Thread by @WhitneyEpi

🧵1/x My 3 yo got his 1st #COVID19 vaccine dose last week!

Starting this 2-dose process (Moderna) was more satisfying and joyful for our family & friends than I’d expected 😁

🧵2/x Last year I wrote about my reasons for wanting to vaccinate my young kids against #COVID19

https://twitter.com/whitneyepi/status/1442836760111816705

🧵3/x I also like to read informed takes that are opposed to mine, and this @ShamezLadhani tweetorial was a good one for that

It focuses on #CovidVaccine for 5-11 yo kids, but thread says he’d make similar arguments against immunization efforts for younger kids like my 3 yo

https://twitter.com/ShamezLadhani/status/1543145360553549826

🧵4/x The crux of his argument is skepticism whether the benefits are worth the trouble (1) on a societal scale re: mandates or even recommendations & (2) re: individual benefits to children

🧵5/x Some points (re: long COVID, preventing re-infection) are about absence of direct evidence

Personally this doesn’t sway me much. Inaction in face of uncertainty has risks too.

Here’s how I’ve approached decision-making in situations w uncertainty
theinsight.org/p/how-one-epid…

🧵6/x Another big issue is vaccine efficacy stats.

(For the first few months after immunization w mRNA COVID-19, people get strong protection vs infection: even w lots of exposure, most people have low likelihood of infection. After that, efficacy vs infection closer to 50%)

🧵7/x I think these vax efficacy (VE) numbers seem “not-worth-the-effort”-low to many people bc

(1) original VE vs OG SARS-CoV-2 was SO good (“anchoring”)

and

(2) we all interpreted efficacy as protection against lifetime risk instead of (correctly) like a rate

🧵8/x With the COVID virus everywhere, illness disruptive to family & civic life, & long term effects of repeated childhood infections unclear, a 50% efficacy vax seems valuable:

1-2 infections per yr instead of 2-4…

Or maybe even 0 in a given year instead of 1 or 2

🧵9/x Despite doubts about efficacy, the author recommends giving the vaccine to kids who have ⬆️ risk of hospitalization *given* infection

“High-risk” strategies like these are intuitive to people, but the math often doesn’t work the way people think it does

🧵10/x Basically it’s a denominator problem.
Say u can reliably identify* the 1% subset of highest risk kids…say they have 10x(!) risk vs others
(*harder than it sounds)

Do you eliminate nearly all kid hospitalization by focusing on high-risk & not lower risk 99%?

No

🧵11/x For more on the high-risk strategy, I highly recommend Geoffrey Rose’s 1985 classic article "Sick Individuals and Sick Populations" (reprinted in @IntJEpidemiol).

Here’s a Wikipedia article for the quick highlights en.wikipedia.org/wiki/Geoffrey_…

🧵12/x Another argument that the author makes is about opportunity cost: Do efforts to vaccinate children against #COVID19 reduce more impactful efforts to improve child health?

🧵13/x Full disclosure:
I am attracted to this argument in theory, but I’m skeptical based on experience: it’s often used in bad faith, with no specific strategy or $ to ramp up highly impactful efforts X in place of Y (thing they don’t like)

We end up with no Y & no better X

🧵14/x But, assuming the author is sincere (I actually do), this argument is HIGHLY context-specific.

The author is from the UK, I’m in the US South. It’s possible this is a strong argument, given their system. But I’ll focus here, on the system I’m experiencing

🧵15/x In US states like TN & FL here, kid-COVID vaccination is not an organized state effort displacing other kid-health policies.

Instead, the states’ anti-kid-COVID-vax political movement are on-ramps and engines to weaken other childhood immunization programs

🧵16/x A final consideration:

If we don’t vaccinate against COVID when kids are little, then when should we do it?

🧵17/x A lot of his argument is, Almost all the kids already had COVID so 🤷🏾‍♀️…

I have several objections to this argument, but I’ll focus on the big picture:

New #SARSCoV2-naive people are born every day.

What’s the long game?

🧵18/x Going forward, is there some optimal age for vaccinating against COVID-19?

Or would he just go with a high-risk strategy of restricting immunization campaigns to subgroups w some threshold of risk *given infection*? (The medical model, “high-risk strategy”)

🧵19/x I like the idea of starting the #COVID19 vaccination sequence when people are young bc the side effect profile is best then and you have greatest likelihood of catching people before their first #SARSCoV2 infection.

🧵20/x These are my quick thoughts

These vaccines aren’t perfect.

And there are trade-offs in public health and medicine (and parenting, for that matter!)

But one of my guiding parenting strategies is, Don’t let the perfect be the enemy of the good

🥃<— a half-full glass 😉

Also big shout-out to @OrangeHealthNC! 👏🏾

They do SO much (their COVID vaccine clinics are just a small part of their efforts). I’ve been impressed by their resources and on-the-ground efforts.

I’m glad to live in a place w such a strong public health dept