Vaccines for Teens and Preteens: A Live Q&A with Dr. Nneka Holder
Oct 05, 2021

— Transcript —

Najma Roberts:

Welcome everyone, thank you so much for being here, so excited to have this conversation. My name is Najma Roberts, I am an advisor with Vaccinate Your Family, and again just welcome. Before we dig in, I have to say, while you’re here I’m going to ask everyone to please follow Vaccinate Your Family on Facebook, on all their social media platforms, please share the website with family and friends, and we’ll post this video too so we’re asking that you like it and you share it, that’s the biggest thing.

I would love to introduce a vaccine expert and pediatric specialist, Dr. Nneka Holder, she’s the attending physician at the Department of Pediatrics at MedStar Georgetown University and an associate professor at Georgetown University. She specializes in pediatrics and adolescent medicine and is a mom of two, as I understand it, and so am I! We can chat about being a mom in the quarantine world later because that’s a whole different topic. But welcome Dr. Holder, thank you so much for joining us.

Dr. Nneka Holder:

Thank you so much for having me.

Najma Roberts:

Great, well let’s just dive right in. So today, we’re here to talk about vaccines with a special focus on the COVID vaccine. We want to dispel a few myths, we want to get some information out there, and this conversation, while we encourage everyone to listen, is really for those parents of children that are 12 and older. We know parents, you and I are moms, moms have lots of questions. I think my doctor probably has blocked me from her cell phone because I text her constantly, like “wait, what about this one thing?” so we thought this would be a good opportunity to just get those questions out there and really be a resource for parents. Sound good?

Dr. Nneka Holder:

Yes.

Najma Roberts:

Great. Alright, let’s kick it off. So first, of course everyone’s talking about COVID, we’re living in a COVID world, it’s on the headlines every day, so let’s kick it off Dr. Holder. Why should kids 12 and older get vaccinated with the COVID-19 vaccine?

Dr. Nneka Holder:

Is it alright if I just do a brief overview of vaccines in general and how they’re approved? Because I think that would dispel some of the mystery behind vaccines. I think as scientists there’s a lot that we do that we don’t do as well of a job disseminating to the public, even if we think we’re being transparent.

Najma Roberts:

I would love that.

Dr. Nneka Holder:

Okay, so with any vaccine developed, before it’s even taken to the FDA, any company has to do their background research and initially they start trials in animals. Then, they do some very very small trials in humans to make sure they are safe and effective.

Once they’re shown to be safe and effective, then they take it to the FDA to start the licensure process. And as they increase their numbers of study participants, they have more data to present to the FDA to make sure that their product is safe and effective, and they gradually increase the numbers of study participants. And with each study participant, that brings new data and new information, more numbers to show that it’s safe and effective. Then there are ongoing safety trials, even after the vaccine is licensed.

The virus is mutating, it’s becoming more contagious and it’s affecting younger populations, so the younger populations are getting sicker and sicker quicker.

In addition to that, there’s an agency called the Advisory Committee on Immunization Practices that has appointed members from the Department of Health and Human Services as well as liaisons from the general public and from professional organizations, including one that I belong to called the Society for Adolescent Health and Medicine, and there’s similar member including the American Academy of Pediatrics, the American College of Family Medicine Physicians, the American College of Physicians, the American College of Obstetrics and Gynecology, Indian Health Service, all of these liaisons work closely and review details about vaccine safety and efficacy. For every single vaccine, there’s a working group that meets at different time points to determine, ad nauseum, the data behind each particular vaccine.

The exciting thing about COVID vaccines is that for the height of the pandemic, in 2020, all other research and scientific studies were put on hold so that people could focus on COVID. That’s how the vaccine was developed so rapidly, because all of the other stuff was put on hold and everybody focused on COVID. So it seems to the public that this vaccine was developed really quickly, but that’s because all of the scientists worked on it all at the same time. There was the background knowledge about vaccines, but all of that seemed to be accelerated because everyone was working on it all at once.

