COVID-19 Vaccine Communication Guide:

Communicating about the Vaccine for Kids

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Purpose

This presentation will help you conduct productive conversations about COVID-19 vaccines in children and youth (ages 5-18)

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We will:

• Provide key background information and talking points so you are comfortable and confident talking to caregivers
• Share conversation strategies to help you build trust with caregivers while avoiding conflict and argument

Topics

1. Key Background Information

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• Communication Skills and Strategies

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• Conversation Examples and Key Talking Points

What are viruses?

Genetic material surrounded by proteins

• Genetic material (“How to build”)
• This is RNA in the COVID-19 virus
• Enters your cells and tells your body to make more of the virus
• Proteins
• Protect the genetic material
• Help the virus enter your cells

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COVID Variants

When the COVID virus is spreading, new versions of the virus can develop that:

• Spread more easily
• Affect different groups (e.g. children, vaccinated individuals)
• Make people more (or less) sick

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Recent variants

• Delta variant: Dominant over Summer-Fall 2021
• Omicron variant: Dominant currently

COVID Variants

Omicron Math

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*Particularly for people who are vaccinated

The state of COVID-19 in kids

Since the beginning of the pandemic, over 6.6 million kids have gotten COVID-19

• At the beginning of the pandemic, kids were less likely to get sick
• With the more contagious variants, kids are much more likely to get sick

*Most recent data is week ending in 1/6

COVID-19 complications in kids: long COVID

“Long” COVID

• Having COVID-19 symptoms that last weeks or months
• Less common than adults, but still happens in kids
• We don’t know exact numbers yet, but it can cause:
• Missed school
• Trouble focusing in school
• Missed extracurricular activities
• Other longer terms impacts?

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COVID-19 complications in kids: MIS-C

Multisystem Inflammatory Syndrome

• Can happen after a case of COVID-19, even if the child was asymptomatic
• Delayed: usually appears 2-6 weeks after getting sick with COVID-19
• Different body parts can become inflamed, including the heart, lung, kidneys and brain
• It is rare but can result in hospitalization or even death

• Symptoms of MIS-C include:
• Fever
• Abdominal pain
• Diarrhea
• Vomiting
• Rash
• Red eyes
• Acting sleepy of confused
• Dizziness
• Weakness

What are vaccines?

Vaccines help protect us from getting sick by training our immune system to recognize the viruses or bacteria that can get us sick

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Many vaccines require more than one dose to give the most protection. Also, protection from vaccines can go down over time and booster doses are needed.

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The COVID-19 vaccines contain ingredients that will train our immune system, but won’t get us sick with COVID-19

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How COVID-19 vaccines work

The COVID-19 vaccines available for children have mRNA

• mRNA are instructions for creating protein
• This teaches your body recognize COVID-19 if you are ever infected in the future

What are vaccines supposed to do?

The COVID-19 vaccines make kids:

• Less likely to get sick with COVID-19
• Much less to get severely sick (e.g. hospital, ICU, death)
• Less likely to spread the virus to others

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The current COVID-19 vaccines work against the Omicron variant for adults, youth, and children. Even though it is still possible to get COVID-19 after getting vaccinated, it makes it:

• less severe, and
• less likely to spread to others.

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Why get kids vaccinated?

The Omicron variant has caused more kids to get sick

• Some have to be hospitalized
• Some get MIS-C or “long” COVID

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Even though kids are less likely to get very sick with COVID-19

• They may have to miss school or quarantine
• They could spread the virus to family members and others in the community who are more likely to get very sick

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What makes up the virus and vaccine

The virus vs. the vaccine

COVID in your body vs. the vaccine in your body

MIS-C, Myocarditis, and Long-COVID

Who is eligible for the vaccine?

• In May of 2021, the FDA gave Emergency Use Authorization of the Pfizer vaccine for kids ages 12-15
• In October of 2021, the FDA authorized the Pfizer COVID-19 vaccine for emergency use in children 5-11 years old

Which vaccine is available for kids?

