One of the most popular types of sessions at medical meetings is the pro-con debate. Its popularity stems the fact that the topic is relevant and that the debaters are skilled appraisers and presenters of the evidence. Today on Sensible Medicine we present such a debate. The topic could not be more relevant:
I'd really like to see a FUP to this Pro/Con with a point/counterpoint from both after reading each others comments. I also think that Cifu would have been better replaced by Offit when making the "Pro" argument vs. VP, but Paul is not going to be available for such things.
I am practicing pediatrician, father and a strong advocate for preventive medicine.
Which populations is discussed in this topic?
Children <11yr old, who cannot make an informed decision.
What is a COVID 19 virus?
It is a respiratory virus which cause damage to lung and blood vessels.
What are the symptoms?
Patients can be from totally asymptomatic, mild to moderate respiratory symptoms managed at home, to severe and critical symptoms managed at hospitals. ( it is a spectrum)
Who are at risk?
Elderly population (>65yr) and younger population with co-morbidities.
Are children hospitalized and critical because of COVID?
Yes, at least 40000 hospitalized and at least 5000 needed critical care support and nearly 1000 died in nearly 2 yr period. (above video)
We will jump into other topic – Immune system?
This is the defense system for our body (like border security forces). Mainly we have innate immunity (neutrophils, monocytes, eosinophils, NK cells and complements) like walls and fences at the border, as soon as bacteria or virus attack the human body immediately these cells attack, these are not specific. Other one is adaptive immunity (T cell and B cells basically lymphocytes) which are like guns and rocket at the border. They make antibodies and other chemicals specific for this virus/bacteria.
Does immune system work?
Yes, but it has limitations. Simple example if you don’t treat a strep throat, your immune system make take care of it, but more number of days of symptoms and sometime would get complications. That why we treat with penicillin to decrease symptoms and complications. If you see modern medicine is only 400 years old and other form of medicine existed in all known civilizations. All kind of infection were rampant through out history. But with modern medicine (vaccination/ antibiotics and antivirals) the complication of infections have decreased and number of people who die with infections has decreased. I cannot understate importance of safe water, sanitation and housing- which also improved during same period.
Bottom line- Immune system works with limitation. Vaccination and Antibiotics work as adjunct to help immune system work better.
In newborn and infants the immune system is naïve – so it has to learn, the elder population the immune system is weaker and in few younger population due to genetic or medication induced, they don’t have good immune system. In a community/region we have continuously have new babies born, and few of them age out, with time the immunity of whole community decreases. Other factors like nutrition, stress, sleep also contribute to immunity of the population at large .
Bottom line – In an individual level and the population level the level of immunity continuously changes.
What is a herd immunity?
If all the eligible people in the a community are immunized for a particular infection with help of herd immunity we can protect naïve newborns and elderly population.
How is COVID vaccination helping?
It is doing its job by decreasing number of severe infection (hospitalizations and ICU) and death, but does not prevent mild infections.
Can covid reinfection after primary infection possible?
Yes, but with different strain/variant. Infection with same strain/variant is extremely low.
How many children have COVID infection so far?
18 million out of 75 million in USA.
What is seroprevalence?
It is national cross sectional sampling to check how many people are infected with COVID 19. Nearly 60% of whole population had infection at some point of time, in children at least 75% have antibodies.
Take a movement and think if 70% percent of population is vaccinated and at least 60% have previous infection, why do we still have people in hospitals and at least 10000 die every month because of COVID. Possible some are uninfected and unvaccinated, there is always grey area we don’t know.
They take population at whole and stratify according to risk group and compare between group and give recommendations. It is good for population at whole but may not meet need of individual or family.
They look for top causes of death in each group and give recommendation, In 2020 even in pediatric CVID deaths are listed in top 15 causes. (for me if you save 200 deaths in < 5yr group with vaccination then it worth it.)
How we as parent and individual should think of this?
