Melissa Harris-Perry: I'm Melissa Harris-Perry. You're listening to The Takeaway. On Monday, Pfizer announced that its COVID-19 vaccine had proven safe and highly effective for children ages 5 to 11. For some, this was a moment of pure celebration, I'm raising my hand, but for other parents, even those who enthusiastically got the vaccines for themselves, there are additional concerns about their kids getting the shots. For more on this, we're joined now by Dr. Miriam Laufer, pediatric infectious disease specialist at the University of Maryland School of Medicine's Center for Vaccine Development and Global Health. Dr. Laufer, it's so great to have you back.

Dr. Miriam Laufer: I'm happy to be here.

Melissa Harris-Perry: Considering that younger children are at lower risk for the most serious consequences of COVID, why is it important for them to be vaccinated?

Dr. Miriam Laufer: That's the question on everyone's mind, and I have two answers to that. One is, we are seeing in pediatric hospitals now that there are rising numbers of cases of children being hospitalized with COVID. That's probably because they're the population that is universally unvaccinated, and we are seeing the spread of this more contagious Delta variant. There is certainly a pretty significant burden of disease and even severe disease in children now.

The other important issue is that in order to stop the transmission of the COVID virus, we have to have immunity in the entire population. Even though younger children are probably at lower risk to get sick if they get infected with COVID, they can still get infected and they can still spread their infection to others, including people who have poor immune systems, the elderly, and people who will ultimately get sick. Without controlling the spread of COVID infection in this country, we are not going to be able to get rid of the infection.

Melissa Harris-Perry: Do you have an expectation for how soon the FDA is likely to authorize the Pfizer vaccine for, as I like to call them, the little people ages 5 to 11?

Dr. Miriam Laufer: I think it's going to come quickly. Certainly, there's a lot of pressure to get this vaccine authorized, at least the emergency use authorization that's being discussed right now. That's because, of course, kids have just gone back to school, and so they're all in group settings. Although they're wearing masks and taking precautions, the need is really urgent right now as kids are back in school as we're about to enter into the winter months. My understanding is that the FDA is reviewing this as absolutely quickly as they can while still being thorough.

The two issues that the FDA will review are, first and foremost, the safety of the vaccine to see if there are any concerning side effects. Then the other is to look at the efficacy, how well it works. Now, because children tend to not get as sick as adults with COVID, we're looking not necessarily at how well it did at preventing hospitalizations, which was, of course, what we looked at the most in the adult studies, but we're looking at how high the antibody titers are, that is how well the immune system responded to the vaccine to make sure it reaches a level that we are confident will be protective for children.

Melissa Harris-Perry: Is it the same vaccine? In other words, is it the same medication, for lack of a better word, that is simply dosed differently for younger people, or is there something actually different about how the kiddo vaccine is operating?

Dr. Miriam Laufer: It's exactly the same vaccine at a lower dose. That was one of the reasons we do vaccine trials in children after we do vaccine trials in adults. We decide on the best dose for adults based on the lowest side effects, the highest immune responses, and then we have to look in kids. Kids are not just small adults, they tend to have a more robust immune response to both infections and vaccines. We know that because children tend to get fevers more often with a run-of-the-mill illness compared to adults.

When we were doing trials of the COVID vaccine in children, we knew that probably we could do a lower dose in order to elicit a good immune response, and also that we would need a lower dose because children were likely to have more side effects than adults. That's, in fact, what happened. We found that at the higher dose, at the dose closer to the adult dose, there were more side effects, and with a lower dose, there were a lot less side effects. They actually tolerated the vaccine very well, and they were able to get an immune response that was going to protect them against COVID.

Melissa Harris-Perry: When you say side effects, are you talking about the thing that many of us experienced, which was a day of feeling achy and groggy and sleepy?

Dr. Miriam Laufer: Exactly. This usual fever, achiness, feeling tired, sometimes headache, all of those things happen with the COVID vaccine because we're trying to encourage your body to make an immune response, and that's one of the side effects of your body making an immune response. I always joke that's how you got the vaccine is if you have some side effects afterwards. We try to, of course, limit that. You give as low a dose as you can so people have as few of those side effects as possible while still having a good immune response.

The other concern that had been raised about the COVID vaccine was, they had noticed in some of the big observational studies in Israel and other places that maybe there was a risk of myocarditis or inflammation of the heart. As a result of that, the FDA required that Pfizer and also Moderna increase the size of their vaccine trials in children to be able to see if there is, in fact, any increased risk of this heart inflammation. They haven't found any concerns for that yet but it is the reason why even after we roll out a vaccine, we continue to be very vigilant about the safety of vaccines and make sure there isn't just a very, very, very rare side effect that we need to know about.

What we know definitively is that COVID infection is much worse for your heart than COVID vaccine. I think that the companies and the FDA are being as careful as they can and as attentive as they can to concerns about safety, in particular, this element of safety, to make sure that there isn't a risk that we are unaware of.

Melissa Harris-Perry: Now we're going to dive a bit deeper into how parents are navigating this moment and how so many of us are trying to manage the everyday risks and balance the various aspects of child-rearing. We've got just some basic questions here for you. Let's go to our first call from Oklahoma.

Scarlett: Hi, I'm Scarlett. My question is just how do I get a toddler to wear a mask? I live in a very, very red state who is very, very unvaxxed and I have a two-year-old. I can't stay home all the time, but I still need to keep him safe. Not sure what to do.

Melissa Harris-Perry: All right. What's your response, Dr. Laufer?