• People who are immunocompromised should talk with their doctor

Vaccine dose

Children ages 5-11

• Two doses, 3 weeks apart
• ⅓ of the adult dose
• Adult dose: 30mcg
• Kid’s dose: 10mcg

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• Children 5-11 get a smaller dose because:
• In clinical trials, the smaller dose worked as well as the full dose
• Kids had less side effects with the smaller dose

Children ages 12-18

• Two doses, 3 weeks apart
• Same dose as adults (30mcg)

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If an 11-year-old turns 12 between doses, they will get the adult dose for their second shot

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Topics

• Key Background Information

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• Communication Skills and Strategies

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• Conversation Examples and Key Talking Points

Communication skills and strategies

• Vaccine Hesitancy
• Importance of trust
• Communication Strategies
• Acknowledge
• Affirm
• Reflective Listening
• Building Reflections
• Ask-Tell-Ask

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Vaccine communication strategies

The first important step in communicating about the COVID vaccines is to establish trust.

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We can build on this trust by communicating in a way that makes people feel heard and respected.

Acknowledge

There is often a kernel of truth at the center of common concerns or worries about the COVID-19 vaccines. Acknowledging the truth behind these concerns help people feel heard.

Here are some reflective starters to help you acknowledge truth:

• “You’re right that…”
• “It’s true that…”

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Affirm

It can be helpful to recognize and affirm common motivations (e.g. for health, for safety, for certainty) that may drive some worries about the COVID-19 vaccine. This helps people feel respected. They might also become more open to new information or perspectives.

Here are some reflective starters to help you affirm motivations:

• “You care about your child’s health.”
• “You want to make sure this is safe.”

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Reflective listening

Here are some strategies that can help you have a productive conversation about COVID-19 vaccines:

• Make a statement, not a question
• The pitch of your voice should go down at the end rather than up
• Restate what the patient said - but change the words, don’t parrot

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Effective techniques will:

• Soften the ground for information exchange and attitude shift
• Build trust
• Lower resistance

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Building reflections

Here are some starters to help you reflect:

• “It sounds like you are feeling…”
• “You are concerned that…”
• “You’re worried that the vaccine may cause….”
• “You are unsure about getting your child the vaccine because…”

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Notice that “YOU” is the core of each statement!

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Ask-Tell-Ask

It is very common for healthcare professionals or health advocates to provide large amounts of detailed information to patients very quickly.

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We call this an info dump (or “briefcase dump”). This can be overwhelming for people or make them defensive.

Ask-Tell-Ask (cont.)

Consider instead using an Ask-Tell-Ask (also known as Elicit-Provide-Elicit) approach.

1. Ask the patient to tell you what they already know about the topic
1. Reflect and Affirm what they tell you
2. Ask permission to give them information (ex. Is it ok if I give you some information about X?)
3. Tell: Give the patient some information about the topic. This should be pretty brief. Usually just a few sentences will be enough
4. Ask what they think of the information.

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“Hard no” and conspiracy beliefs

Misinformation about COVID-19 and COVID-19 vaccines is prevalent

Direct conflict is unlikely to be helpful and may increase resistance

Listen and build trust for future conversations

“Hard no” communication strategies

Reflective Listening: “You’re concerned that…”

Acknowledge: “There is a lot of information and misinformation and sometimes it can be hard to know who to trust.”

Affirm: “You care about your child’s health and have given this a lot of thought.”

Ask-Tell-Ask

• Truth Sandwich: State the truth, Acknowledge existence of misinformation, State the truth
• Think about trusted sources of information (1-1 conversations)

Graceful exit

Addressing kid’s feelings

Since the beginning of the pandemic, signs of depression or anxiety have doubled in kids.

