This webinar focused on COVID-19 communications to answer parents’ questions about COVID-19 vaccination for children.

1. HOW TO ANSWER PARENTS'
QUESTIONS ON COVID-19
VACCINATIONS AND CHILDREN
JUNE 23, 2021
1:00-2:00 PM ET / 10:00-11:00 AM PT
This event will be recorded. The recording and slides will be available on the PHCC website later this week.
All attendees are automatically muted upon entry.

2. Poll Questions
Which term best describes where you
work?
A. National governmental public health
organization
B. State health department
C. Local health department
D. Public health NGO (non-governmental
organization)
E. Health care facility
F. K-12 school or school system
G. University or higher education
H. Other
What is your most pressing
communications challenge?
A. Vaccine distribution
B. Vaccine confidence
C. Safety precautions (masks, distancing,
etc.)
D. Trust in public health
E. Message consistency (federal, state,
local)
F. Health literacy

3. Agenda
• Insights from Karen Remley, MD, MBA, MPH, FAAP, Director of the
National Center on Birth Defects and Developmental Disabilities at the
CDC and former Executive Director and CEO of American Academy of
Pediatrics
• Insights from Nicole Alexander-Scott, MD, MPH, Director of the Rhode
Island Department of Health
• Audience Q&A with Drs. Remley and Alexander-Scott, facilitated by Dr.
Lisa Waddell, Chief Medical Officer of the CDC Foundation

4. For more information: www.cdc.gov/COVID19
COVID-19 Vaccine
Implementation and
Adolescents
June 23, 2021
Karen Remley, MD, MBA, MPH, FAAP
Director
National Center on Birth Defects and Developmental Disabilities
Centers for Disease Control and Prevention

5. COVID-19 Incidence among Adolescents
March 1, 2020 – April 30, 2021
https://covid.cdc.gov/covid-data-tracker/#demographicsovertime
>1.5 million
cases among
adolescents 12-17
years of age
0
50
100
150
200
250
300
350
400
450
Mar-20 Apr-20 May-20 Jun-20 Jul-20 Aug-20 Sep-20 Oct-20 Nov-20 Dec-20 Jan-21 Feb-21 Mar-21 Apr-21
Incident
Cases
per
100,000
Population
Case Earliest Date by Week
12 - 15 Years
16 - 17 Years
5

6. COVID-19 Adolescent Hospitalization Rates
https://www.cdc.gov/mmwr/volumes/70/wr/mm7023e1.htm

7. 0
10
20
30
40
50
60
70
80
90
100
<1 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20
COVID-19
Deaths
Age in Years
COVID-19 Deaths in children and adolescents
—January 1, 2020–April 30, 2021
https://data.cdc.gov/NCHS/Provisional-COVID-19-Deaths-Counts-by-Age-in-Years/3apk-4u4f/data
Adolescents 12–17 years:
127 COVID-19 deaths
1.3% of all deaths among
adolescents
7

8. Multisystem Inflammatory Syndrome in Children
(MIS-C)
 Severe hyperinflammatory syndrome occurring 2-6 weeks after acute SARS-CoV-
2 infection, resulting in a wide range of manifestations and complications
– 60-70% of patients are admitted to intensive care, 1-2% die1,2
 3,742 MIS-C cases have been reported as of May 3, 20213
– Median age of 9, with 21% (804) of cases occurred in adolescents 12-17 years
– 63% of reported cases occurred in children who are Hispanic/Latino or Black, Non-Hispanic
– Estimated incidence of 1 to 8.5 MIS-C cases per million person-months
1. Feldstein LR, Tenforde MW, Friedman KG, et al. Characteristics and Outcomes of US Children and Adolescents With Multisystem Inflammatory Syndrome in Children (MIS-C)
Compared With Severe Acute COVID-19. JAMA. 2021;325(11):1074-1087. doi:10.1001/jama.2021.2091
2. Belay ED, Abrams J, Oster ME, et al. Trends in Geographic and Temporal Distribution of US Children With Multisystem Inflammatory Syndrome During the COVID-19
Pandemic [published online ahead of print, 2021 Apr 6]. JAMA Pediatr. 2021;e210630. doi:10.1001/jamapediatrics.2021.0630
3. Health Department-Reported Cases of Multisystem Inflammatory Syndrome in Children (MIS-C) in the United States. https://www.cdc.gov/mis-c/cases/index.html
8