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So to answer your question about why kids 12 and up should be vaccinated against COVID, now that we’ve learned more from a tremendous amount of data – data keeps coming out every day about coronavirus since the start of the pandemic – we know that wearing masks has been shown to be safe and protective, we know that physical distancing has been shown to be safe and protective, but quite honestly this is a virus, and viruses mutate and evolve, that’s how they become stronger and survive as a species. So every time we try to beat a virus, it mutates and becomes better, stronger, and faster. One way to combat mutations is developing vaccines.

The reason we recommend vaccinating younger patients is, thankfully older populations have been vaccinated against COVID-19, but again it’s a virus – what is a virus going to do? – any self-respecting microorganism is going to figure out who to infect next. Now that most of the older population is vaccinated, the next group would be younger populations, and we have data showing that younger populations are getting infected with COVID and in fact they’re getting infected with the mutated forms of the virus.

The virus is mutating, it’s becoming more contagious and it’s affecting younger populations, so the younger populations are getting sicker and sicker quicker.

Najma Roberts:

Wow. Well one, thank you for that background because that’s one of the big things people are saying, like “Oh, how did this happen so fast?” and it’s a conspiracy. And what I hear you saying is like the analogy of building a house. If you have one construction worker building a home, it’s going to take a while, but if you throw a hundred folks working on that same home you can build it in two days because you have everyone doing different parts of it. And it sounds like that’s what happened here, they knew this was a pandemic killing hundreds of thousands of people and they needed to throw everything they had at it, and that’s how the vaccine was able to be approved so quickly.

Dr. Nneka Holder:

I like your analogy better than mine!

Najma Roberts:

Well, I’m trying to convince my husband for a home remodel, so I’m all into HGTV. You know, one thing you said too that really resonates, and I’ve heard others say it, is viruses are smart and if they can’t find somewhere to live, they’re going to mutate. What I hear you saying is that’s why it’s even more important to get that younger population, 12 and older, vaccinated. Then the virus has fewer places to go. Is that correct?

Dr. Nneka Holder:

Yes, that’s very accurate. And again, we’re still learning about coronaviruses, unlike some of the other things and viruses that we know about in medicine such as the flu virus and even the virus that causes mononucleosis, the mono infection. There’s so much we know about those viruses because we’ve had time to study them, we’re still learning about COVID. At the beginning of this pandemic we thought it didn’t affect kids and kids had mild disease, and we never imagined kids would need to be hospitalized.

But now, we are getting more and more case reports of pediatric systems being overwhelmed with younger and younger patients, even teenage patients, and we have some data showing that those long-haul symptoms, which we thought only affected older people, I do have a few adolescent patients in my practice who have long-haul symptoms of COVID. I have one patient who has been suffering from chest pain for 8 months, since being diagnosed with COVID, and I have another patient who is not growing due to loss of sense of taste and smell from COVID. Pediatric patients can get long-haul symptoms from COVID, which we are still trying to figure out how to manage.

Najma Roberts:

Well that brings me to my next point, we’re still learning about and studying the virus, so the question that I’m hearing in parent circles is “If we’re still studying the virus, how do we know that the vaccine is safe?” What gives you and the medical community the reassurance that the vaccine is safe and that we should give it to our children in the 12-18 age group, those are still our babies, so what’s your response to that?

Dr. Nneka Holder:

So, yes, definitely as a parent, I want what’s best for my children. I have a 12-year-old and a 14-year-old, both of my children have been vaccinated against COVID-19.  My 12-year-old in particular is not a fan of vaccines, but for this one she rolled up her sleeve and said “Mom, let’s get this over with.”

We know it’s safe based on the data, again these vaccine trials have been going on for over a year so we know from the preliminary data before it was licensed that those study participants suffered minimal side effects that they’ve all recovered from, such as fever, pain at injection site, feeling ill and achy, all of those symptoms have resolved.

Even when the adolescent trials concluded, there were some initial case reports of similar side effects to those we see in adults and some concern about heart inflammation, particularly in adolescent boys, we now have more data showing that compared to heart inflammation you’d get from actual COVID disease, patients who have a side effect from the vaccine all recover whereas patients who get COVID don’t always recover. So, vaccine side effects are temporary whereas the actual effects of the disease may not go away.

