NASHVILLE, TN –Four of the country’s top COVID experts welcomed the news last week that Moderna is seeking FDA approval of its COVID-19 vaccine for kids five and under.
“It’s big news, of course,” said Dr. Manisha Newaskar, Clinical Assistant Professor of Pediatrics at Stanford University. Her speciality is pediatric pulmonary medicine.
“The date needs full review. But my understanding is that for the under five age group it’s two doses, one month apart, and it’s going to be one fourth of the adult dose. Hopefully, by June we will see some announcement,” Newaskar said.
The risk of heart infection from the vaccine is very small in adults. It’s even less with children. “The risk of myocarditis seems to be lower as we go down in age,” said Dr. William Schaffner, Professor of Medicine in the Division of Infectious Diseases at the Vanderbilt University School of Medicine.
“We want to make sure when we communicate to parents we have very clearly in mind that these are vaccines that are safe, comparable to the vaccines that we give in pediatric practice every day,” Schaffner said.
He compared getting a COVID vaccine to an annual flu shot and predicted that in the future, both vaccines will be combined into the same shot.
“Schools may have a role to play in getting the vaccine out there,” said Dr. Ben Neuman, Chief Virologist at the Global Health Research Complex at Texas A&M University.
Neuman noted that about 350 children die each year from meningitis. The number of children who have died from COVID is about the same. Vaccine requirements and immunization programs through schools is long-standing public health practice in the U.S.
FDA Approval is Too Slow
Dr. Eric Feigl-Ding is an epidemiologist and health economist and a Senior Fellow at the Federation of American Scientists in Washington DC. He was one of the first scientists to alert the public on the pandemic risk of COVID-19.
“We’re using a very different criteria for approving kids’ vaccines and adults because adult vaccines were approved using data of infections from mid to late 2020…which we know respond very well to the Wuhan 1.0 spike protein upon which our current vaccines are based,” Feigl-Ding said.
But trials for kids’ vaccines were run much later against the omicron variant—while the vaccine was developed against the original Wuhan strain and the Beta variant. Both of those have been extinct in the U.S. for a year.
“It’s really an unfair comparison to hold the same criteria,” Feigl-Ding said.
The efficacy of what is essentially an out-of-date vaccine is not as high as it once was for adults and he said that is to be expected. The virus is nimble and constantly changing unlike human bureaucracy that lumbers along at its own pace.
But vaccines do work, not only reducing hospitalizations and deaths, but also lower the chances of getting long-term COVID. About 20-30% of patients with long COVID are unvaccinated compared with 5-10% who are vaccinated.
Sometimes CDC is like a Fish Riding a Bicycle
On April 18, a federal judge in Florida, a Trump appointee, stuck down the federal mandate requiring masks for airline travel. “We should absolutely not have attorneys making these decisions,” Schaffner said.
“Right now we’ve thrown precaution to the wind with all the mask lifting and other mitigation requirements,” Feigl-Ding said. He said even if you’re boosted you may have 90-95% protection against hospitalization and death but your protection against infection is only about 45% after ten weeks of waning of the booster,” he said.
Feigl-Ding likened the chances of catching omicron to driving across a four-lane bridge. “Your bridge is not going to collapse. You’re not going to die but with 45% symptomatic transmission efficacy and probably even lower with asymptomatic, you basically only close two lanes of a four-lane highway, “ he said.
He noted adults are going out to clubs and large venues once again, too. Although Puerto Rico is having a large COVID outbreak and New York is experiencing a moderate one, hospitalizations are down in most U.S. cities.
“If hospital beds are not full do we tell kids and adults you don’t have to wear a bike helmet? If hospital beds are not full do we say you don’t have to buckle your seat belt? If hospital beds are not full do we say ‘oh, you can drink and drive drunk because we have hospital beds for you?’ “No, we don’t do any of that,” he said.
He said the CDC’s “community level” COVID advisory precautions are pretty dumb. “That’s not public health in any way…that’s an abdication of public health,” he said.
“Although the variants are changing, and they may reduce the effectiveness somewhat, the real story is that these vaccines continue to work and we must continue to try and get people who are unvaccinated, to get them their first dose,” Schaffner said.
“What about wearing masks on public transport today—buses, trains, and airplanes?” he asked. If you are older, frail, immune-compromised, or have an underlying disease or if you care for someone who has one, or if you have children, then you should wear a mask.
Regarding boosters, Feigl-Deng said that the third shot is the most important.
“Two shots in Pfizer trials gave out 700 antibody levels. After 6 months of waning it drops 3-400. But after a booster shot of the Pfizer you get 2000-2500 antibody levels. So in terms of absolute gain, the biggest gain is with the booster shot,” he said.
“You car has a fuel gauge that tells you when you need to fill it up again and the immune system does not have any external readout whatsoever. So we’re trying to schedule these boosters in a way that will keep most of your tanks full in the immunological sense, but the ideal going forward would be to find a better way to do that. For now the boosters are essential. They’re really the only way to bring your immunity back up,” Neuman said.
