Melissa Harris-Perry: Anna, I wanted to tell you something.

Anna: What?

Melissa Harris-Perry: Pretty soon, maybe as soon as next week, they're going to have COVID shots for kids.

Anna: I'm very scared.

Melissa Harris-Perry: Oh, you are. Tell me why you're scared. What are you scared about?

Anna: Because I don't like shots.

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Melissa Harris-Perry: This is The Takeaway. I'm Melissa Harris-Perry and you're listening to a conversation I had with my seven-year-old this weekend. As the youngest in our family, Anna is the only unvaccinated person in our household. Coronavirus pandemic began while she was still just a kindergartener; masks, social distance, canceled trips, and curtailed time with friends and family has characterized much of her childhood, but I wasn't sure how she was feeling, so we had some extended family conversations about this vaccine this weekend. Would you like to have the vaccine?

Anna: Yes.

Melissa Harris-Perry: Okay, so why would you like to have the vaccine?

Anna: So that COVID might go away one day.

Melissa Harris-Perry: What would be your favorite thing about coronavirus going away?

Anna: Being able to visit my friend's house a lot again.

Melissa Harris-Perry: I got to say, I was happy to hear that my kiddo didn't feel afraid of illness or sickness, but like many of us, she's hoping to get back to a little bit more normalcy. It's a theme echoed by Dr. Janet Woodcock, the acting FDA commissioner last week

Dr. Janet Woodcock: Now as a mother and as a physician, I know parents, caregivers, school staff, and children have been waiting for today's authorization. Vaccinating younger children against COVID-19 will bring us closer to returning to a sense of normalcy.

Melissa Harris-Perry: We're now just days away from the CDC expected recommendation to authorize COVID-19 vaccines for kids ages 5 to 11 after study showing 90% efficacy. Last week, the FDA approved the administration of the Pfizer vaccine for this age group leaving it up to the CDC for final approval. If the CDC gives this expected approval, 5 to 11-year-olds could be eligible for a shot by the end of this week. A recent Kaiser Family Foundation survey found that about 3 out of 10 parents say they were making a mad dash to the doctor's office with their children while the rest may not be so eager.

Even many parents who quickly secured vaccinations for themselves and their elders may have lingering questions, and there were plenty of questions at our house this weekend. Are you feeling more scared of the shot or more scared about coronavirus?

Anna: Both.

Melissa Harris-Perry: Both.

Anna: Do they have to do it with a shot?

Melissa Harris-Perry: That's a great question, Anna. We'll ask that question, okay? I'm not sure, we'll have to ask. Why does it have to be a shot? We begin today with this question and with the questions you and your family might have about the vaccine before you're ready to make an appointment with your pediatrician. Here with me now is Dr. Bhakti Hansoti who's director of the Center for Global Emergency Care and associate professor of emergency medicine at International Health at Johns Hopkins. Dr. Hansoti, thank you for being here.

Dr. Bhakti Hansoti: Thank you for having me. What an exciting conversations.

Melissa Harris-Perry: I know, right? Can we start with Anna's question? Why is the vaccine delivered as a shot?

Dr. Bhakti Hansoti: You know what? I don't think that's going to be the state constantly. I think we're going to get an oral or a spray version of the vaccine just like the flu mist, but we're just not there yet right now. This is the best way we know to get you exposed to the virus and start building an immune response.

Melissa Harris-Perry: The FDA has approved the Pfizer vaccine. Given that, does that mean that parents could go and get it right now? Is it necessary to wait for that CDC recommendation?

Dr. Bhakti Hansoti: We'll need the CDC approval before health practices are able to distribute the vaccine and give it to your children. November 2nd, tomorrow is when the advisory committee for immunization practices meets and we think the CDC will give their approval within 24 hours of that meeting tomorrow. It's happening, this weekend is a big one.

Melissa Harris-Perry: It is a big one. I kind of almost wish, I'm just thinking about having handed out a lot of Halloween candy last night. There was a little part of me that thought, "Sort of wish we'd had that 5 to 11 vaccine before," but so happy that it's finally here, but I'm wondering where do we stand right now in terms of vaccination rates and spread of the virus?

Dr. Bhakti Hansoti: We're in a good place. I think 67% of Americans have had that first shot, 58% have been fully immunized. Our COVID cases are low as our COVID hospitalization and deaths. We're in a good spot, but winter is coming as they say, and people go indoors, people like to eat indoors, and there is increased opportunities for transmission. This is a great time for us to get our children vaccinated.

Melissa Harris-Perry: Tell me why, why does, and how does vaccinating this age group, the 3 to 11-year-olds, how does it likely to affect the overall community spread?

Dr. Bhakti Hansoti: There are certain individuals in our community that are unable to mount an immune response, those that have underlying illness or on medications for treating those illnesses, such as cancer patients, individuals who have conditions such as HIV. Children are still able to transmit the virus. They may not get severely ill, although some do get ill and some do die. They can still transmit the virus to other vulnerable populations, and so vaccinating this group will hopefully decrease the amount of virus that is transmitted in the population.