Najma Roberts:

Absolutely, that’s a great point. Would you say that the patients in the clinical trials were diverse? As a woman of color, it’s always important to me because with some things, people of color do react differently. Would you say the study was a diverse sample size?

Dr. Nneka Holder:

When I looked at the data, the two initial vaccines that were licensed in the United States were intentional in making sure that their sample size was diverse. I’m not promoting one over the other so I will leave names out of it, but there was a slight lag between the two initial vaccines that were licensed in the United States because one company was more intentional about the study population being diverse and that was a reason why one vaccine was approved weeks before the other one.

Najma Roberts:

Makes complete sense. Well, let’s talk a little bit about, I’m hearing on the news and on my social media feeds about this concept of breakthrough cases. Can you explain first, what does a breakthrough case mean?

Dr. Nneka Holder:

Thank you for bringing up, that is really important. Again, I think one thing we’re not doing well as scientists is disseminating to the public what we already know. So, there is no vaccine that’s 100%. What vaccines do is they make it less likely to get the disease, make it harder to transmit the disease if you do get the disease, and they make it less likely for you to suffer severe illness or complications if you do get the disease. The vaccine is not a cure, but it is one more strategy to fight this pandemic and to fight diseases, and particularly viruses. When we have breakthrough cases, it’s expected, but the breakthrough patients tend to be less sick than those who get the illness without being vaccinated against it.

…As a parent, I want what’s best for my children. I have a 12-year-old and a 14-year-old, both of my children have been vaccinated against COVID-19.

Najma Roberts:

So it sounds like breakthrough means you’ve gotten the vaccine, you were exposed and have now tested positive and maybe even showing some light symptoms of it, that person is a breakthrough case. But what I hear you saying is that this doesn’t mean the vaccine didn’t work, the vaccine is preventing ultimately death and hospitalization for severe symptoms. I imagine that’s what we’re saying, the vaccine doesn’t mean you may not get it, you still may feel icky, but it’ll keep you out of the ICU in most cases. I know nothing is 100%, but we’re seeing in most cases that vaccinated people are not the severely ill patients.

Dr. Nneka Holder:

Exactly, in the cases that are being reported where hospitals and health systems are overwhelmed with COVID patients, the outstanding majority of the patients are unvaccinated.

Najma Roberts:

Okay, got it. And I think that’s very helpful again, as a mom, we don’t want to put things into our kids’ bodies that they don’t need, but it does matter that we are doing everything we can to keep them out of the ICU. There’s a possibility if they are exposed that they show symptoms or test positive, but we’re keeping them as healthy as we can, even if there is exposure.

Dr. Nneka Holder:

Exactly, this is one more way to target this virus, we’re trying to stay ahead of this virus. As it gets smarter, we’re trying to stay one, two, three steps ahead. We figured out that we need to wear our masks, we figured out that physical distancing and vaccines are additional complements to our strategy for fighting this pandemic.

Najma Roberts:

That’s super helpful. Well I just have one other question about the COVID vaccine and then I want to get into a couple of other quick topics. So, we’re all on social media, we’re all seeing the news, there’s misinformation everywhere. In you experience as a physician, are there two pieces of misinformation that you want to dispel? If you had to pick the top two things that you continue to hear, I’m sure your friends and your kids’ friends’ parents are talking about, what are those top two things that, for the record, you’d like to dispel right now?

Dr. Nneka Holder:

So, yes, what I’ve been hearing in the little times I dabble in social media, infertility has been a big issue with not just this vaccine, with many vaccines. It seems to keep popping up every few years about fertility problems and vaccines, and quite honestly, there’s data showing that vaccines do not affect fertility. But it keeps coming up because it’s near and dear to all of us, so it’s a strong argument to make but it has no proof or validity.

We do need to keep in mind that again, being infected with a virus can affect fertility. We know this from mumps, mumps can affect and cause inflammation of the ovaries and can cause inflammation of the testes. Natural infection of a virus can affect fertility, vaccines cannot affect fertility. In fact we now have data that if a pregnant woman gets vaccinated against COVID, she actually makes antibodies, which are the body’s immune and defense system, and babies are born with protection against COVID. So the newborn is protected against COVID.