What is my risk or my child risk of acquiring covid infection, possible hospitalization and ICU need. What are the side effect of covid vaccinations?
At this point of children <5yr – can be easily divided
1. Previously infected ( does not mean population seroprevalence, individually infected and tested) – they have immunity to specific strain
2. naïve or no previous infection
3. Born to mother who had vaccination and breast feeding – they have some immunity
4. Born to mother who had covid primary infection and breast feeding – they have some immunity especially to the strain
I agree there is no data on pediatric reinfection after primary infection, still they are prone with new variants/strains. With vaccination even though the breakthrough infections are more common than previous infection, severe disease can be avoided with vaccination.
What is the difference in symptoms with primary covid infection and vaccination in < 5yr?
With covid primary infection majority are asymptomatic or mild symptomatic mostly managed in outpatient basis. Very few present with low oxygen and pneumonia or croup needing oxygen and possible antiviral. Very few need ICU and critical care and very very few die.
With covid vaccination same like routine vaccination – they have soreness at the sight of injection and fever, luckily in < 11 yr, not many had myocarditis ( possible the mRNA dose is very low)
Now choice is ours to choose the safest route.
Most important – What is difference between natural infection vs vaccine?
In COVID natural infection we come across the person who has covid, we inhale or touch the secretion and then the virus get attached to our respiratory cells using spike protein on the virus. Once the virus is attached, it send RNA into the respiratory epithelium, changes to DNA and then commands our DNA to make more virus particles, the virus particles are released out side the cell and more and more cells are infected. Million of copies are made with help of our respiratory cells.
Vaccine for COVID in children is mRNA- it is given intramuscular into our muscle, the immune cells in the muscle take up mRNA and make spike protein from the instructions provided- the immune system recognized the spike protein and make antibodies towards it, as our immune system is trained to identify this spike protein and attack it.
Bottom line: Similar to natural infection, vaccine give instruction to our cells to make spike protein.
How does evidence/ cause and effect studied in medicine?
For a disease to manifest in a individual there are many quantifiable factors (age, gender, race and other) and many non- quantifiable factors (exposure, stress, sleep, hydration and others). To distribute all the factors equally we randomize means divide the population into groups anticipating all the quantifiable and non-quantifiable factors are equally divided among the groups so they are no confounders.
In initial Adult COVID vaccine trial one group was given vaccine and other group was given placebo. Anticipating no difference in groups. We have noticed fewer infections in the vaccine group.
In children the vaccine dose was identified and the antibody titers were compared to adolescents and young adults. As the benefit of COVID vaccine in preventing severe infections and deaths is already established. To cut the time to deliver vaccine to children, large trial are usually avoided.
In preventive medicine (mammograms, prostate cancer screening) or vaccinations – large population should be screened of vaccinated to get small benefit. ( the epidemiologist and policy makes view in different way)
In therapeutic medicine like antiviral (remdesivir) for covid infection – usually they are not that large as the benefit between the groups is significant.
Take home message – As a pediatrician and as a parent, my calculation is for an individual covid vaccination is safer than natural infection even in less than 5 yr old’s.
Very Very important - What do I anticipate in future?
The severe infection and death would be less in the vaccinated < 5yr old from COVID. Similar to what we see with influenzas every year.
It seems like you could have found someone to argue the pro side who might be a little better than this. I am all for debate and would love to hear both sides but this doctor arguing the affirmative here is not doing any service to the pro side of this argument. If this is really the best argument to be made I am not sure why anyone would ever consider getting a kid vaccinated for this. Very flawed argument on the pro side here.
I think the COVID-19 dividing line is trust/distrust of the federal health agencies - NIH/CDC/FDA. In my view, the sooner those agencies are discredited and dismantled, the better.
just how misinformed or corrupt is any doctor who would suggest that ANYONE get these death jabs that have zero long-term safety data? VAERs system prove these shots should be ended.
