We are excited to share the results of the Boost Up project, the culmination of work performed at the Harvard T.H. Chan School of Public Health that brought together leading organizations seeking to achieve COVID-19 pediatric vaccine equity.
This website also includes results from a statewide poll of more than 1,300 parents in Massachusetts that addressed their concerns about vaccine side effects and the role that they may have played in diminishing greater uptake of the COVID-19 vaccine. We greatly value the work of Steve Koczela, President of MassINC Polling, who developed the survey with Alan Geller, conducted the survey, and led the survey analysis.
COVID-19 disparities
The idea for this project stemmed from the stark disparities in rates of COVID-19 infections and deaths that we first saw in communities of color in Massachusetts as early as the summer of 2020. The impetus for the project grew even stronger as we saw striking vaccine uptake disparities again by race and socio-economic status, first for children ages 12 to 17 and then with successive waves of vaccine rollout for children ages 5 to 11 and then ages 6 months to 4 years of age. Investigation of national data reinforced what was first observed in Massachusetts.
We became more passionate about the continual need for a more aggressive rollout of vaccines to children as now more than 185,000 children in the United States have been hospitalized due to COVID-19 since the inception of the pandemic—most of these children were likely not vaccinated. We saw a profound gap between the benefits of the COVID-19 vaccine and the extraordinarily high burden that COVID-19 placed on parents and their children—including disease, school absenteeism, learning loss, and parental work burdens.
Our partners
Over the past two years, we have editorialized on the importance of comprehensive campaigns to boost COVID-19 vaccinations in children. We have worked closely with individual superintendents of schools and their organization, the Massachusetts Association of School Superintendents; teachers and their organization, the Massachusetts Teachers Association; and with pediatricians individually and through the Massachusetts Chapter of the American Academy of Pediatrics.
We have attempted to arm these organizations with the most up-to-date data on the burden of COVID-19 in their communities and the rates of vaccine uptake. We have called for the use of school buildings as vaccination sites for communities with low vaccination rates and attempted to recruit more pediatricians and family physicians as COVID-19 vaccine providers, to argue for adequate supply of vaccine, and to emphasize the need for parent and pediatrician conversations about the benefit–to–risk ratio for children.
Central issues
While working with many community organizations, we tried to keep our ears to the ground and to listen for the overarching questions that parents had both for themselves and for their children:
- Does the vaccine make a measurable difference in these populations on disease severity/death?
- Are the benefits of the COVID-19 vaccine for children outweighed in any way by vaccine risks and accompanying side effects?
The brief answers to these questions are:
For adults, vaccination confers an overall 5 times lower risk of dying from COVID-19 compared with people who were unvaccinated and people who were vaccinated with an updated (bivalent) booster dose had lower rates of dying from COVID-19 compared with people who were vaccinated but had not received an updated booster dose.
For children, vaccine effectiveness against hospitalization remains high and booster doses confer additional protection.
Of equal importance to parents, it is clear that risks to children have proven to be minimal. Approximately 5.1% of parents reported that their child was unable to perform normal daily activities on the day after receipt of dose 1, and 7.4% after receipt of dose 2. Approximately 1% of parents reported seeking medical care in the week after vaccination; most medical care was received via a clinic appointment.
We are very encouraged by evidence showing the power of vaccination: A recent modeling study that found for children ages 5 to 17 years old, a bivalent booster campaign could have averted more than 10,000 hospitalizations and 5 million days of school absenteeism if it reached the same penetration as influenza vaccination.
We hope that the information provided herein to parents, pediatricians, and policymakers helps to balance and weigh the evidence, raises awareness of the need for boosters, and leads parents to provide this lifesaving vaccine for their children.
Acknowledgments
We would like to acknowledge the individuals who have helped us to develop this website:
Dr. Howard K. Koh
Dr. Regina Larocque
Manika Kosaraju, MPH
We would also like to acknowledge those from prominent organizations who sought to expand access and utilization of the COVID-19 vaccine for parents and their children:
Max Page, current President of the Massachusetts Teachers Association
Merrie Najimi, former President of the Massachusetts Teachers Association
Dr. Tom Scott, Executive Director of the Massachusetts Association of School Superintendents
State Senator Becca Rausch
Steve Koczela, President of MassINC Polling
Claire Hannan, MPH, Executive Director, Association of Immunization Managers
Dr. Lloyd Fisher, former President of the Massachusetts Chapter of the American Academy of Pediatrics
Dr. Carole Allen, former President of the Massachusetts Medical Society
Dr. Andrea Ciaranello, Associate Professor, Harvard Medical School
Dr. Alan Stern, pediatrician, Needham, MA