9. People with developmental disabilities are particularly
vulnerable during the COVID-19 pandemic
Aishworiya R and Kang YQ. “Including children with developmental disabilities in the equation during this COVID-19 pandemic
(Commentary)” Journal of Autism and Developmental Disorders 2020.
 Greater healthcare needs
 Reliance on community-based services
 Mental health concerns

10. Currently Approved COVID-19 Vaccine for Adolescents:
Pfizer-BioNTech Safety
 Local or systemic reactions occurred in 91% of vaccine trial recipients
– Pain at the injection site, fatigue, and headache most common
– More common after dose 2
– Most symptoms resolved in 1-2 days
 No serious adverse events were considered by FDA to be possibly related to
the vaccine.
10

11. Programmatic Considerations for
Vaccination of Adolescents
11

12. Ensuring equity – adolescents needing additional
consideration
 Adolescents who may be at increased risk for severe COVID-19
 Adolescents with limited access to routine vaccination services
 Adolescents who are experiencing homelessness, live in rural areas, or have special healthcare needs
 Adolescents who experience systemic health or social inequities
 Racial and ethnic minority groups
 Adolescents in households with lower income
 Adolescents with disabilities
 Adolescents living in congregate settings
 Additional potentially hard to reach populations
 Adolescents with mental illness
 Adolescents with substance use disorder
 LGBTQ+ adolescents
 Adolescents who are immigrants or undocumented
 Adolescents who are non-English speakers

13. Consent
 The federal government does not have specific requirements for medical
consent for vaccination.
 States/jurisdictions have medical consent laws that address the
circumstances requiring and the processes for obtaining consent.
– These laws vary across jurisdictions.
– Providers may also be subject to policy requirements for consent within their
own organizations.
 Sites administering vaccines should follow current state/jurisdictional
policies and practices for other routine immunizations in this age group.
https://www.cdc.gov/vaccines/covid-19/info-by-product/pfizer/pfizer-bioNTech-faqs.html 13

14. Coadministration
 COVID-19 vaccines and other vaccines may now be administered without
regard to timing. This includes simultaneous administration of COVID-19
vaccines and other vaccines on the same day, as well as coadministration
within 14 days.
 When deciding whether to coadminister other vaccines with COVID-19
vaccines, providers should consider:
– If the patient is behind or at risk of becoming behind on recommended vaccines
– Their risk of vaccine-preventable diseases (e.g., during an outbreak)
– Reactogenicity profile of the vaccines
 If multiple vaccines are administered at a single visit, administer each injection
in a different injection site. 14

15. Where parents are most comfortable with their teen
getting vaccinated
CDC/U Iowa Survey of Parents and Adolescents, April 2021
15

16. Stepwise approach to increasing vaccine access for
adolescents
Augment existing infrastructure for vaccination
Strategically add providers that can reach adolescents
Apply school-focused strategies to
ensure vaccination opportunities
Adolescent
vaccination
3
1
2
May June July August September

17. Resources for Parents and Adolescents
New printable fact sheet
New web page
Mythbusters on COVID-
19 vaccine and fertility,
menstrual cycle
New FAQs

18. Resources for Providers and Community-Based Organizations
New pediatrician toolkit
New customizable
patient letter to
encourage vaccination
New FAQs on vaccination
of minors
Updated CBO toolkit

19. Links for communications resources
Information for Parents and Adolescents
•New web page: COVID-19 Vaccines for Children and Teens
•New fact sheet: COVID-19 Vaccines for Preteens and Teens
•New frequently asked questions: Two new FAQs about the safety and benefits of COVID-19 vaccination for adolescents.
•New myth-buster about menstrual cycles: question and answer
•Myth-buster about infertility: question and answer
•Key things to know: Key Things to Know about COVID-19 Vaccines and About COVID-19 Vaccines
•Vaccine information for specific groups: COVID-19 Vaccine Information for Specific Groups
Information for Healthcare and Vaccine Providers
•New pediatric toolkit: Pediatric Healthcare Professionals COVID-19 Vaccination Toolkit
•New FAQs about consent for minors: FAQs
•New sample patient letter: this sample letter
•Recipient education page: Vaccine Recipient Education
Information for Community Groups and Health Departments
•Toolkit for community-based organizations: Community-Based Organizations COVID-19 Vaccine Toolkit

20. For more information, contact CDC
1-800-CDC-INFO (232-4636)
TTY: 1-888-232-6348 www.cdc.gov
The findings and conclusions in this report are those of the authors and do not necessarily represent the
official position of the Centers for Disease Control and Prevention.

