systems failing and require hospitalization. Although most children who experience MIS-C improve and go home, there is evidence that some continue to experience weakened health even after they are discharged. Like many of the uncertainties with covid, we cannot yet predict the long-term outcome of these children’s experiences of infection, hospitalization and organ failure.
Questions about the long-term outcomes of infection are significant. Many viruses have demonstrated a great capacity to cause harm long after infection has seemingly ended. For example, measles can erase the body’s immune memory and undermine its ability to fight subsequent infections. Although polio causes paralysis in only a small number of people, post-polio syndrome can appear decades later, causing disability and weakness in those who seemingly recovered in childhood. Those who argue that it is better to acquire immunity derived after infection must acknowledge that this immunity is often costly to the person who becomes ill and carries additional unknown risks.
Further, just because we do not yet know everything about coronavirus vaccines does not mean we know nothing. We know, for example, that these vaccines are exceptionally good at preventing hospitalization and death, even in the face of the more contagious delta variant. With the data accumulated thus far, we also know that the vaccines are very safe. We know that in children 16 and younger, the risk of myocarditis, inflammation in or around the heart, is much lower after the vaccine than after falling ill with covid. Since rare events do not always appear in trial data, the ongoing monitoring post-vaccination will provide additional information about safety, but there were no cases of myocarditis among those 5- to 11-year-olds vaccinated as part of the clinical trial.
We also know that vaccines play an enormous role in protecting the community. This virus, like most infectious diseases, ties us together in inextricable ways. Cases of MIS-C, for instance, track with community rates of covid-19, with rates noticeably increasing this fall as covid cases rose again. We know that whether we see additional variants that might undermine vaccine effectiveness will depend on whether individuals get vaccinated and limit the ability for the virus to mutate. And data are accumulating that suggest transmissibility of the virus is reduced with vaccination. This helps to limit spread, which protects those who are too young, too sick or otherwise unable to be vaccinated.
As researchers who understand concerns about vaccines, and as parents making these decisions for our own children, we see how important it is to acknowledge that some families find the decision to vaccinate difficult. It makes sense to worry about uncertainty, especially when it concerns your children. Nonetheless, parents would be wise to bet on the vaccine rather than the virus. The vaccine has been subjected to rigorous testing, with ongoing rapid cycle analyses to continuously add to our understanding of its safety. The novel coronavirus, meanwhile, remains unpredictable; and is bound to carry far more uncertainty for years to come.
Jennifer Reich is professor of sociology at the University of Colorado Denver and author of “Calling the Shots: Why Parents Reject Vaccines.”
Douglas Opel is an associate professor of pediatrics at the University of Washington School of Medicine.