I have a confession: I used to judge parents all of the time. As a pediatrician in training, before I had my own daughter, it was easy to silently criticize. Usually my judgment was mild, silent and fleeting, breezing through my mind as parents confessed the small ways in which they had been unable to follow whatever pediatric rule I was reviewing. But with vaccines, it was hard not to judge more harshly. As I counseled parent after parent who had declined to give their children potentially lifesaving immunizations, I could not reconcile their love and adoration with their decision to deny their babies these miracles of modern medicine.
Parenthood changed everything
Becoming a parent changed everything for me, including how I practice pediatric medicine. What surprised me more than anything, however, is how much it changed my perspective on those parents who deny their children vaccines. I had seen through my own grueling pregnancy, delivery and postpartum experience just how easy it is to become disenchanted with medicine. I felt pediatric safety checklists gnaw at my own postpartum anxiety. I grew weary at each well-intentioned counseling session, wanting someone to simply tell me that my daughter and I would be fine, that there was some way to ensure the health and happiness of my baby. At night, unable to sleep but too exhausted to function, I scrolled through social media and parenting blogs in search of solace. That's where I experienced the seductive call of the anti-vaccine movement.
The siren call of conspiracy theories
As my daughter slept, then cried, then fed, then cried, I read each and every post, comment and article. I let myself be swept into the tide of anti-vaccine rhetoric, allowing myself to feel what it must be like to encounter these messages anew during a time of such physical and emotional turmoil. In the blue light of my phone I found a message that targeted my deepest fears with surgical precision, then offered a seemingly simple solution. Anti-vaccine propagandists were waiting for me, ready to pounce on my darkest anxiety that something terrible would happen to my daughter. They told me that they understood my worries, that they had seen my journey through the medical establishment, that they understood my pain as a new mother. And they had an answer. There was one thing, and one thing only, that posed a risk to my child. Vaccines were the threat, and by refusing them, I could free my family from all of the messy "what ifs."
The scientific method at its best
Had I not spent the previous years so deeply immersed in pediatric medicine, vaccine research and public health advocacy, it is entirely possible that this message might have taken at least a temporary hold in my psyche. But I knew the truth. The safety data we have on vaccines is staggering, and their power in saving children's lives is unparalleled. The anti-vaccine narrative is founded on a fundamental lie: that vaccines are somehow inherently less safe than other medications and treatments, that they are hiding some dark potential for harm that can never fully be disproved.
With these vaccines, as with all vaccines, we see the scientific method at its best
The vaccines to protect against covid-19 are new. It would be irresponsible to approach their use without a healthy dose of skepticism. Our history shows us just how important it is to critically evaluate every scientific advancement. And our nature pushes us to fear novelty, bristle at uncertainty and embrace all inventions with caution. So when I read the steady progress of clinical trials, followed real-world post-trial safety and efficacy data, and saw how scientists continue to interrogate and investigate, I felt proud. With these vaccines, as with all vaccines, we see the scientific method at its best. We see how curiosity and doubt form the backbone of medical research. I cheered as each vaccine's results emerged, and stayed patient as this testing finally extended to children.
Online, however, the anti-vaccine propagandists gathered. Months before any pediatric data was available, they had built and disseminated a new anti-vaccine narrative. This time, it targeted even those parents who understand fully how safe and effective vaccines are, capitalizing on the endless fears and unknowns of pandemic parenting.
Now we have data.
In Pfizer's clinical trial of nearly 2,300 children ages 12 to 15 (half of whom were given a placebo), the vaccine produced stronger immune responses in the adolescents than those found in young adults, with comparable side effects. With FDA authorization expected for that age group by next week, clinical trials continue to enroll younger children across the nation, and are designed to assess efficacy, fine-tune dosing, monitor immune response and assure safety.
Amid promising hard data, critics may argue that even the lowest level of vaccine risk is unacceptable because covid itself is rarely fatal in children.
But you can remain comforted by the low mortality rate in pediatric covid patients while understanding that risk is far more than a single number. Any mortality rate, no matter how low, is a percentage that translates to a greater number of deaths when there are a greater number of people affected, and vaccinating children will lead to fewer covid deaths.
Long COVID in kids
And of course, the dangers of any illness extend beyond the potential for fatality. Children do become sick with covid, with both brief and lingering effects that occur less commonly than with adults, but nonetheless cause impairment and suffering.
You may hear that "natural infection" is somehow better than vaccine immunity. You can embrace decades of research in immunology and infectious diseases that show us the opposite. You can recall how covid is already behaving just like so many other viruses and bacteria that carry the potential for serious long-term effects even in those who experience only mild disease. Working in my hospital in the US, I continue to treat cases of MIS-C (multisystem inflammatory syndrome in children), a rare, treatable but severe and life-threatening condition that can occur in kids even after asymptomatic infection. Like with adults, ongoing research points toward inflammatory changes that may linger in children, showing other pathways by which covid complications may occur down the line.
You can use these facts not to heighten your worries but instead to rejoice in how immunizations dramatically decrease these types of complications. You can remind yourself that in this post-pandemic landscape, the downstream effects of covid infection and transmission are innumerable. Even mild covid infection in children will translate into more time in isolation, more school closures, more time away from activities, more deprivation of the normal life we are trying so desperately to restore to them.
Let the data speak for itself
And yet, vaccine anxiety may still take hold. You must also know that this is completely valid, and that these feelings can be honoured without entertaining the false narratives that fuel them. For parents, every day brings this kind of conflict. We make most of our parenting decisions based on much less science than we already have available for these incredible vaccines. The "what-ifs" of covid infection and an uncontrolled pandemic pose far more danger and have far more evidence than the vaccines that can prevent them.
Let's let the data speak for itself. When immunizations against covid become available to children, as a result of thorough safety testing and ample science, I hope that all parents will feel empowered to embrace them like any other lifesaving vaccine. Meanwhile, you can simply tune out the noise, ignore those who would prey on your anxiety for profit, and sit confidently with the knowledge that you are fully capable of making even the most challenging parenting decisions that come your way.
Rebekah Diamond is a hospital pediatrician in New York City and an assistant professor of pediatrics at Columbia University.