Margaret Moon, MD, is the co-director, pediatrician-in-chief, and director of the Department of Pediatrics at Johns Hopkins Children’s Center. She is also an associate professor of pediatrics at the Johns Hopkins University School of Medicine.
On Oct. 29, the Food and Drug Administration (FDA) authorized a smaller dose of the Pfizer-BioNTech COVID-19 vaccine for emergency use in children ages 5-11, allowing access for approximately 28 million children in the U.S.
In this Q&A, Moon lays out Johns Hopkins’ plan for distributing the vaccine, addresses parent concerns, and highlights the pandemic’s impact on child mental health.
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Nicole Pasia: How has Johns Hopkins, and Maryland in general, fared with COVID-19 recently?
Margaret Moon, MD: “We have worked incredibly hard to get our population vaccinated. I think our vaccination rates have stayed on the good side. The rates of new COVID infections in the state of Maryland have been trending down, steadily. We had the initial surge in March of 2020. We really worked incredibly quickly and incredibly hard at the hospital level to care for patients. It was actually a remarkable experience. We were moving very, very quickly, communicating directly on a daily or twice-a-day basis to make sure that we had the resources in place.
I’m a pediatrician and the head of the Children’s Center, which is our pediatric hospital. That is integrated within Hopkins hospital system. We were actually able to even shift some of the pediatric resources — including pediatric intensive care unit beds — to care for adult patients when the adult [COVID] patient population was threatening to overwhelm the adult side of the hospital. It was a great experience of being an integrated Children’s Center, right there next to our adult colleagues, working with them, helping them, [and] sharing resources for the betterment of the whole community … That was the horrible first surge, and then things calmed down for everybody in the summer and early fall. Then, we experienced the second surge. [Cases have] been up and down ever since, but I’m thrilled to say that our vaccine rates are high in [Baltimore], our new cases are low, and mask mandates have been effective.”
NP: With the Pfizer vaccine now authorized for children ages 5-11, what conversations are you having with parents who might have concerns about potential side effects, such as myocarditis?
MM: “There’s a question about the side effects of the vaccine, but it’s the way people respond to things. It’s fascinating that one of the problems with the COVID infection in children is actually its impact on the heart. So any viral infection can cause some myocarditis. There’s been lots of studies saying that the myocarditis risk for children infected with COVID was over 30 times higher than children without COVID. So, COVID itself really increases the risk of myocarditis.
Not only myocarditis, but other significant cardiac effects. If a child has COVID, the impact on the heart is very much higher. So it is true that when we develop a new vaccine, we spend a huge amount of time and energy looking very carefully for side effects. For the COVID vaccine, the one side effect that did come up above the normal range for adolescent boys, was myocarditis. It was still very rare — I think four or five cases in millions of vaccines given. But because people worry about vaccines anyway, I think people focus on the risk of the vaccine and forget about the risk of the illness itself.
That’s why we do vaccine programs. Every vaccine program has risks associated with it, but we always focus on, ‘Does the benefit of the vaccine outweigh the risk?’ For COVID, I think the answer is tremendously, ‘Yes, it does.’ We do vaccine programs in order to promote well-being, to avoid illness. COVID itself is bad enough, but the heart effects of COVID, and also the multi-inflammatory syndrome in children (MIS-C), can be deadly. We have seen children here in this institution — perfectly healthy children — get COVID and come in and we had some deaths early on from MIS-C. It’s terrifying.
I totally understand the anxiety around a new vaccine and wondering if this vaccine is right for a child. I really want parents to listen carefully to the risks of the vaccine, but then step back and spend some time thinking hard about the risks of the illness. I feel very strongly and I would be happy to talk to any parents to help them understand the risks of COVID in children. If you get sick with it, you can be really sick … We saw what happened with adults and it was very obvious, but sometimes we don’t look as carefully as what’s happening to children because they tend to be healthier. They don’t have as many underlying health conditions. They tend to do better. But better than adults is not good enough in this situation. Kids really need to be protected.”
NP: How is Johns Hopkins planning to distribute the vaccine to kids? What partners are you working with, and what are your main priorities with the distribution plan?
MM: “We have been working with the city in the state to understand the best way to get these vaccines out to the greatest number of children. Unlike the initial rollout of the adult vaccination, the government has decided that the pediatric vaccinations will go out to primary care pediatricians’ offices, which is great. Parents are used to getting their kids vaccinated with their primary care pediatrician. I love the idea that this COVID vaccine will also be available to primary care pediatricians to do it just like we do everything else, just like we did with flu vaccines.
In addition to that, because we’re anticipating that there will be a surge of interest in this, we are working with the state and city to set up some extra COVID vaccination sites. On the Hopkins website, there is a list of vaccine clinics where children can get vaccines in the next couple of weeks. We have mobile clinics that go around the city. We have our own primary pediatric site that will be offering vaccines. In addition to primary care pediatricians offices, pharmacies will be able to give these vaccines to children.
Our colleagues at the Kennedy Krieger Institute, they’re specialized in caring for children who have special needs, and they’ve actually set up some vaccine clinics for kids with special needs. These are kids who may have a harder time accepting the vaccines. So they’ve really set up an experience that speaks to the needs of kids with neurobehavioral disorders. Everybody’s working together to make sure we get this out as quickly, efficiently, and smoothly as possible in the places that kids can access it.
… We’re still figuring out how [many vaccines] we’re going to get and where we’re going to get it, but Governor Hogan’s office is everyday putting out new information about how the counties and city [are] going to manage this. So I think there’s plenty of information out there, and the information will change and grow as we get a stronger sense of where the next vaccines are coming.”
NP: Are there any other concerns that are top-of-mind at Johns Hopkins right now? The pandemic seems to have taken a toll on mental health, especially for kids.
MM: “When we think about COVID, we initially thought so hard and focused so much on the impact on adults. Those of us who care for children, we’re also speaking directly about the non-physical impact on children. Children suffered in so many ways. Even though they weren’t getting physically sick from COVID, their parents and grandparents were. Their schools were shut down and their communities were different, and they didn’t have access to the normal social networks that keep them safe and help them grow and develop. It’s important that we all understand that the impact of COVID on children is much more than the physical impact. It is the social, environmental, economic impact that will be very, very long term.
We always talked about, ‘The vaccines are coming. It’s a light at the end of the tunnel.’ I want everybody to understand that the tunnel, for children, is very long, very windy, and very dark, still. There is some light at the end of the tunnel as we all come out of this, but the impact on children will be felt for years and years to come. We all need to think very carefully about how to support children, and how to help them recover in all the non-physical ways, so that these years don’t end up being lost years for our children.”
This interview was edited for clarity and length. Image: Johns Hopkins Medicine