Najma Roberts:

Wow. So I hear you saying, just to make it plain, there is no data that shows that the COVID vaccine or really any other FDA approved vaccine has a direct link to infertility, but, if we get one of the viruses without being vaccinated, that has a higher potential to cause infertility.

Dr. Nneka Holder:

Exactly. One of the other myths that keeps popping up, and this is a big one and I’m not sure where it came from, is that these vaccines are implants and tracking by some larger agency or government, and that’s just a myth. It’s just a myth.

Najma Roberts:

I’ve heard that one too, and it’s so funny my 16-year-old son who was ready to get back on the lacrosse field and get his vaccine because that was the only way he could play, he said “Mom I don’t know why people are worried about being tracked, advertisers know what I’m looking at, what I’m ordering on Amazon, what I’m eating on DoorDash anyways, so, we’re already being followed!” I don’t know if that makes anyone feel any better, but if you’re online, you’re already being tracked.

So I’ve heard that one too, and it’s hard because you don’t want to make light of it because you know people genuinely have these concerns, but you as a physician seeing young people in the ICU and unfortunately pass away from what could’ve been a preventable disease, we have to make sure we’re helping people understand to live by the science and what women of color even that are scientists and physicians are saying that isn’t true, we’re trying to save lives here.

Dr. Nneka Holder:

Yes and I’ll piggy-back on that here, elephant in the room, we’re both women of color and medicine has not always done people of color right. And unfortunately, there have been major health implications, going back even longer than 100 years, where medicine has not been in favor of people of color.

What’s different about this vaccine is one of the key developers of one of the vaccines is a woman of color, she spearheaded the development of this vaccine. And that’s amazing! And like I said, the study participants were diverse and this vaccine is being offered to people of all ethnicities, which has not happened in this country historically. There were treatments that were withheld, but this vaccine is not being withheld, it’s being offered to everyone, so this is a first and it’s one of those things that makes me proud in medicine.

Another thing is, medicine is not perfect. Science is evolving and we’re learning more every day, and one of the big successes as a pediatrician is vaccines. Handwashing, clean water, and vaccines. I’ve been a physician longer than I’ve been a mom, my oldest is 14 and I’ve been a physician for over 20 years, and I can remember some of the illnesses in pediatric patients from vaccine-preventable diseases, and it’s heartbreaking to see someone get sick from something that could’ve been prevented.

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Najma Roberts:

I completely agree, it is heartbreaking. And there are vaccines now that my kids have taken that they didn’t have when I was little, which brings me to my next subject, I feel like we’re so COVID focused that even me working in public health fell a little behind on my 6-year-old’s routine vaccines. Let’s talk a little bit about that, was this just me because we were hunkered down and quarantined and not going anywhere? Are you seeing that across the country, the rates of routine vaccinations going down?

Dr. Nneka Holder:

So unfortunately, with the pandemic there was a significant decline in routine health visits, at least initially, in this country because we were trying to figure out everything as cities, hospitals, and doctor’s offices took turns shutting down, that did lead to a drop and a delay in routine visits which meant a lot of kids fell significantly far behind on their immunizations. So we are still playing catch-up, there are patients in my office who I have not seen all of last year, and I had to personally reach out to a lot of my patients to get them back in the office and say my office is safe, these are our safety practices, these are how we’re decreasing risk and exposure, it’s safe to come into the office please come in and get your routine immunizations. We don’t need a pandemic on top of another pandemic.

Najma Roberts:

Yes, you and my kids’ doctor must’ve had done it together because that’s literally what she said, we don’t need another pandemic on top of this one so let’s get these others out of the way. Absolutely.

So it sounds like, to the moms, dads, and caretakers who are listening, you need to get COVID vaccines done for children 12 and up, but we also need to pay attention and get our routine vaccinations. Don’t be embarrassed if you’re a little behind, go ahead and make that appointment. At my kids’ doctor it was great, we wait in the car and call once we’ve arrived, wait in the car or outside, and then go straight to the exam room with no sitting in the waiting room. And different offices take different precautions, but it sounds like those are the two takeaways – COVID vaccine and routine immunizations, we’ve got to get those up.