The corruption of the health industry will never recover.
Nice job Vinay! Thank you Adam for your insight. Adam I would like to address your 3 assumptions on vacc hesitancy.
1. Concern for side effects. You bet! The data presented for approval was abysmal. Worst of all no one can provide the long term consequences for these children. Experimenting on anyone let alone children is a crime!
2. Belief that C19 is harmless to children. I think you'd be hard pressed to find one HEALTHY child who has died FROM C19 exclusively. I would encourage you to search Dr Marty Makary's work from John's Hopkins on child vaccines. Also view the VAERS reports.
3. Belief that vaccines do not work.
Do they prevent infection? No. Do they prevent transmission? No. Drop the mic! BOOM!
Doctors, doctors: data refers to plurality, data are, data were etc.. Any good peer reviewer will make that edit in a manuscript. Re the debate: Evidence in the form of much additional data stratified by age, co-morbidities and known or verifiable previous infection against outcomes such as p/a of disease and if yes- severity of disease course are needed before blanket and absolute statements can be made.
What was the health condition of the children who did get hospitalized or died of the virus? Current health status should be considered. Vaccinate the whole population didn't make sense to me. For my healthy covid recovered now 12 year old it is a hard no. And my pediatrician made no mention of the virus or vaccine. It sounded like Adam was just making stuff up.
If you're not in favor of vaccinating children against COVID, then what is your theory of
childhood vaccination? Should we be vaccinating against meningitis, rubella or chickenpox? In their worst pre-vaccine years, meningitis, rubella, and rotavirus killed 8, 17, and 20 kids a year. Vaccines have dramatically reduced these tolls. From Jan 2020 to May 2022, COVID on average, killed 86 kids (age 6 months to 4 years) each year. Small numbers, yes, but kids AREN'T SUPPOSED to die. Depending on age range, COVID is the #4-5 leading cause of death in kids, and while vaccines don't reduce cases much in the omicron era, they make COVID milder and reduce death. Adam is right.
I'd like to point out 1 reason many parents, myself included, have chosen not to vaccinate their children that Dr. Cifu failed to mention: Previous COVID 19 infection. I had concerns about EUA for this vaccination in children. I think EUA was absolutely appropriate for adults, but the paltry number of kids in the studies combined with the relatively low risk all make it difficult to determine true effectiveness, let alone serious safety signals on this age group. I opted to wait since I had concerns about the myocarditis risk for my 12 year old son. I finally decided to get their first vaccination over their Christmas break so they would not miss school due to side effects. Then an unvaccinated coworker got Omicron and my children and I got sick. Although I was sick, it was not nearly as bad as when I had Influenza in college. I no longer see a need to vaccinate them as they should have better immunity from the infection than they would have gotten from the vaccine. Also, my pediatrician did not recommend the COVID 19 vaccination when my kids were in for their flu shots or their recent Gardesil shots.
Adam Cif’s point 3. It seems that he’s comparing Covid 19 death rates in kids aged 5-11 to death rates due to measles and varicella in the general population. Either I misunderstood or it makes no sense.
Disappointed Prasad did not discuss the risks of these vaccines especially pericarditis and myocarditis. The argument goes beyond whether or not children actually “need” this protection or not. For some children they can be quite dangerous. Even if it’s a minority of kids, who wants to roll the dice with their child?
The jury is out as far as I'm concerned. No need to take the additional risks and I'm from Singapore.
I'd really like to see a FUP to this Pro/Con with a point/counterpoint from both after reading each others comments. I also think that Cifu would have been better replaced by Offit when making the "Pro" argument vs. VP, but Paul is not going to be available for such things.
Dr. Cufi and Dr. Prasad have generated a new confusion for parents. Let me go through one my one.
You may read this Q&A or just see this video from Dr Paul Offit, an expert in vaccines.
https://www.chop.edu/centers-programs/vaccine-education-center/video/what-are-parents-asking-about-covid-19-vaccine-children-younger-5-years-old#:~:text=Dr.,a%20risk%20for%20your%20child.
