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Tag: doses

  • Small children don’t get ‘80 different vaccines’

    President Donald Trump repeatedly exaggerated the number of vaccines recommended for small children, comparing it with vaccinating a horse. 

    “They give — I mean, for a little baby to be injected with that much fluid?” Trump first said Sept. 21 during an Air Force One press gaggle. “Even beyond the actual ingredients, they have sometimes 80 different vaccines … It’s like you’re shooting up a horse.” 

    He used the number four more times during a Sept. 22 press conference in which he also pushed an unproven link between autism and Tylenol.

    “You have a little child, little fragile child, that you get a vat of 80 different vaccines, I guess, 80 different blends, and they pump it in,” he said.

    Then again: “It’s like 80 different vaccines and beyond vaccines and 80. Then you give that to a little kid.”

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    How many vaccines do young children actually receive? It’s not 80, by any measure. 

    The White House didn’t respond to our questions about how Trump arrived at that number. But because Trump’s comments referred to “little” kids and babies, we tallied the overall number of recommended childhood vaccines for children ages 10 and under in four ways: by the number of vaccine formulations a child receives; by the number of diseases the vaccines protect against; by the total number of doses each child receives of all the recommended vaccine formulations; and by the number of physical injections or shots a child would receive if following the recommended vaccination schedule. 

    No matter how we counted, the number of vaccines a young child receives didn’t reach Trump’s claim of 80.

    CDC schedule recommends 11 vaccines for kids 10 and younger

    Over a child’s first year of life, the Centers for Disease Control and Prevention recommends seven different vaccine formulations, plus an annual flu vaccine. They are:

    • Hepatitis B

    • RSV (respiratory syncytial virus), if not yet given to the mother in pregnancy

    • DTaP (diphtheria, tetanus, and pertussis) 

    • Polio

    • Hib (Haemophilus influenzae type B)

    • PCV (Pneumococcal disease)

    • Rotavirus

    By age 2, children will get their first of two doses of varicella (chickenpox), hepatitis A and MMR (measles, mumps, rubella).

    By age 6, children who follow the recommended vaccination schedule and receive all doses of the 10 recommended vaccines will be fully vaccinated against 14 diseases. 

    Starting when a baby is 6 months old, annual flu vaccines are recommended with two doses the first time. That bumps the total to 11 vaccines, and 15 diseases. 

    Trump’s CDC no longer recommends annual COVID-19 vaccination for all children but patients can still receive the vaccine after consulting with a health care provider. The Food and Drug Administration, meanwhile, approved the vaccine for kids 6 months and older with underlying health conditions. 

    The American Academy of Pediatrics, which publishes its own vaccine schedule, still recommends annual COVID-19 vaccines for all people 6 months and older. If including COVID-19 vaccines, the total vaccines for children comes to 12, with some protection against 16 diseases. 

    The next batch of vaccines starts when children are 11 to 13 years old. Up to four more vaccines are recommended at this age to protect against HPV (human papillomavirus) and meningococcal types A, C, W, and Y. Children in this age group also get a tetanus, diphtheria and acellular pertussis booster called Tdap. If they are at high risk, children this age are also recommended to get the meningococcal B vaccine. 

    When it comes to total doses for children 10 and under, the US vaccine schedule calls for 30 to 52 

    Many childhood vaccines are not given all at once, but spread out over several doses. 

    For example, the CDC recommends three doses of the hepatitis B vaccine, one at birth, and one each at 2 and 6 months. Other vaccines are given in up to four to five separate doses. Sometimes the same vaccine can be administered in a two- or three-dose series.

    “For most vaccines, multiple doses are because we’ve shown that fewer doses than whatever is in the schedule is not fully protective,” said Dr. James Campbell, a University of Maryland pediatrician and infectious disease expert. The reasons behind timing and frequency of doses depends on the vaccine. 

    Take DTaP. The first three doses given to infants trains their immune system to recognize and defend against the infection. Those doses do create a protective response, but the more long-lasting protection comes when they get a booster as toddlers. “They make more mature, what we call memory B cells, which means long lasting protection,” said Campbell, “So if a long time after that, they were to be exposed, they would then be able to respond.”

    In the case of the measles, mumps and rubella vaccine, the second recommended dose isn’t meant to boost but rather catch “primary failures,” or the 2% to 7% of people who don’t get an immune response from the first dose. 

    “It’s just a matter of what induces the best immune response,” said Dr. Paul Offit, a Children’s Hospital of Philadelphia pediatrician and infectious disease expert.

    We added up all the doses recommended in the childhood vaccine schedule for kids 10 and under. Assuming the most robust dosing series (for example, opting for a four-dose series over a three-dose series), a 10-year-old could receive 30 doses of vaccines. That would be 52 doses if a child receives every single annual flu and COVID-19 vaccine, including two of each their first year. 