Melissa Harris-Perry: It wasn't just my household where there were some questions, we know a lot of parents have questions. We asked our take-away community to send us some of those questions. We know that the American Academy of Pediatrics has cited findings talking about benefits outweighing the risks, but there are still some parents concerned about risk. Let's take a listen to Kathleen.

Kathleen: I've heard that children have a low chance of getting COVID. Could you compare the risks of children getting COVID with the statistical risk of the side effects that they've talked about in kids such as myocarditis?

Dr. Bhakti Hansoti: Absolutely. The risk of myocarditis is far lower than the likelihood of your child getting COVID and being severely ill. In September alone in the United States, we had 40 children die of COVID and millions were affected. Again, the risk of death and dying and having severe illness, COVID is low, but the risk of myocarditis is lower. Also, the numbers in the myocarditis vary depending on the type of vaccine and the specific age of the child. However, the other thing is that we know that while children with myocarditis are temporarily ill, many of them do recover while those who are severely ill with COVID may have significant long-standing side effects.

Melissa Harris-Perry: Can you say just a few more words about that long-term COVID? We know it's something we've talked a bit about here on the show with adults, but what does long haul COVID look like in kids?

Dr. Bhakti Hansoti: I think that's a bit of a challenge here in characterizing long COVID. Let's start with what it looks like in adults. In adults, some individuals will have, for greater than 12 weeks, symptoms of persistently high heart rates, difficulty breathing, shortness of breath, and all urological complications, either longstanding mental health complications, such as depression, or this phenomenon called COVID fog, this haziness that exists. In children, we have even less data. We have not been able to fully characterize COVID and make that case definition.

Long COVID studies have, depending on their case definition, have said that up to 50%, up to half of children will have persistent symptoms after 120 days. Then in half of these patients, so 25% of the overall population, these can impact the activities of daily living. However, there was another recent large review that said that across 14 international studies between 20,000 patients, that they found that there was a lack of case definition. That we know it was poorly characterized how many weeks after the index infection and people continue to have symptoms.

If you look at the overall studies, we're thinking that 1 in 10 children are actually likely to have long COVID, but let's define that as symptoms greater than 12 weeks and symptoms where the child is feeling impaired to do their daily activities or their play as normal.

Melissa Harris-Perry: One of the things, obviously, we have characterized and distributed this vaccine based on age. Initially, it was for elders, and then we opened it up to all folks, and now, we're looking at the 5 to 11, but we had several parents, we'll listen to three calls here back to back, several parents who wanted to think about size of children at the same time that we were thinking about age of children. Let's take a listen.

Ashley: My name is Ashley, I'm from Orinda, California.

Jennifer: This is Jennifer from East Hampton, New York.

Katherine Hammer: My name is Katherine Hammer and I'm calling from Tampa, Florida. My five-year-old is on the small end of the growth charts. Will that impact the safety and/or efficacy of the vaccine?

Jennifer: I have a daughter aged 11 and she is about 5"5' and a normal adult weight. Will the dosage be adjusted to her height and weight?

Ashley: Why it is safe to give the vaccine to my five-year-old who only weighs 40 pounds the same dose as an 11-year-old who might weigh a lot more.

Melissa Harris-Perry: All really good questions. How should we understand that size and age together?

Dr. Bhakti Hansoti: Great questions. As parents, we are all about the dosing of Tylenol and ibuprofen and the weight of our child. We do that because those medications have active ingredients and the amount of available active ingredient is dependent on how much you weigh. Vaccines are different. With vaccines, what you're trying to do is expose the body to an inoculum that will mount an immune response. The truth is that your immune response or how your immune system responds to a virus is dependent on your age and children between ages 5 to 11 have a really robust immune system.

The great thing was a smaller amount of inoculum was required to mount the same response as we had in adults, but we also found it was safer. The question about the dose of the vaccine was about safety, not about how much is effective given that we're doing a lower dose.

Melissa Harris-Perry: So helpful. Okay, we know a lot of parents are going to need a little convincing when it comes to vaccinating their kids. Let's listen to this call from Jonathan.

Jonathan: Our daughter is eight years old and we were wondering why she should get a COVID-19 shot since it's only less than 700 children have died from coronavirus since the pandemic started out of the 73 million children that are in this country who are under 18.

Melissa Harris-Perry: Yes, for parents who were saying why take any risk when that seems like a small percentage of kids.

Dr. Bhakti Hansoti Is it really a small percentage of kids? When I heard those numbers, I was like, "Whoa, 700 children." Those are 700 avoidable deaths and that's what the vaccine does, it decreases your likelihood of a severe illness, hospitalization, and death. I think 700 deaths are potentially avoidable when I hear that. The risks, the side effects, feeling a bit icky for a couple of days, maybe a day off school, I would say that those are worth it if it means my child is with me.