21. COVID-19 Vaccinations and Children: Answering
Parents’ Questions
Public Health Communications Collaborative Webinar
June 23, 2021

22. COVID-19 Vaccination in Rhode Island
22
Vaccination is our top strategy to sustain gains, prepare for outbreaks in the fall, and keep
schools and the economy open. Vaccination campaigns for children and adolescents are
ramping up, amidst high uptake rates in adults.
01
Adolescent Vaccination in Rhode
Island
Administration rates snapshot,
adolescent vaccination opportunities to
date.
03
Communications Campaign Strategy
Informed by formative research,
learning from other child vaccination
campaigns, national trends, and
ongoing two-way communications.
02
Ongoing Efforts
Meeting people where they are,
addressing questions and concerns,
healthcare providers as key
spokespeople, partnering with trusted
messengers, and the Education
Operations Center.

23. VACCINATING OUR
CHILDREN AGAINST
COVID-19
An Update from Rhode Island

24. Age Group Population
First Doses
Administered
% Coverage
12-15 48,304 19,847 41.1%
16-19 59,286 31,931 53.9%
20-34 223,363 126,216 56.5%
35-44 124,080 85,478 68.9%
45-54 139,341 97,353 69.9%
55-64 149,189 124,505 83.5%
65+ 181,930 171,141 94.1%
Cumulative Progress Through the Age Bands
As of June 17, 54% of the adolescents age 16 to 19 and 41% age 12 to 15 in Rhode Island have
been at least partially vaccinated. Adolescents have been able to receive vaccine across all
channels (mass vaccination sites, pharmacies, primary care providers, hospitals/home health,
and municipal school clinics).
Data as of 6/17. Doses administered do not include administrations through the VA, Department of Defense, or Tribal Providers, as those are not
reported in RICAIR.
24
Vaccinated as of June 17
43,078
(49%)
Age 12-18

25. 25
School Clinics Onboarding Primary Care Providers
Local, school-based vaccination
opportunities.
Engage family practice and pediatric
providers, particularly in high density
communities.
• Working with municipalities and school
districts to ensure first-dose vaccination
events occur within each district.
• More than 120 local, vaccination opportunities
offered to all students age 12 to 18, through
June.
• Family members and school staff older than
18 are encouraged to participate.
• School-located vaccination opportunities
supported by school nurses.
• 140 providers surveyed for interest in
administration, 70 have COVIDReadi
applications, and 28 rapidly onboarded.
• We conducted additional outreach to providers
who did not respond to the interest survey to
understand barriers and solutions.
• We are collaborating with providers currently
administering COVID-19 vaccinations to share
their experiences as a way to recruit additional
providers.

26. CRAFTING A
COMMUNICATIONS
STRATEGY

27. Snapshot: Rhode Islanders and Child
Vaccination
27
In a recent survey, 80% of Rhode Islanders are comfortable vaccinating children against COVID-
19, if the CDC says it’s safe, and depending upon the child’s age.
No concerns Oppose
No for kids Healthy
What do you personally find concerning about
vaccinating kids? • I have no concerns about
vaccinating children. (29%)
• I oppose vaccination in general.
(9%)
• I am just not comfortable with
vaccinating children. (10%)
• Kids are healthy, so it’s not
necessary. (12%)
• The vaccine may give them a
disease. (4%)
• The vaccine may cause them to be
infertile. (6%)
• The vaccine may make them sick.
(30%)
Responses:
• 33% feel comfortable vaccinating
all children, newborn to 17 years
old;
• +10% only children 2 and older;
• +12% only children 6 and older;
• +4% only children 9 and older;
• +15% only children 12 and older;
• +6% only children 16 and older; and
• 20% are not comfortable
vaccinating any children.
How do you feel about vaccinating
children against COVID-19 if the
CDC says it is safe?