    The closest we got to the 80 vaccines that Trump referenced was to count every single dose of every vaccine separately, including each annual flu and COVID-19 shot from birth to age 18. That adds up to 72 doses, half of which are COVID-19 and flu, among all kids, including tweens and teenagers, not only the little kids and babies that Trump talked about. 

    Different vaccine doses are often administered together in one shot

    Fifty-two vaccine doses rarely means 52 shots in a kid’s arm. That’s because many childhood vaccine doses can be delivered in combination vaccines, in which one syringe can contain several vaccines. Other times vaccines can be given orally, like rotavirus, or via nasal spray, like the flu vaccine.  

    Here’s an example: A baby at its two-month appointment is recommended to get doses of six different vaccines. Using a combination vaccine, the child can receive all six vaccinations in the form of two injections and one oral administration by way of drops.

    “We’ve worked for a long time, over decades, to figure out which vaccines can go together in the same needle and syringe and still be safe and still immunogenic and protective, meaning you don’t have any worse protection by putting them together,” Campbell said. 

    Vaccines such as MMR are offered only as a combination in the U.S. 

    “We agree that we want to reduce the number of shots,” said Dr. Flor Muñoz, associate professor of pediatrics, infectious diseases and molecular virology at Baylor College of Medicine. “We’ve been successful at doing that with combination vaccines to protect against more diseases.”

    Using combination vaccines does not overload children’s bodies with “liquid” as Trump was concerned about though. For infants, the standard is, at most, half a milliliter to a milliliter — or about 1/10 to 1/5 of one teaspoon. “It’s tiny, and babies tolerate it perfectly fine,” Campbell said.

    Our ruling

    On multiple occasions Trump said “little” kids and “little” babies are given “80 different vaccines.”

    According to the current CDC recommended vaccine schedule, a 10-year-old child could receive up to 12 different vaccine formulations, protecting from 16 different diseases. Those vaccines could be administered in up to 52 separate doses, but almost certainly less than 52 injections because many vaccines are delivered in one shot. 

    None of those numbers equals 80 different vaccines. We rate this claim False.

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  • Annual COVID Shots Mean We Can Stop Counting

    Annual COVID Shots Mean We Can Stop Counting

    A couple of weeks ago, a friend asked me how many COVID shots I’d gotten so far. And for a brief, wonderful moment, I forgot.

    “Three,” I told them, before shaking my head. “No, actually, four.” I had no trouble recalling when I’d received my most recent shot (September). But it took me a moment to tabulate all the doses that had preceded it.

    By this point in the pandemic, a lot of people must be losing track. “I actually think this is a good thing,” says Grace Lee, a pediatrician at Stanford, and the chair of the CDC’s Advisory Committee on Immunization Practices. Now that so many Americans have racked up several shots or infections, she told me, the question is no longer “‘How many doses have you gotten cumulatively?’ It’s ‘Are you up to date for the season?’”

    The flip is subtle, but it marks a rethink of the COVID-vaccination paradigm. We’re at a define-the-relationship moment with these shots, when people are trying to commit—to normalize them as a routine part of our lives. At a September ACIP meeting, CDC officials noted that “we are changing the way we are thinking about these vaccines,” and trying to “get on a more regular schedule.” If COVID shots are here for good, then at least we can be rid of the bother of counting them.

    Read: It’s a bad time to be a booster slacker

    Counting doses was more apt early in the vaccine rollout, when it seemed that two jabs (or even one) would be enough to get Americans “fully vaccinated” and out of the danger zone. When more shots followed, they were often advertised with confusing finality: What some initially described as the booster was later retconned as the first booster after a second one was recommended for certain groups. But with immunity against infection more fragile than some hoped, and a virus that quickly shapeshifts out of antibodies’ grasp, those ordinal adjectives have stopped making sense. Until our vaccine tech becomes much more durable or variant-proof, repeat doses will be, for most of us, a fixture of the future—and it won’t do anyone much good to say, “‘I’m on shot 15’ or ‘I’m on shot 16,’” Angela Shen, a vaccine expert at Children’s Hospital of Philadelphia, told me.

    The numbers certainly matter when they’re small: It will continue to be important for people to count off their first few shots, for instance, especially those without a history of infections. But after that initial set of viral-spike-protein exposures, the total count is moot. In most cases, about three vaccinations or infections—preferably vaccinations, which are both safer and easier to accurately track—should be “enough to fully charge up the immune system’s battery” for the first time, says Rishi Goel, an immunologist at the University of Pennsylvania. Further COVID shots will help only insofar as they can recharge the battery toward max capacity when it starts to lose its juice. Scheduling a vaccine, then, becomes a matter of “how long it’s been since your last immunity-conferring event,” regardless of how many exposures a body has racked up, says Avnika Amin, a vaccine epidemiologist at Emory University.