Dr. Miriam Laufer: Oh, I feel for that mother and I think this has been a big challenge trying to get children, especially the youngest children, to keep masks on. Some of the advice that I give to parents and I have used myself include explaining the need to wear a mask and how important it is to protect everybody. That's obviously harder to do with the two-year-old than it is with a four or five or six-year-old. I think making sure that parents and the other adults that their child interacts with are wearing masks all the time certainly helps to normalize mask-wearing. Some kids respond well to having a special mask or that they're looking forward to wearing, almost like a special item of clothing.

I'll say that I think we have to view this as not an option. Unvaccinated children who leave the house have to wear masks. I give the example of one of my children who, when he was a toddler, did not like to wear pants and he took them off when he came home, but when we went to the grocery store, I didn't wonder whether or not I needed to make him put his pants back on. He had to put them back on when we left the house. I do understand the challenge of it, but I think we have to persist because it's critical that our especially unvaccinated children are wearing the masks, and those two-year-olds actually are quite vulnerable.

Melissa Harris-Perry: It's funny, at seven, my daughter is much more willing to put on a mask than pants, so I completely understand that. Next up, we've got two callers who were curious about extracurricular activities and the risks involved. Let's take a listen.

Jen: Hi, my name is Jen. I'm calling from Ronkonkoma. My question is if masks are required in school and the rates are getting higher, why have they not reinstated masks for sports activities that are indoors?

Anne Marie: Hi, this is Anne Marie from Louisville, Kentucky. I want to know how to balance socialization with safety for kids who are too young to vaccinate. Things like swim and dance lessons are important for developing balance and lifesaving skills, and they can't be put off indefinitely, but we definitely want to protect our little ones at the same time.

Melissa Harris-Perry: Doctor, responses?

Dr. Miriam Laufer: Yes. These are all great questions. I struggle with them myself as a parent of school-age children. We obviously live in a world in which we're willing to take risks. We see that when we get in the car, with all the things that we do in our day-to-day life. Sending children to school during a pandemic also has some small amount of risk. Then from there, when we start thinking about making additional decisions, I like to think you have to weigh, safer, not safer, outside safer than inside, wearing a mask is safer than not wearing a mask. More distant activities are safer than activities where children are bunching up.

Some examples of easy things to take out of the equation that I think are probably high-risk transmission or crowded locker rooms for kids sports. I think each parent, each family member needs to think for themselves. Each family needs to decide for itself what's the level of risk you feel comfortable with, and making the decisions always on the side of if I have two choices, what's less risky? If I have options that are just a little bit worse but still okay, then maybe choosing that instead of choosing the higher risk if there's very little benefit for it.

We are at the point where we're over a year and a half into this pandemic, children have really suffered a lot from isolation. I understand there is a desire to resume normal life. What I suggest that people do is they try and get as close to normal as they can with as many safety measures and risk mitigation measures as they are able to accomplish.

Melissa Harris-Perry: On this same topic, we've got a parent asking about the famous pods that so many of us begin to try to develop to allow some level of normality and socialization. Let's take a listen.

Kathleen: Hi, this is Kathleen from Brooklyn. I'm wondering if the kids are in school all day together, is it safe to allow them to play together indoors with friends at home, especially once winter arrives? I spent a lot of time outdoors in freezing cold weather last year. I'm wondering if windows were open or a fan on, could they be masked and distanced and still play indoors together in the winter?

Dr. Miriam Laufer: This is another interesting question that I think is going to come up more and more. Last year, especially for the situations where children are not in school, this was less of an issue. Now, we have kids who we know are together most of the year or most of the day. Then is there some reason why once the school bell rings at the end of the day, they shouldn't be together anymore? Again, I put this to you as a series of everything has some element of risk. In schools, children are supposed to be keeping some distance. I'm sure that the practice of that is highly variable and only under so much control of the teachers and the administrators.

Staying in same groups in which in particular you are able to follow up if people have illnesses, if people have positive COVID tests in the family is certainly safe than groups where you don't have that amount of information because if something comes up you'll be able to know and be able to act accordingly. Keeping children in the same groups as they're together in school and using similar risk mitigation measures as in school. For example, they're wearing masks inside, they're not on top of each other inside, they have space between each other when they're eating, then I think that that certainly seems like a reasonable option in this setting.

Kathleen: My seven-year-old is very keenly aware that we live in a pandemic. The other night, while she was having her bath, she said, "Should I make the water hot or cold? Do the COVID germs like cold water or hot water? I want to make sure I get rid of them." It just did a little thing to my heart. How do we talk to our kids? Keep them informed, let them have some control and agency, but not terrify them.

Dr. Miriam Laufer: Yes. I think every child responds to this differently. What I think about our particular crazy time that we're living in is that on the one hand, there's this very scary infection that is making a lot of people ill. Now, of course, there's children who are getting very ill with COVID, so it's scary. On the other hand, everybody has something that they can do. By putting on their mask, by keeping their distance, they're actually empowered to make a difference in the pandemic and keep themselves and their friends safe. I try to balance the, "Yes, this is very important, it's no joke. You have to do this. You have to do these things because there are significant risks involved," but on the other hand, what a great message to teach kids. Today, you as a seven-year-old have things that you can do to stop the spread of COVID.

Melissa Harris-Perry: I love that. Dr. Miriam Laufer is a Pediatrics Infectious Disease specialist at the University of Maryland School of Medicine Center for Vaccine Development and Global Health. Dr. Laufer, thank you for joining us.

Dr. Miriam Laufer: It's my pleasure.

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