28. Formative Research Drives Content and Tactics
28
RIDOH’s approach to encourage vaccine uptake is driven by research. Key questions and
concerns are addressed through a focus on data and science, trusted messengers, correcting
misinformation, countering disinformation, and timely and agile outreach as new information
emerges.
• Post-vaccination
symptoms
• Makes kids sick
• Long-term impacts
unknown, especially
infertility
• Parents want to hear from
healthcare providers to
address their concerns
• Speed of a “new” vaccine = it was
rushed so people want to “wait
and see” (emergency use
authorization)
• Relative risk of effects from
vaccination versus COVID-19
infection
• Real-world efficacy, including
breakthrough cases and variants
• Get back to normal – sports,
school, friends, and activities
without masks
• Travel and time with family
• Incentives may be perceived as
“fishy”
• Threats are unappreciated
• Ok to partner with key community
figures, but not as main
messenger
Safety
Concerns
Fear of
Unknown
“Carrots”

29. Lessons Learned Help Shape Key Campaign
Elements
29
Elements of the approach are informed by national actors and experience with flu, H1N1, and
HPV vaccination campaigns in Rhode Island. However, the COVID-19 pandemic and vaccines
present unique challenges and we are learning what is most effective in real time locally,
regionally, and nationally.
• Pediatricians are the most trusted source of information for parents. We rely upon them as spokespeople.
• Partnerships with communities/organizations use close connections to help educate and counter
misinformation and disinformation. Schools disseminate information. Mothers who are doctors and scientists
outreach to neighbors and communities through Facebook, blogs, texting, and other channels as though they are chatting at
the playground.
• Targeted messages and relatable messengers aim to raise awareness of risks and benefits. Some
examples: “A ticket to normalcy” campaign for teens in Louisiana; Youth ambassadors to promote vaccination, testimonial
from kids who missed their senior year of high school, and community service as incentive in New York; and testimonial
from a RI mother who experienced the death of her adolescent daughter who did not get vaccinated during the H1N1 flu
pandemic.
• Direct outreach to parents. Nurse in RIDOH Office of Immunization contacted families who have children that are
either unvaccinated or under vaccinated against flu to educate them about risks and answer their questions.

30. Education Operations Center (EdOC)
30
Innovative interagency center. Focused resources to effectively communicate about the specific
needs of school communities during a pandemic. Enabled unified and consistent messaging,
two-way communications, and school staff and nurses as trusted messengers.
Rhode Island State Interagency Partnership
• Governor’s Office; RIDE; RIDOH; Department of Children, Youth, and Families; Emergency Management
Agency; National Guard; and Disaster Medical Assistance Teams.
• Unified understanding, purpose, and approach to prioritize children’s wellbeing. Goal to have children
learning in person 100%.
Support Services
• 24/7 phone line;
• Personalized, rapid responses;
• Best practice guidance;
• Scenario-based feedback;
• Clarification on guidance, vaccination, health and
safety concerns;
• Focused and collaborative problem-solving;
• Health, safety, social, and emotional trainings for
all levels of school personnel.

31. 31
• Encourage conversations in
multiple languages, with
diverse representation, ASL
interpretation, and direct
support services.
• Address specific concerns --
e.g., share testimonials from
people who were vaccinated
months ago to get at “wait and
see” mentality.
• Utilize media platforms,
channels, partners, and
trusted messengers.
• Community discussions;
regional school group
meetings with RIDOH, RIDE,
and the Education Operations
Center.
• Partner with pediatricians and
healthcare providers as key
spokespeople.
• Media pairing families,
adolescents, and
pediatricians; Facebook Live
Q&A events for families with
pediatricians.
• COVID-19 Vaccine
Subcommittee of PCPs,
epidemiologists, pharmacists,
pediatricians, long-term care
advocates, ethicists, nonprofit
leaders, school leaders, faith
leaders, and others.
Meeting people where they
are
Regular and targeted outreach Appropriate messengers

32. 32
VACCINE CONFIDENCE FLYER INSTAGRAM POST FACEBOOK SPOT
Talk with Dr. Phil Chan about COVID-19
Vaccinations for Children