    People who are immunocompromised may need four or more shots to establish that initial immunity charge, and their own (maybe smaller) peak capacity. But ultimately, the threshold effect they experience—a point of “diminishing returns”—is similar, says Marion Pepper, an immunologist at the University of Washington. Given how many vaccinations and infections the U.S. has now logged, the majority of Americans “can be done with counting,” she told me.

    If we’re going to shift our focus to timing shots, instead of counting them, we’ll have to schedule our shots smartly. Several prominent figures have already come out and said that yearly doses are a top choice. Albert Bourla, Pfizer’s CEO, has been pushing that idea since early 2021; Peter Marks, who heads the FDA’s Center for Biologics Evaluation and Research, has been delivering a similar line for several months. Even President Joe Biden has endorsed the annual approach, noting in a September statement that the debut of the bivalent shot heralded a new phase in COVID vaccination, in which Americans would receive a dose “once a year, each fall.”

    That plan is not unreasonable. Shots will have to come with at least some regularity, as variants keep rolling in and immunity against infection ebbs. But re-dose prematurely with a shot with similar ingredients, and the body—still hopped up from the previous dose—may destroy the vaccine before it has much effect, making it about as useful as charging a battery that’s already at 95 percent. SARS-CoV-2 antibody levels drop off steeply in the first six months following a vaccine dose, and then, the rate of drain slows down. It’s as if the immune system goes into “power-saver mode,” Goel told me, which means there might not be a huge difference between revaccinating twice a year or only once. Plus, living out much of the year with lower antibody levels is not as worrisome as it might sound. Although antibodies can be a rather useful proxy for our level of protection, especially against infection, they don’t paint the whole defensive picture: T cells and other fighters tend to stick around for far longer, maintaining safeguards against severe disease. (The immunocompromised and older people may still need more frequent COVID-immunity top-offs.)

    Read: Are we really getting COVID boosters every year forever?

    The optimal pace for COVID vaccination will also depend on the speed at which the virus spews out variants. A yearly schedule works for influenza, Shen told me, but “we know flu’s cadence.” SARS-CoV-2 hasn’t yet settled down into a predictable, seasonal pattern; its waves aren’t relegated to the chilliest months. The degree to which we, as the coronavirus’s hosts, tamp down transmission also matters quite a bit. Having more virus around puts more pressure on vaccines to perform, especially when there aren’t many other mitigation measures in place. If all this talk of “once a year, each fall” turns out to be another red-herring recommendation, Amin told me, it could undermine any messaging that follows.

    All of that said, the autumn regimen may yet stick around because it’s the easiest approach. Flu-shot uptake is far from perfect, but the messaging around it is “simple and clean,” says Rupali Limaye, a behavioral scientist and vaccine-attitudes researcher at Johns Hopkins. After dosing up twice in four weeks as infants, people are asked to get a yearly shot, and that’s it. Compare that with the most convoluted days of COVID vaccination, when people couldn’t dose up without accounting for their age, health status, number of previous doses, vaccine brand, time since last dose, and more. “That’s absolute overload,” Limaye told me. Complicated schedules burn people out—or dissuade them from showing up at all. This fall, when the bivalent shot debuted, a troubling proportion of Americans didn’t even know they were eligible.

    Encouraging COVID vaccines at the same, straightforward pace as flu shots would make it easy for people to sign up for both at once, and maybe, eventually, to get them in the same syringe. Vaccines tend to ride one another’s coattails, Shen told me. “In the fall, there’s a bump in other routine vaccines,” she said, because people “are already there for their flu shot.” It would also make a big difference if the COVID-vaccine recipes changed for everyone at the same time, as they do for flu.

    Read: When’s the perfect time to get a flu shot?

    If we’re going to pivot from numbering doses to timing them, we might as well take the opportunity to discard the term booster as well. Some people don’t understand what it means, Limaye told me, or they default to a logical question—How many more boosters will I need? Plus, booster may no longer fit the science. “When we start updating formulas, it’s not really a booster anymore,” Amin told me. That’s not how we generally talk about flu shots: I certainly couldn’t tell you how many “boosters” of that vaccine I’ve had. (I don’t know, maybe 14? 15?) Pivoting to a terminology of “seasonal shots” could make COVID vaccination that much more routine.

    So, fine, if anyone should ask: I’ve had (count ’em: one, two, three) four doses of the vaccine so far. But more important, I’ve gotten the shot most recently available to me.

    Katherine J. Wu

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