Who am I?
I am practicing pediatrician, father and a strong advocate for preventive medicine.
Which populations is discussed in this topic?
Children <11yr old, who cannot make an informed decision.
What is a COVID 19 virus?
It is a respiratory virus which cause damage to lung and blood vessels.
What are the symptoms?
Patients can be from totally asymptomatic, mild to moderate respiratory symptoms managed at home, to severe and critical symptoms managed at hospitals. ( it is a spectrum)
Who are at risk?
Elderly population (>65yr) and younger population with co-morbidities.
Are children hospitalized and critical because of COVID?
Yes, at least 40000 hospitalized and at least 5000 needed critical care support and nearly 1000 died in nearly 2 yr period. (above video)
We will jump into other topic – Immune system?
This is the defense system for our body (like border security forces). Mainly we have innate immunity (neutrophils, monocytes, eosinophils, NK cells and complements) like walls and fences at the border, as soon as bacteria or virus attack the human body immediately these cells attack, these are not specific. Other one is adaptive immunity (T cell and B cells basically lymphocytes) which are like guns and rocket at the border. They make antibodies and other chemicals specific for this virus/bacteria.
Does immune system work?
Yes, but it has limitations. Simple example if you don’t treat a strep throat, your immune system make take care of it, but more number of days of symptoms and sometime would get complications. That why we treat with penicillin to decrease symptoms and complications. If you see modern medicine is only 400 years old and other form of medicine existed in all known civilizations. All kind of infection were rampant through out history. But with modern medicine (vaccination/ antibiotics and antivirals) the complication of infections have decreased and number of people who die with infections has decreased. I cannot understate importance of safe water, sanitation and housing- which also improved during same period.
Bottom line- Immune system works with limitation. Vaccination and Antibiotics work as adjunct to help immune system work better.
https://www.who.int/health-topics/vaccines-and-immunization#tab=tab_1
Why everyone don’t have same immune system?
In newborn and infants the immune system is naïve – so it has to learn, the elder population the immune system is weaker and in few younger population due to genetic or medication induced, they don’t have good immune system. In a community/region we have continuously have new babies born, and few of them age out, with time the immunity of whole community decreases. Other factors like nutrition, stress, sleep also contribute to immunity of the population at large .
Bottom line – In an individual level and the population level the level of immunity continuously changes.
What is a herd immunity?
If all the eligible people in the a community are immunized for a particular infection with help of herd immunity we can protect naïve newborns and elderly population.
How is COVID vaccination helping?
It is doing its job by decreasing number of severe infection (hospitalizations and ICU) and death, but does not prevent mild infections.
Can covid reinfection after primary infection possible?
Yes, but with different strain/variant. Infection with same strain/variant is extremely low.
How many children have COVID infection so far?
18 million out of 75 million in USA.
What is seroprevalence?
It is national cross sectional sampling to check how many people are infected with COVID 19. Nearly 60% of whole population had infection at some point of time, in children at least 75% have antibodies.
Take a movement and think if 70% percent of population is vaccinated and at least 60% have previous infection, why do we still have people in hospitals and at least 10000 die every month because of COVID. Possible some are uninfected and unvaccinated, there is always grey area we don’t know.
https://www.cdc.gov/mmwr/volumes/71/wr/mm7117e3.htm
How do epidemiologist, policy maker look at this?
They take population at whole and stratify according to risk group and compare between group and give recommendations. It is good for population at whole but may not meet need of individual or family.
They look for top causes of death in each group and give recommendation, In 2020 even in pediatric CVID deaths are listed in top 15 causes. (for me if you save 200 deaths in < 5yr group with vaccination then it worth it.)
https://wonder.cdc.gov/controller/datarequest/D76;jsessionid=6813B66296E661176D4EA8E7782C
How we as parent and individual should think of this?
