Lisa Costello, MD, MPH, on push to get vaccines into physician offices

Watch the AMA's daily COVID-19 update, with insights from AMA leaders and experts about the pandemic.

In today’s COVID-19 Update, Lisa Costello, MD, MPH, assistant professor and co-clerkship director in the  department of pediatrics at the West Virginia University School of Medicine, discusses rolling out COVID vaccines in provider practices and catching kids up on their immunizations.

Learn more at the AMA COVID-19 resource center.

Speaker

• Lisa Costello, MD, MPH, president, West Virginia chapter, American Academy of Pediatrics

Unger: Hello, this is the American Medical Association's COVID-19 Update. Today, we're talking to Dr. Lisa Costello, assistant professor and co-clerkship director in the department of pediatrics at the West Virginia University School of Medicine in Morgantown, West Virginia about rolling out COVID vaccines and physician practices and catching kids up on their immunizations. Dr. Costello is also president of the West Virginia chapter of the American Academy of Pediatrics and vice president of the West Virginia State Medical Association. I'm Todd Unger, AMA's chief experience officer in Chicago. Well, Dr. Costello, physician practices were largely left out of the initial vaccine roll out and now we're seeing a big push to get the vaccine to physician offices. What is the most important reason you see for bringing physicians into the picture here, particularly pediatricians?

Dr. Costello: We know that physicians, pediatricians, family medicine physicians, primary care physicians, those local health providers are really the trusted source of health information that people ask and they want to have a discussion with their trusted health professional because they have questions, and that's our job as physicians, to help answer those questions. And so getting vaccines into providers offices is allowing individuals to have that conversation, ask those questions with the health professional they trust. And as a pediatrician, we're used to having these conversations. We talk about vaccines all the time, and so it allows us to have those conversations to provide that information so individuals can make decisions for themselves and their families about choosing to be vaccinated.

Unger: Well, at least from a logistical standpoint, this has not been exactly set up for easy access to physician offices. What challenges are the biggest ones you can see in bringing that to physician offices at this point?

Dr. Costello: I think each practice, each office is going to have to look at what works best for them. There have been logistical challenges. The Pfizer product is a very large order, over 900 doses, and for many providers, that's hard to be able to manage that or you may not have a volume. I live in a rural state. Many of the practices, they would not see individuals at that number that they would be able to administer that many vaccines, plus the storage and handling, the very low cold temperatures, particularly in the beginning of this rollout, were really challenging. As we've learned more about the vaccines, we're seeing adjustments being made to the recommendations of storage and handling. Recently, the Pfizer product can be stored now in a refrigerator for a month. Those type of storage and handling changes that we're seeing being made I think will make it easier for physician offices to have the vaccine at their locations.

But there are a lot of logistics. People are used to getting vaccines at their provider offices, but this vaccine is a little bit different in regards to storage and that temperature piece, as well as it's a multi-use vial. So I think as we've seen the supply increase, we've seen where it's not that we are so strict on using every single dose. That's obviously the goal. We want to use all the vaccine that we have, but really we want to ensure if there is an individual who is choosing to be vaccinated, that we're able to give them that vaccine. So there's many different considerations each practice is going to have to take into consideration to see if being able to administer vaccines is right for them.

Unger: So we have the Pfizer vaccine, which has been authorized for children as young as 12 and we have Moderna too applying for FDA authorization for 12 to 17-year-olds. What's your advice to physicians and physician practices out there to get ready for these folks to come in and get those vaccines?

Dr. Costello: This is very promising news. When we saw the Pfizer product be authorized for use for 12 to 15-year-olds, many of my colleagues were calling me, texting me, saying, "This is like in December. There are so many people hopeful. They've been waiting for the opportunity to be vaccinated," and now with the news from Moderna that will even further expand access and the amount of vaccine that we have available for younger individuals. And we know that vaccines are powerful tools, and the COVID-19 vaccine in particular, is a powerful tool in helping us to stop this pandemic. So, again, practices need to look at what's best for them, also working with their state health departments in how the state rollout has been happening in their state.

Each state is different and so making sure that you connect, we've been doing that a lot through our state medical association, through the organization I'm president of, the American Academy of Pediatrics, to make sure that physician offices have the resources they need and have the information they need to make a decision on how they can get access into their office or their clinic.

Unger: Well, you mentioned up front that important role that physicians play in communicating with patients because they're trusted in this. I'm curious, what's the number one question that you get from parents about getting their children vaccinated?

Dr. Costello: The question that I frequently get is, is this vaccine safe and are there any side effects? And we know that based upon months of clinical trials with tens of thousands of people and now millions of Americans getting vaccinated that the FDA, the CDC has determined that these vaccines are safe and effective. And really the reactions individuals have are very similar to reactions that we see with other vaccines like pain at the injection site, redness at the injection site, swelling in the arm. We may also see some fevers or chills, some tiredness. Tiredness was definitely the symptom that I received when I chose to be vaccinated. And so as a pediatrician, we know that individuals have questions about vaccines, and we want them to ask questions, and certainly the question I've received the most is about, "What type of side effects might my child or might I experience?" And I think the more we're able to provide that clear, consistent, and scientifically sound information of what we know the better it helps individuals make that informed decision to choose to be vaccinated.

Unger: Are you dealing with a lot of misinformation? Are you correcting a lot of things that are not factual out there? That's always obviously been a big problem for some time. What are you seeing there?