Many things can contribute to this:

• Less social interaction
• Missed school
• Stressed parents
• Family financial instability
• Losing family member to COVID-19
• Living in an area with many outbreaks

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Addressing kid’s feelings

It can be helpful to encourage parents to talk to their kids about how they are feeling, and about the vaccine. Here are some things you can encourage parents to do:

• Take care of their own mental health to act as a role model
• Talk to their children about mental health and encourage them to ask for help if they need it
• Encourage and support their kids to build relationships with their peers
• Talk to their kids about the vaccine and why it’s important (see next slide)

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Getting kids ready for the vaccine

Michigan Medicine suggests 5 ways to prepare your child for the COVID-19 vaccine

1. Ask your child how they feel about getting the vaccine
2. Tell your child the details
3. Tell them why they are getting the vaccine
4. Make a plan for getting vaccinated
5. Practice

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Topics

1. Key Background Information

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• Communication Skills and Strategies

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• Conversation Examples and Key Talking Points

Common Concerns

• Kids don’t get sick enough to get vaccinated
• Safety/Side-Effects
• Safety/Vaccine developed too quickly
• Safety/Long term side effects
• Infertility/puberty
• Natural immunity is better

Concern: Kids don’t get sick enough to get vaccinated

Affirm: You're right. When the pandemic started, kids did not seem to get sick with COVID.

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Ask: Doctors and scientists have been tracking the new COVID-19 variants. Is it ok if I share what they have learned about the new variant?

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Concern: Kids don’t get sick enough to get vaccinated

Tell:

• The new variant is more contagious than other versions of the virus. This means that it is easier for people to get sick, including children.
• Many more kids are now getting sick and hospitalization rates have gone up. Some kids have even had to go to the ICU.
• Some kids who get COVID also get
• “Long COVID” (and feel sick for several months) or
• MIS-C, a rare but severe form of whole body inflammation.
• Kids who get sick will have to miss school.
• And they could spread the virus to other people who might get more sick.

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Ask: What do you think of this information?

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Concern: Kids don’t get sick enough to get vaccinated

• Over 6 million kids have gotten COVID-19 since the beginning of the pandemic
• More kids are getting sick now with the new COVID-19 variant
• Hospitalization rates in kids have gone up
• Some kids get very sick with MIS-C or experience “long” COVID
• Might have to miss school, quarantine, etc.

Concern: Safety/side-effects

Affirm: You're concerned about health of your children

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Ask: Is it ok to share with you information from doctors who are looking at COVID vaccine for children?

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Concern: Safety/side-effects

Tell:

• You are right that there are some side effects from the COVID vaccines.
• Most children will have soreness in their arm, feel tired, or have a headache for a day or two. Some children, about 1 in 5, report also having a fever or chills.
• All of these reactions are normal. It is your child's natural response to the vaccine. It means that the vaccine is working in your their body to learn to fight the virus.
• All of this is much milder than if your child gets COVID. That could mean 1-2 weeks of feeling sick, missed school, and possibly needing to go to the hospital.

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Ask: What do you think about this?

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Concern: Safety/side-effects

• Most children and youth will have soreness in their arm, feel tired, or have a headache
• Some children and youth will have a fever or chills
• This is more common after the second dose
• All of these reactions are normal and are a sign that the vaccine is working
• All of these side effects are milder than getting covid which could mean:
• 1-2 weeks of illness, Long COVID, MIS-C, hospitalization, missed school, etc.

Concern: Safety/vaccine developed too quickly

Affirm: You're concerned about safety. You're right that vaccine developed quickly.

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Ask: Is it ok to share with you information from doctors who are looking at COVID vaccine for children?

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Concern: Safety/vaccine developed too quickly

Tell:

• The vaccine was developed quickly because we had so many people working together.
• Since COVID-19 has affected everybody, there were scientists, vaccine makers, and community members all working together to develop the vaccine.
• No steps were skipped to make the vaccine. Safety has been closely monitored and millions of children and youth age 5 and older have already been vaccinated.
• So far, the vaccine is very safe and there have been very few cases or serious side effects.
• It is certainly much safer for children to get the vaccine compared get getting COVID.

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Ask: How do you feel about this information?