Dr. Nneka Holder:

Exactly.

Najma Roberts:

Great, great. Well this is super exciting, is there anything else that you want to share that maybe I didn’t cover, or maybe any insider knowledge you’ve got in the medical community, any secrets you want to share for our listeners?

Dr. Nneka Holder:

I wish I could tell you that I had some secrets but my colleagues in medicine have been very open and some of my patients have even educated me about information as it comes. Again I don’t think we’ve been as open as we could be about vaccine development, which I think it has hurt us, and again I think we need to work on trust, but unfortunately I don’t have any new secrets about anything coming down the pipeline.

Najma Roberts:

I agree, I think it’d be important to incorporate vaccine development as a part of a core curriculum in schools so even the little kids can learn about it. Well, there is one more question I wanted to ask before we head out. There is a lot of information out there, where do you tell your patients to go for trusted, science-based resources?

Dr. Nneka Holder:

You’re right, the internet is overwhelming with information, not always accurate information. Sites that have accurate information are the Centers for Disease Control and Prevention, so www.cdc.gov, another one is a site sponsored by the American Academy of Pediatrics called www.healthychildren.org, I think you guys (Vaccinate Your Family) have on as well, www.vaccinateyourfamily.org, and another one that focuses specifically on vaccines is sponsored by the Immunization Action Coalition, it’s called www.immunize.org.

Najma Roberts:

Great, and I know a lot of times people are searching for information on the vaccines, but also a lot of us are working hard, trying to stretch our dollars, are there resources for families who are uninsured or underinsured and can’t afford to pay out of pocket for vaccines?

Dr. Nneka Holder:

For children, there is a federal program called Vaccines for Children and it’s a free program sponsored by the federal government, abbreviated VFC. It’s for patients between the ages of 0-18, and many pediatrician offices have vaccines allotted from the federal government which are reserved for VFC patients who don’t have insurance or who are underinsured, so that families don’t have to pay for those immunizations or the cost to administer those immunizations. If your primary care provider does not have stock of VFCs, most if not all public health departments have VFC service or can get you information about which offices are VFC providers.

Najma Roberts:

Okay that’s great, thank you for that. And then also for those that are listening, www.vaccinateyourfamily.org also has resources for paying for vaccines and tools to help direct people to the right places. We also continue to update these resources as well.

Dr. Nneka Holder:

There is information, you may have to dig for it, but many of the pharmaceutical companies for each individual vaccine have some programs, again they don’t advertise these very well for whatever reason, but they have some programs to offer the vaccines at a significantly reduced rate to older patients or patients who are unable to qualify VFC. You have to go to the company website and there are specific forms and criteria that you can complete in order to get vaccinated.

Najma Roberts:

Great, great. And the COVID-19 vaccine is free, so there’s no excuse. No out-of-pocket dollars, whether or not you have insurance, everyone that is age-wise eligible can get the vaccine.

Dr. Nneka Holder:

Correct.

Najma Roberts:

Great, well Dr. Holder this has been lovely. Thank you so much for your time and your transparency, these conversations are so important. There are so many of us parents and caretakers out here trying to understand this new world we’re living in, and while vaccines aren’t new, this pandemic is still very scary and we’re still learning about it. But again, we’re so grateful for your time and for your insight.

Dr. Nneka Holder:

Thank you again for having me, it was great.

Najma Roberts:

Good, thank you so much. Well, thank you everyone for tuning in, again I ask that you share this video with your family, your friends, your community, retweet it, repost it on your timeline, and visit www.vaccinateyourfamily.org if you have any questions, we can even shoot Dr. Holder an email with any questions for her and I’m sure she and her team would be happy to answer those for us. We’ll keep you updated as we learn more, not only about the COVID-19 vaccine, but also encouraging people to keep getting their routine vaccinations. Alright, well thanks again Dr. Holder, I’ll talk to you soon, thank you so much!

Dr. Nneka Holder:

Thank you!