What is my risk or my child risk of acquiring covid infection, possible hospitalization and ICU need. What are the side effect of covid vaccinations?
At this point of children <5yr – can be easily divided
1. Previously infected ( does not mean population seroprevalence, individually infected and tested) – they have immunity to specific strain
2. naïve or no previous infection
3. Born to mother who had vaccination and breast feeding – they have some immunity
4. Born to mother who had covid primary infection and breast feeding – they have some immunity especially to the strain
I agree there is no data on pediatric reinfection after primary infection, still they are prone with new variants/strains. With vaccination even though the breakthrough infections are more common than previous infection, severe disease can be avoided with vaccination.
https://stacks.cdc.gov/view/cdc/113253
What is the difference in symptoms with primary covid infection and vaccination in < 5yr?
With covid primary infection majority are asymptomatic or mild symptomatic mostly managed in outpatient basis. Very few present with low oxygen and pneumonia or croup needing oxygen and possible antiviral. Very few need ICU and critical care and very very few die.
With covid vaccination same like routine vaccination – they have soreness at the sight of injection and fever, luckily in < 11 yr, not many had myocarditis ( possible the mRNA dose is very low)
Now choice is ours to choose the safest route.
Most important – What is difference between natural infection vs vaccine?
In COVID natural infection we come across the person who has covid, we inhale or touch the secretion and then the virus get attached to our respiratory cells using spike protein on the virus. Once the virus is attached, it send RNA into the respiratory epithelium, changes to DNA and then commands our DNA to make more virus particles, the virus particles are released out side the cell and more and more cells are infected. Million of copies are made with help of our respiratory cells.
Vaccine for COVID in children is mRNA- it is given intramuscular into our muscle, the immune cells in the muscle take up mRNA and make spike protein from the instructions provided- the immune system recognized the spike protein and make antibodies towards it, as our immune system is trained to identify this spike protein and attack it.
Bottom line: Similar to natural infection, vaccine give instruction to our cells to make spike protein.
How does evidence/ cause and effect studied in medicine?
For a disease to manifest in a individual there are many quantifiable factors (age, gender, race and other) and many non- quantifiable factors (exposure, stress, sleep, hydration and others). To distribute all the factors equally we randomize means divide the population into groups anticipating all the quantifiable and non-quantifiable factors are equally divided among the groups so they are no confounders.
In initial Adult COVID vaccine trial one group was given vaccine and other group was given placebo. Anticipating no difference in groups. We have noticed fewer infections in the vaccine group.
In children the vaccine dose was identified and the antibody titers were compared to adolescents and young adults. As the benefit of COVID vaccine in preventing severe infections and deaths is already established. To cut the time to deliver vaccine to children, large trial are usually avoided.
In preventive medicine (mammograms, prostate cancer screening) or vaccinations – large population should be screened of vaccinated to get small benefit. ( the epidemiologist and policy makes view in different way)
In therapeutic medicine like antiviral (remdesivir) for covid infection – usually they are not that large as the benefit between the groups is significant.
Take home message – As a pediatrician and as a parent, my calculation is for an individual covid vaccination is safer than natural infection even in less than 5 yr old’s.
Very Very important - What do I anticipate in future?
The severe infection and death would be less in the vaccinated < 5yr old from COVID. Similar to what we see with influenzas every year.
https://publications.aap.org/pediatrics/article/139/5/e20164244/38814/Influenza-Vaccine-Effectiveness-Against-Pediatric?autologincheck=redirected
It seems like you could have found someone to argue the pro side who might be a little better than this. I am all for debate and would love to hear both sides but this doctor arguing the affirmative here is not doing any service to the pro side of this argument. If this is really the best argument to be made I am not sure why anyone would ever consider getting a kid vaccinated for this. Very flawed argument on the pro side here.