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Concern: Safety/vaccine developed too quickly

• It was developed quickly because everyone was working together
• No steps were skipped, things just moved faster along
• Safety has been closely monitored and the vaccine is very safe
• Millions of kids age 5 and older have already been vaccinated
• It is much safer for children to get the vaccine compared to getting COVID.

Concern: Safety/long-term side effects

Affirm: You're concerned about safety. These vaccines are new, so we haven’t studied everything about the vaccines yet

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Ask: Is it ok to share with you information from doctors who are looking at COVID vaccine for children?

Concern: Safety/long-term side effects

Tell:

• In other childhood vaccines, there haven’t been any reports of side effects that happen later in life. If a vaccine has a side effect, it typically happens within a couple months of getting the vaccine.
• Specifically for COVID-19 vaccines, the vaccine ingredients don’t stay in the body for very long. In fact, after just a few hours, your body destroys the mRNA which is the active ingredient of the vaccine. Since the ingredients don’t stay in the body for long, there is no reason to think that long term side effects from the vaccine would happen.
• Of course the CDC is also monitoring any side effects to make sure the vaccine is safe.
• We do know the vaccine protects children from severe illness which could lead to “long COVID” or missing school and other activities which can also have longer term effects.

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Ask: What do you think about this information?

Concern: Safety/long-term side effects

• Long term side effects are extremely rare (if they happen at all) in any vaccine
• Any vaccine side effect is usually within a couple months of getting vaccinated (and we are not seeing this)
• The vaccine doesn’t stay in the body for more than a few hours
• The vaccine protects from long term effects of the COVID-19 virus

Concern: Infertility/puberty

Affirm: You want to take the best care of your children, so you’ve really looked into the safety of the COVID-19 vaccine.

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Ask: Is it ok to share with you information from doctors who work with children, teens, young adults, and pregnant people?

Concern: Infertility/puberty

Tell:

• Kids who have already been vaccinated are still young, so fertility or puberty issues haven’t specifically been studied yet. However, there isn’t any evidence that the COVID-19 vaccine, or any vaccine, can cause fertility problems.
• The vaccine doesn’t stay in the body for more than a few hours, so it’s unlikely that the vaccine would cause fertility or puberty issues later in life.
• In adults, many people have gotten pregnant after getting vaccinated, and there aren’t any negative effects on pregnancy. In fact, the vaccine is strongly recommended for pregnant women.

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Ask: What do you think about this?

Concern: Infertility/puberty

• There is no evidence that any vaccine can cause fertility issues
• The mRNA in the vaccine (the key ingredient) doesn’t stay in the body for more than a few hours, so fertility issues later in life are unlikely
• In adults who have gotten the vaccine, fertility rates have not dropped
• Vaccinated people have gotten pregnant, and haven’t been experiencing pregnancy issues

Concern: Natural immunity is better/kids will get COVID-19 anyway

Affirm: You want to take the best care of your children, so you’ve given a lot of thought into whether or not to get the COVID-19 vaccine for them.

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Ask: Is it ok to share with you information from doctors who are looking at COVID vaccine for children?

Concern: Natural immunity is better/kids will get COVID-19 anyway

Tell:

• While children are less likely to get very sick from COVID-19, the new COVID variant has caused many more kids to get sick and have to go to the hospital. Some kids have even had to go to the ICU.
• Getting COVID-19 can also cause some complications such as “long COVID” that can for several months or it can even cause whole body inflammation, called MIS-C.
• Getting vaccinated can keep kids in school, protect kids around them, and protect people around them

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Ask: What do you think about this?

Concern: Natural immunity is better/kids will get COVID-19 anyway

• Even though kids are less likely to get sick than adults, some have to go to the hospital
• Some kids even have to go to the ICU
• Getting COVID-19 can cause MIS-C or long COVID
• Getting vaccinated helps keep kids in school
• Getting vaccinated protects people around them from getting COVID-19

Contact us

Larry An, MD

lcan@med.umich.edu

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Center for Health Communications Research

CHCRinfo@umich.edu