Polling from the Kaiser Family Foundation in October shows that about one-third of American parents are eager for their kids to get the COVID vaccine, while another third say that they definitely won’t get the vaccine for their kid. Pediatricians and public health experts are most interested in the last third: the parents who want to wait and see how the vaccine works in kids. But in the meantime, the pandemic continues to infect people of all ages. What can convince the parents who aren’t firmly in the pro- or anti- vaccine camps to vaccinate their kids?
On Friday’s episode of What Next: TBD, I spoke with Aaron Carroll, a pediatrician and professor of pediatrics at Indiana University School of Medicine, about how he convinces nervous parents that getting the shot is the best thing for their kid—and whether that’s the right way to think about children and vaccines. Our conversation has been edited and condensed for clarity.
Lizzie O’Leary: What is the most accurate way to describe what you’re facing in terms of kids and parental attitudes around the COVID vaccine?
Aaron Carroll: I think people have this that people who are hesitant about vaccination are all woefully misguided or just adamant about this is never going to happen. But people are often vaccine hesitant for their kids, because they just are worried. People are much more risk-averse for their children than they often are for themselves. The risks that people are willing to take in their daily lives even and what they’re willing to do are not the same as what they’re willing to tolerate for their children
What kind of questions do you hear from parents
It’s amazing because most of the questions I see from are people who are otherwise totally pro-vaccine. I get a lot of people who absolutely got vaccinated, but now it’s their children and they’re like, “Well, my child is prepubescent. I’m worried about her fertility.” Or “We just don’t know how many kids are going to get myocarditis.” Or “A bunch of people had COVID. It’s very possible my kids even already had COVID and didn’t know. Why should I then vaccinate them? Isn’t that dangerous? Would it be worse if they’ve already had COVID?”
What do you say?
For people that are worried about fertility, that’s just unfortunately a myth. Or people are worried when they hear mRNA—that somehow mRNA gets into the DNA and it’s going to change your genes. In which case you have to go through the explanation of how there is no mechanism in the body to turn mRNA into DNA. If it’s people worried about myocarditis, then I have to talk about how relatively rare that is and how the risk of myocarditis from COVID is so much greater than the risk of myocarditis from a vaccine. Given how infectious Delta is and other variants, everyone’s eventually going to get vaccinated or COVID. You’re much, much, much, much better off getting the vaccine.
I’m listening to you talk, and I’ve also watched some of the webinars you do: Ask Aaron. It feels a little bit like you’re kind of on “variations on a theme” autopilot. You get this question, you say this answer, you get this question, you say this one. Does it feel like you’re just a vending machine with, “I hear you and here’s the answer”?
It eventually gets there because there are only so many questions. The questions eventually become repetitive to me and to people who watch every single webinar, but they’re new to the person asking it. And really, people’s concerns are very individual, and until they are specifically answered in person, many people will not be converted. If they hear a message that doesn’t resonate with them, that feels like you’re trying to skirt the issue, they assume you’re trying to hide something.
I think that this unfortunately is just very retail work. It has to be done individually. It’s actually one of the things that makes me happy about the way that we’re actually distributing the vaccines to children is that we’re now finally making use of the healthcare system. We have not been giving out vaccines in the traditional method with respect to COVID. It’s at pharmacies. It’s at big centers. What we’re doing with COVID finally is that we’re distributing these to actual pediatrician’s offices. That’s a way to get to people who are vaccine hesitant.
Why do you think there’s this disconnect that might exist between what a vaccinated parent is willing to do for themselves and what they might be willing to do for their kid?
One is that you feel a sense of responsibility to your children that sometimes feels harder than to yourself, because you’ve been taking risks with yourself your whole life. You’ve probably made some reasonably risky decisions in your 20s, both with respect to sexual activity and perhaps with substances—you’re used to understanding tradeoffs. With kids however, we’re much more restrictive. And we feel that we could be blamed. The dangers seem much bigger and the benefits sometimes pale in comparison.
Of course, weighing benefits and risks of vaccines is nothing new. That’s why families turn to their pediatricians for advice. For years, doctors have tried to increase vaccination rates and fight hesitancy. Did this same struggle occur with earlier vaccines?
When the varicella vaccine got approved in the ’90s, lots of parents were like, “Why should I vaccinate my kid against chicken pox? It’s a nothing big, minor illness. Everybody gets it.” And for a lot of people, that’s true. But when adults get chicken pox, it’s massively bad. Plus, some number of babies died every year of varicella infection. It wasn’t huge numbers, but they were real numbers.
And just a couple of years after we really started vaccinating kids, in the early 2000s, zero babies died of chicken pox. That’s a huge win, given that zero babies are immunized against chicken pox. You can’t get it until you’re 1 year of age. But by vaccinating children, we’ve protected everyone. And now today we have like 86 percent of eligible children vaccinated, and chicken pox has largely gone away.
You wrote about your experience as a young pediatrician, vaccinating kids with the varicella vaccine against chicken pox. How did you break through to skeptical parents?
I think it’s time and effort and it’s building up trust. I would talk about risk and benefits. In fact, this is part of what we do with everything. When parents are like, “I want an antibiotic for my kid’s ear infection,” I talk about these are the benefits of it and these are the risks.
It’s negotiation. It’s making sure people feel heard, making sure that you understand what they’re going through, that it’s not unreasonable and trying to find a solution that works.
In your writing about varicella, I noticed that you said in 2008, only about 34 percent of eligible adolescents were fully immunized. And by 2018, about 90 percent of kids have been vaccinated. That seems both great, and made me think: Are we talking about immunizing kids against COVID on a decade long timeframe? Is it going to take us 10 years?
Unless we have mandates, yeah, I think it is because, and, to be honest with you, we won’t get all the way there without mandates. Let’s be clear too. I can’t win 90 percent as a pediatrician. I just own that. It’s not going to happen. You need these to become so expected that the school system’s requiring it. The default has to be “vaccinated,” so that most people will do it.
There’s this thing that a lot of pediatricians use called the presumptive approach when they’re talking about vaccination writ large. Can you walk me through how that works in a vaccine setting?
They go in with the idea “we’re going to vaccinate.” It’s about norms. It’s not you have to opt in, it’s you have to opt out. You can do that even in conversation. If you normalize getting a vaccination, a lot of people, far more than you’d think, will do the default.
A lot has been made over the past week about Big Bird from Sesame Street “getting” the vaccine. In your experience, do these kinds of campaigns work to increase vaccination?
I think everything works a bit. Trying to find all the levers we can pull makes sense. Will Big Bird be the thing that gets everybody vaccinated? No. No chance. Some number of people may be swayed by Big Bird. But truly, the way to get through to people is to have good messages come from trusted sources. The problem is that one person’s trusted source is another person’s mistrusted source.
What makes you optimistic?
One, you can’t get unvaccinated. So the numbers only really go up. As more and more people over time see this as the norm, they will convert. But over time, pandemics burn out. They do. The flu pandemic of 1917, 1918, 1919 burned out. Other flu pandemics have burned out. It will. It’s just how much damage will we sustain on the way. And we’ve already got a vaccine and these vaccines are incredible. I do think eventually we’ll get to a better place. I just know that if we would do it faster, we would do it better.