Rhode Island may begin vaccinating children as young as age 5 against COVID-19 as early as Nov. 8. Dr. Elizabeth Lange, a pediatrician and former president of the Rhode Island chapter of the American Academy of Pediatrics, spoke with Health Reporter Lynn Arditi about vaccinating children.

If a parent asks you how to weigh the risk of their child getting the vaccine compared with the risk of the child getting COVID-19, what do you tell them?

Dr. Lange: The data is pretty clear that children tolerate the vaccine very well with minimal side effects. What is also very clear is that we know that COVID infection in children can be as far as a mild illness or it could be a very significant illness to the point that many children have been hospitalized with it. So while each family needs to weigh the benefits and the risks for their own family, the scientific community believes that the risks of getting the vaccine are very small compared to the risk of a child having a significant COVID infection.

So we tend to think of children as not getting very sick from COVID-19. The American Academy of Pediatrics reports that, as of mid-October, just over 300 children in Rhode Island had been hospitalized for COVID-19-related illness since the state began tracking cases in early 2020. That's about 2.5% of the state's total COVID-related hospitalizations.

Dr. Lange: Now the children are out and about and running their normal lives, even with masks on mitigating measures, and now that the grandparents are all vaccinated, or the majority of them are, the illness is still looking for people to infect. And so the infection age of people who are sick with COVID is much younger . Children are getting sick. Just a couple of weeks ago 25% of the nation's infections for COVID were in children.

So Rhode Island actually has one of the highest vaccination rates in the country, as you know. But according to data published recently by the American Academy of Pediatrics, nationally, Rhode Island ranks in the top 10 for infection rates among children. No other New England state is even close. Why have so many children in Rhode Island been infected?

Dr. Lange: The infection rates that you see in children in that graph from the American Academy of Pediatrics goes back to the beginning of the pandemic. We didn't have 90% vaccination rates (among adults) in January, but we do now. There are many zip codes where the vaccination rates are much lower in the vaccine eligible people. So that puts children at risk of getting infections. Rhode Island is one of the densest populated states, compared to so many others. And COVID is a very contagious illness. So if one person in the family is sick with COVID, the infection runs through the house much more quickly than it would in a household that is not so densely populated. 

So if my kids were under 12, I'd want to talk to our pediatrician and preferably have them get the COVID vaccine in their office. But less than half of all pediatric and family medicine practices, just over 40%, have signed up to offer the vaccine. Why is that?

Dr. Lange: That number is changing day by day. The logistics of giving the COVID vaccine are significant, and pediatric practices and family physician practices are very good at giving the general pediatric vaccinations, which is why we have won the highest pediatric vaccination rates. The COVID vaccine has a little bit different preparation, different storage and the 15-minute wait time in the office before children can be dismissed after receiving their dose. And for some practices, the logistics are just too difficult. But I know that those practices are working with other community-based partners to make sure that all those patients are inoculated and certainly any parent who has a question about the COVID vaccine and children should talk to their family physician or pediatrician.

If the vaccination rate among 12- to 15-year-olds in Rhode Island is any guide, demand for the pediatric vaccine is going to vary widely from one community to the next. Central Falls had one of the highest infection rates in the state, only 35% of 12-to 15-year-olds are vaccinated. And that's compared with 80% for that age group in East Greenwich and Barrington. How do we tackle these discrepancies?

Dr. Lange: The state Department of Health and everybody who is invested in vaccinating the state and keeping everybody healthy in the state is very much aware of those discrepancies. The physician community and the community at large in our high-risk zip codes are working door by door, community center by community center, to answer people's questions, to make sure that they understand the risks and the benefits and make sure they feel comfortable with the recommendations to vaccinate. We are at the point now where these personal relationships make a difference, so that everybody has comfort in receiving this vaccine and protecting against a very serious illness.

As a pediatrician at Coastal Medical, what's your experience so far with vaccinating kids in your practice?

Dr. Lange: It's all across the map. We are a COVID vaccinating office, we do spend time talking to each of our families, some who are very eager to sign up right now and get their child vaccinated the first day it's approved for that age group. And we have other families who are more thoughtful, and other families are ‘heck, no!’ families. We need to stop the spread of this virus and every person who is unvaccinated is at risk of getting sick, or significantly sick, from this virus. So we'll keep talking to people about vaccinations but in our office, we are here and open and ready, as I know all my pediatric colleagues are, to talk to families about their concerns.

This story has been updated.

Lynn Arditi, health reporter for The Public’s Radio, can be reached at larditi@thepublicsradio.org. Follow her Twitter @LynnArditi