33. THANK YOU

34. Appendix

35. While adolescents age 12 to 17 have experienced downward trends in COVID-19 case counts and
percent positivity in recent weeks, they may potentially be stabilizing. Looking at weekly case rate,
weekly test rate, and weekly percent positivity, the gap between adolescents age 12 to 17 and all
ages has narrowed over the past three weeks.
0
100
200
300
400
500
600 95% since
4/25
35
Notes: Data current as of 6/21/2021 at 8:30 AM. Counts of 1-4 are suppressed (displayed graphically as zeros),
in line with RIDOH’s Small Numbers Policy.
0
2000
4000
6000
8000 62% since
4/25
0.0%
2.5%
5.0%
7.5%
10.0%
85% since
4/25
Weekly Percent Positive, Ages 12-
17
Weekly Test Counts, Ages 12-17
Weekly Case Counts, Ages 12-17
Source: Rhode Island Department of Health (RIDOH) SalesForce COVID-19 Case Dataset; RIDOH Electronic Lab Reporting
Dataset; US Census Bureau 2018 annual estimates by single year of age (ages 12-17) and 2018 ACS 5-year estimates (total
population).
Weekly Case Rates per 100,000 Weekly Test Rates per 100,000
Weekly Percent Positive
Comparison
0
200
400
600
800
1000
Ages 12-17 All ages
0
5000
10000
15000
Ages 12-17 All ages
0.0%
2.5%
5.0%
7.5%
10.0%
Ages 12-17 All Ages

36. Adolescent Vaccinations (Age 12 to 18)
As of June 17, 56% of adolescents age 16 to 18 and 41% age 12 to 15 in Rhode Island have
gotten vaccinated. RIDOH has worked with school districts to support vaccination events within
each district.
Vaccinated as of 6/17*
23,231
(56%) Est. Total Rhode
Islanders to vaccinate
70%
30,670
Scheduled*
8
Vaccinated as of 6/17*
19,847
(41%) Est. Total Rhode
Islanders to vaccinate
70%
35,100
*Data as of June 17. Individuals are also getting vaccinated elsewhere through other channels. Family members of
students and any remaining school system personnel may also be vaccinated through this effort.
Completed*
113+
School-Based Clinics*
Ages
16-18
Ages
12-15
36

37. 2021 Fall Reopening of Rhode Island Schools
37
Unified understanding, purpose, and approach to prioritize children’s wellbeing. Goal to have
children learning in person 100%.
• Understanding: Evidence and stories of the impacts of children not being able to come together in a school
setting, big conversation of learning loss, acceleration, social and emotional development.
• Purpose: Enable whole-child approach to health and wellbeing by consolidating the gains, promoting
vaccination, preparing for outbreaks and new developments, and integrating learning and systems to build
resiliency for the future.
• Approach: Work together to do whatever it takes to help children, students, families, and school communities.
• Clear and actionable plans based on science and data,
• Center flexibility, and
• Service orientation.

38. Q&A

39. Q&A Submissions
• Submit questions to ALL PANELISTS via the chat function.
• Please include your affiliation in your question submission.

40. Dr. Karen Remley
Director of the National
Center on Birth Defects
and Developmental
Disabilities at the CDC
Dr. Nicole
Alexander-Scott
Director of the
Rhode Island Department
of Health

41. Resources
• MASK Messaging Box
• Tough Q&A messaging guidance
• One-pagers
• Webinar recordings
Find these and other resources at
publichealthcollaborative.org
41

42. Poll Question
What types of communications resources from PHCC would be most useful and
valuable? Please select all that apply.
A. Infographics/one-pagers
B. Social media graphics/messages
C. Customizable graphics
D. Op-ed templates
E. Advocacy messaging tools
F. Messaging research
G. Tough Q&A content
H. Misinformation alerts
I. Newsletter content/templates

43. Next Webinar
July 21, 2021
COVID-19 and Return to In-Person Learning: Communicating with
Constituents
Featuring: Dave A. Chokshi, MD, MSc, FACP
Commissioner of Health of the City of New York
Anne Zink, MD, FACEP
Chief Medical Officer, Alaska Department of Health and Social Services
President-Elect, ASTHO
Dáaiyah Bilal-Threats
Special Assistant to the Executive Director and Senior Advisor for Strategic Initiatives,
National Education Association (NEA)

44. Thank you
Find more resources at
www.publichealthcollaborative.org
Contact us at
info@publichealthcollaborative.org
Follow us on Twitter @PH_Comms
44