Motivate, Not Force: Israel's Strategy Ahead of Children's COVID Vaccination Drive

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Health Ministry officials discussing the COVID-19 vaccination shot for children aged 5-11 on Wednesday.
Health Ministry officials discussing the COVID-19 vaccination shot for children aged 5-11 on Wednesday.Credit: Moti Milrod

In the wake of a government advisory panel’s recommendation to approve Pfizer’s coronavirus vaccine for children five to 11, senior Health Ministry officials have stressed they won’t press parents to vaccinate their kids, leaving the decision totally up to them.

The recommendation came as no surprise, since the FDA has already approved it. Now, the Health Ministry’s director general must approve it officially, and vaccinations will begin within 10 days after that.

At that point, one million Israelis in this age group will become eligible for the vaccine, but convincing parents to vaccinate their children may prove a tough challenge.

First, infections among the public have been declining, so people feel that the risk of not vaccinating is low. Second, children of this age who do contract the virus generally get mild cases. Finally, many parents are reluctant to use their children as guinea pigs since the vaccine has only just been approved for this age group.

Approving the vaccine will also trigger new questions in the coming weeks. One is how long to wait between the first and second doses. Another is whether children who have recovered from the virus should be vaccinated.

In the United States, the interval between first and second doses is three weeks for adults and children alike. But Israel, which also used a three-week interval for adults, isn’t sure it should do the same for children.

As for recovered patients in this age group, the government’s expert advisory panel was divided over whether vaccination is necessary, and, if so, how soon after the child recovers.

Yet another question relates to the Green Pass, which is required for admission to certain public venues. If the rules are the same for children as they are for adults, then parents who choose not to vaccinate their children will have to pay to have them tested before bringing them anywhere requiring a Green Pass.

The state has paid for these tests until now, since children can’t be vaccinated. Thus, requiring parents to pay for them once the vaccine is approved would contradict senior Health Ministry officials’ promise not to put any pressure on parents to vaccinate their kids.

This question could become moot if infections decline to the point where the Green Pass system is canceled. On the other hand, if infections start rising again, ministry officials might decide that parental autonomy is less important than pressuring them in order to stem the virus.

For now, however, the question for the health-care system is how to convince parents to vaccinate their children without making them feel their parental autonomy is being infringed on. This endeavor will be particularly difficult given a likely flood of disinformation and confusion.

The current plan is to run informational campaigns in the media and on social media involving doctors and other experts, as well as to disseminate targeted, written information to different segments of society. Pediatricians will also be asked to speak to their patients’ parents directly.

“We’re planning webinars with doctors next week,” said Prof. Zachi Grossman, chairman of the Israel Ambulatory Pediatric Association. “We’re also working on a question-and-answer document for parents that will include all the information.”

“In general, the way to convince the public is through pediatricians,” he added. “Therefore, it’s important they themselves be convinced of the vaccines’ importance and safety.”

Pediatricians have a lot of influence over parents of children in this age group, Grossman said, partly because children see their pediatrician much more often than most adults see their doctor, and because parents consult the pediatrician regularly. Moreover, he added, pediatricians regularly discuss vaccines with parents, so they’re familiar with the arguments involved.

“Everyone understands that the younger the age, the greater the sensitivity and the questions about possible side effects, both short-term and long-term,” Grossman said.

Dr. Gil Chapnick, a pediatrician with the Maccabi health maintenance organization, agreed. “We know from studies that a recommendation by a person’s regular local doctor is the thing that most influences the patient,” he said. “Their recommendations are more effective than any broadcast or celebrity campaign on the web.”

“From my conversations with parents, their gut instinct is to vaccinate, but they’re facing a flood of disinformation that would shake any sensible person,” he noted. “They need confirmation of their decision.”

Chapnick said he hasn’t heard any parents saying they don’t need to vaccinate now because the morbidity is low. “We’re all coronavirus veterans after almost two years of the pandemic, and we know that morbidity hasn’t ended,” he added. “This is only a lull.”

The health maintenance organizations say they haven’t been given any timetables or targets for how much of the population aged 5-11 to try to vaccinate, the way they were with adults. But Haim Fernandes, CEO of the Leumit HMO, said his organization plans its own campaign to persuade parents to vaccinate their kids, including explanatory videos featuring pediatricians and both telephone and digital hotlines to answer parents’ questions.

Since children aged 5-11 receive a much lower dose than older people, he added, Leumit has decided to vaccinate them at different hours to reduce the chance of someone accidentally getting the wrong dose. This measure is an additional safeguard on top of the fact that Pfizer sends the children’s doses in vials with different-colored stoppers.

Another reason for separate hours, Fernandes added, is that vaccinating children often takes longer than vaccinating adults. “Sometimes children are more afraid,” he explained. “You have to talk with them or vaccinate them while they’re sitting on their parent’s laps and give them stickers afterward.”

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