Dr. Costello: We know that people get information from a variety of sources, some more reputable than others. And I think it's our job as physicians to provide that scientifically sound evidence based information and recommendations that we have. So individuals can make that informed decision. So I always welcome a conversation starting from a place of empathy and really listening to what concerns individuals have, and then providing based upon my expertise and understanding of the information to provide the facts to the individual and answer the questions they have so that they're able to make those informed decisions. But I think we have known this for a long time, particularly in pediatrics, where there is a great deal of information, a lot of it misinformation out there, and we need to provide that fact-based data, evidence to individuals. That's our job, I think, to provide that education as much as it is to actually perform the administration of the vaccine.

Unger: Well, a lot of people put off a lot of health care over the past year during the pandemic, and unfortunately what we're seeing is that's definitely affected immunization in kids. Can you talk a little bit about the issue here and why it's so concerning?

Dr. Costello: All immunizations are important. We know that there are many diseases that we're able to prevent against and prevention is key. And as a pediatrician, I'll tell you, I've been very concerned about how many children have missed vaccines during the pandemic. They've missed them for diseases like measles or whooping cough, and those can be deadly. So I have strongly been encouraging parents to contact their pediatrician, contact their family physician, to get updated on vaccines. We know from different insurance providers, that there has been a significant decrease in vaccines from 20 to 30, to even higher percentages of individuals that have missed those vaccines. And we've seen outbreaks in the past of these diseases that we, for the most, have had under control. So it's not far-fetched to really believe that we could have another outbreak unless we get children caught up on their vaccination. So I always encourage people, call your pediatrician, call your physician to get updated, because we want to make sure that we're preventing all the diseases we're able to prevent so that we don't have multiple outbreaks while we're also getting through this COVID-19 pandemic.

Unger: So we have a double whammy here on the vaccine front. You have the need to get these folks vaccinated with COVID-19 and we have a lot of missed vaccinations for other preventable diseases. What's the interplay there, and how does that work?

Dr. Costello: We are very encouraged with the recent CDC guidance that now there can be co-administration of vaccines. Early on, since the beginning, back in December, when these vaccines were authorized, it was recommended that there was a two week gap between administration. But what we just learned recently from these expert committees, through the CDC that we know through experience with other vaccines and the way that our bodies develop protection that we're able to get co-administration of vaccines. And so with this, they're generally the same reactions that we see given alone or with other vaccines. The American Academy of Pediatrics has also supported this co-administration, and it really creates that opportunity for children to get the COVID-19 vaccine along with the other routine immunizations that they're due for when they visit their provider offices.

And so we know that if you are going to give multiple injections that the CDC recommends that you give them in different arms, which I think is a great recommendation. And I think that we'll have to continue to monitor side effects. But as we talked about before, really what we're seeing, the side effects to this vaccine are very similar to the common immune responses we see with other vaccines. But certainly encouraging news.

Unger: So that is an important, I guess, adjustment to the guidance and I think with important implications for those young patients, and certainly in terms of convenience and the ability to get caught up. That's pretty important. Thinking about the particular role that pediatricians are going to play in their practices and supporting this overall effort to get children vaccinated, any specific guidance that you want to provide?

Dr. Costello: Pediatricians have been the backbone of the vaccine delivery system in the United States. We give routine vaccinations all the time. We have these conversations with our patients and their families, and there are people that have questions about these vaccines that have been developed. And we as pediatricians need to play that important role of providing that fact-based, clear, consistent, scientifically-sound information to our patients and their families because we have young children who are not yet eligible to be vaccinated. So we need to protect them as well. So by educating the entire family and the role and the importance of vaccination and answering questions individuals may have I think is going to play a really important role, particularly as we move into this next phase.

Because those conversations that happen in our offices or in the hospital setting, those one-on-one or those small setting conversations, I think are really what's going to help build vaccine confidence, provide answers to the questions and provide that education people need to make an informed decision to choose to be vaccinated. And really, we know that vaccination is the safest way to get us back to living regular life. When you choose to be vaccinated, you not only protect yourself, but you protect your loved ones and you protect your community.

Unger: Dr. Costello, how do you address a question maybe a parent has that says, "We're talking about young people, I don't really know how necessary is it for young people, these adolescents, to get vaccinated." What's your response to that?

Dr. Costello: When I get asked that question, I say, "We don't know who is going to get serious disease from COVID-19." We know that there have been millions of children who have had COVID-19 and there's been thousands of them hospitalized. And unfortunately, hundreds of children have died. I personally have cared for children hospitalized with COVID-19. So we know that children can get sick from COVID-19 and we also know that they can spread the disease to others. So even though children have suffered less severe disease compared to the older population, as we see variants emerge more and more and we are learning more about them, we cannot tell who will get more severe disease. So I think it's really important that we get everyone protected and we're able to also protect others around us when we get vaccinated.

Unger: And that is so important. Well, Dr. Costello, thank you. And to all those pediatricians out that are going to help us with those COVID-19 vaccinations and getting kids caught up on the rest, thanks for being here today. That's it for today's COVID-19 Update. We'll be back with another segment tomorrow. In the meantime, for resources on COVID-19, visit ama-assn.org/covid-19. Thanks for joining us. Please take care.

Disclaimer: The viewpoints expressed in this video are those of the participants and/or do not necessarily reflect the views and policies of the AMA.