Full letter linked inside:
https://www.voiceforscienceandsolidarity.org/scientific-blog/pediatricians-internationally-please-call-for-an-immediate-halt-to-the-global-campaign-to-vaccinate-children-against-covid
It is interesting that quite a lot of the "Yes" position is simply deferring to authority.
I think the COVID-19 dividing line is trust/distrust of the federal health agencies - NIH/CDC/FDA. In my view, the sooner those agencies are discredited and dismantled, the better.
just how misinformed or corrupt is any doctor who would suggest that ANYONE get these death jabs that have zero long-term safety data? VAERs system prove these shots should be ended.
The corruption of the health industry will never recover.
Nice job Vinay! Thank you Adam for your insight. Adam I would like to address your 3 assumptions on vacc hesitancy.
1. Concern for side effects. You bet! The data presented for approval was abysmal. Worst of all no one can provide the long term consequences for these children. Experimenting on anyone let alone children is a crime!
2. Belief that C19 is harmless to children. I think you'd be hard pressed to find one HEALTHY child who has died FROM C19 exclusively. I would encourage you to search Dr Marty Makary's work from John's Hopkins on child vaccines. Also view the VAERS reports.
3. Belief that vaccines do not work.
Do they prevent infection? No. Do they prevent transmission? No. Drop the mic! BOOM!
Doctors, doctors: data refers to plurality, data are, data were etc.. Any good peer reviewer will make that edit in a manuscript. Re the debate: Evidence in the form of much additional data stratified by age, co-morbidities and known or verifiable previous infection against outcomes such as p/a of disease and if yes- severity of disease course are needed before blanket and absolute statements can be made.
What was the health condition of the children who did get hospitalized or died of the virus? Current health status should be considered. Vaccinate the whole population didn't make sense to me. For my healthy covid recovered now 12 year old it is a hard no. And my pediatrician made no mention of the virus or vaccine. It sounded like Adam was just making stuff up.
If you're not in favor of vaccinating children against COVID, then what is your theory of
childhood vaccination? Should we be vaccinating against meningitis, rubella or chickenpox? In their worst pre-vaccine years, meningitis, rubella, and rotavirus killed 8, 17, and 20 kids a year. Vaccines have dramatically reduced these tolls. From Jan 2020 to May 2022, COVID on average, killed 86 kids (age 6 months to 4 years) each year. Small numbers, yes, but kids AREN'T SUPPOSED to die. Depending on age range, COVID is the #4-5 leading cause of death in kids, and while vaccines don't reduce cases much in the omicron era, they make COVID milder and reduce death. Adam is right.
I'd like to point out 1 reason many parents, myself included, have chosen not to vaccinate their children that Dr. Cifu failed to mention: Previous COVID 19 infection. I had concerns about EUA for this vaccination in children. I think EUA was absolutely appropriate for adults, but the paltry number of kids in the studies combined with the relatively low risk all make it difficult to determine true effectiveness, let alone serious safety signals on this age group. I opted to wait since I had concerns about the myocarditis risk for my 12 year old son. I finally decided to get their first vaccination over their Christmas break so they would not miss school due to side effects. Then an unvaccinated coworker got Omicron and my children and I got sick. Although I was sick, it was not nearly as bad as when I had Influenza in college. I no longer see a need to vaccinate them as they should have better immunity from the infection than they would have gotten from the vaccine. Also, my pediatrician did not recommend the COVID 19 vaccination when my kids were in for their flu shots or their recent Gardesil shots.
I’m with Prasad on this one.
Adam Cif’s point 3. It seems that he’s comparing Covid 19 death rates in kids aged 5-11 to death rates due to measles and varicella in the general population. Either I misunderstood or it makes no sense.
Disappointed Prasad did not discuss the risks of these vaccines especially pericarditis and myocarditis. The argument goes beyond whether or not children actually “need” this protection or not. For some children they can be quite dangerous. Even if it’s a minority of kids, who wants to roll the dice with their child?