Melissa Harris-Perry: Dr. Hansoti, in part because so much of your work is also in the international arena, we wanted to take this call in part because in China, vaccines have been approved for children under three, and we wanted to hear from this listener who's wondering about vaccinations for her three-year-old.

Katie: I'm Katie and I'm from Red Lake Falls, Minnesota. I have a child who's three and autistic and I'd like to know if I could get a prescription for him to get vaccinated since he's at higher risk.

Dr. Bhakti Hansoti That's a great question, I'm right there with Katie. I have a four and a one-year-old and I am eager to get my child vaccinated. The studies have been ongoing for at least three months, the data is coming in, data looks good. The challenge is is trying to find the safest possible dose for our children, and they're still processing the data for that. I think we as parents, we just have to wait.

Melissa Harris-Perry: As part of that push obviously for the five-year-old and up group is about schools. Let me ask two school questions. One, do you expect schools to go to vaccine mandates at some point, and in this kind of transition as some children will become vaccinated, others won't, how should we be thinking about masking in school?

Dr. Bhakti Hansoti Let's talk the first question. Regarding vaccine mandates, we make it sound like it's a new phenomenon, but it's not. Our children are already required to be extensively vaccinated to go to public schools, and so this is just one more vaccine that's going to be added to that list. I think it's should be coming and it makes a lot of sense because we want to protect all the children that attend school to be as safe as possible.

Regarding the second question around mask, well, I don't think the question is whether we should have mask when some children are vaccinated or not, the real question is should we continue with masking regardless of the vaccine status of our children? The reason is is that it's well established already that individuals who are vaccinated can in fact transmit the virus, they can still have asymptomatic infection. If you look at the healthcare setting, which obviously is leading in this area, in the healthcare setting, all individuals are still required to wear masks at all times within hospitals.

In addition, if you're treating a COVID patient, we still put on a full personal protective equipment, PPE, in order to decrease the chance of us getting infected and/or transmitting that to other patients. What I'd be interested to see as the winter continues is what happens in schools where mass mandates continue or are dismissed, and whether masking is going to be a part of our reality, at least for some activities that are in close proximation with other children.

Melissa Harris-Perry: Where are we on the flu shot as part of this, again, going into the winter, going inside? How should parents also be thinking about the flu shot? If kids are COVID vaccinated, do they also need their annual flu shot?

Dr. Bhakti Hansoti Absolutely. If you haven't had your flu shot already, please go get it right now because that has been available since September 1st. What has been great is with masking, I think the incidence of flu and the number of flu deaths annually has decreased, but flu is a different beast. Flu evolves and changes every single year, and so A, you should go get your flu shot, B we don't know how bad the flu season is going to be this year, but there is some concern because we all were exposed last last year that it may be worse.

Then the third is there is no evidence that if you have the flu shot you can't have the COVID shot or vice versa. Some individuals have been getting both shots at the same time. Your child goes to the pediatrician's office and normally gets multiple shots. I think for the sake of the child, you should maybe spread them out, and that way, they have a chance to recover if they're feeling icky, but it doesn't change the effectiveness of the vaccines.

Melissa Harris-Perry: I was thinking a bit about the booster shot relative to my seven year old who's a little worried about, not so much the vaccine but about the notion of the shot, and I thought, "I wonder if I can get my booster when she gets her vaccination and everybody gets a shot at the same time for a little courage." Who is currently eligible to receive boosters?

Dr. Bhakti Hansoti There's two populations that are currently eligible. Individuals who have not been able to mount an immune response or immunocompromised. Then the second are individuals who have a very high exposure to COVID-19 such as healthcare workers. I think when we talk about boosters, we also have to think, remember this terminology of additional doses? Boosters are administered to individuals who have completed the primary vaccination series and we think depending on the type of vaccine, six to eight months post your initial vaccination series, a booster may be beneficial.

An additional dose is different. An additional dose is for individuals who have done the initial doses but we're not able to mount an immune response due to medications that they may be on or a primary health condition and thus may need additional doses to be able to be adequately vaccinated.

Melissa Harris-Perry: You talked about the possibility of masks just being part of our normal landscape of living, will boosters be similar? Will we expect to be going to our pharmacies and getting COVID boosters each year in the way that flu shots are available?

Dr. Bhakti Hansoti I anticipate so, however, I will say that we have had the Delta variant, but we haven't had a new variant of concern. I'm knocking on what right now. COVID is different to flu in the sense that it doesn't evolve as quickly, and so we don't know how frequently boosters would be needed, it depends on how many variants of concerns we have, and if it's going to be an annual thing or every couple of years or only when a new variate emerges. Honestly, we just don't have that data yet.

Melissa Harris-Perry: Dr. Bhakti Hansoti who is director of the Center for Global Emergency Care, an associate professor of emergency medicine at International Health at Johns Hopkins. As always, thank you so much for answering our questions and walking us through what can be challenging terrain.

Dr. Bhakti Hansoti Thank you so much for having me, always a pleasure.

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