Is it safe to immunize your baby during the COVID-19 pandemic?

We’re hearing reports of plummeting immunization rates since the start of the COVID-19 pandemic. This is partly due to decreased demand and visits to outpatient clinics as people stay home more during the COVID19 pandemic. People also seem to be apprehensive about giving immunizations with a nasty virus going around, because they are worried about the vaccines weakening their baby’s immune system.

This is somewhat ironic if you think about it, since right now the entire world has had their first taste in a long time of what it’s like to have an infectious disease for which there is no cure and no vaccine. This is likely similar to how previous generations felt about whooping cough, diphtheria, polio and others. But with all the apprehension, it is a fair question to ask if it’s safe to immunize during a pandemic, or whether parents should delay immunizations until it dies down.

As a matter of fact, babies’ immune systems are capable of responding to tens of thousands of antigens simultaneously. These antigens are the protein “labels” on bacteria or viruses that identify it to the immune system as a foreign invader. When the body discovers a bacteria or virus with its dozens or hundreds of antigens, it starts the process of creating a antibodies, each one a protein that, when complete, will bind specifically to each antigen. It can take up to two weeks to make a single antibody. When it binds an antigen, the other end of the antibody activate a chemical reaction that signals the rest of the immune system like a homing beacon.

When babies mouth their fingers, binkies, burp-rags, bottles, and moms, they encounter thousands of bacteria that live naturally on the skin and that might be present on other surfaces. Their brand new immune systems don’t have any of their own completed antibodies yet (except for a few that they take across the placenta from mom and through mom’s breastmilk), but they have all the machinery to get started creating antibodies the moment they begin interacting with their environment. The amazing thing is that at any one time, babies can be in the process of producing thousands of antibodies simultaneously, even though it takes up to a couple weeks for each antibody to be completed.

After that, those antibodies will be circulating through their blood, each one ready to bind to its unique antigen if it appears again. The body has a “memory” of those infections because it doesn’t have to start from square one to produce the antibody every time. Immunizations work the same way. Rather than give a baby the entire bacteria or virus, it presents a tiny piece or protein containing just one or a few antigens identical to a germ’s real antigen(s). The body produces antibodies using the exact same machinery it would use for a real infection. It’s similar to the military finding a piece of a blown-up bomber with its serial number– once they know what kind of plane it came from, its armor and defense and attack capabilities, they can learn the best way to defend against it ahead of the next attack.

So getting immunizations does not suppress or impair the immune system in any way. It actually strengthens it, giving it another arsenal in the defense against infection. (For more information about routine childhood immunizations see my previous posts on childhood immunizations.)

One reason why COVID-19 has been so dangerous is because, though related to other Coronaviruses we encounter each year, it is different enough that none or very few of our existing antibodies match it very well. Certainly this varies from person to person for reasons we don’t yet understand. A body without that immunity has to start from scratch to make an antibody that does bind it. Some studies have shown promise using “convalescent plasma” from patients who have recovered from COVID-19 as a treatment. Scientists are working feverishly (no pun intended) on developing a vaccine that will stimulate the creation of that antibody without a person having to get the COVID-19 virus itself.

For some vaccinations, just like some germs, it is easier for the body to create antibody than others. Sometimes the antibody is a stronger fit for the antigen, sometimes not. RSV is a notoriously difficult virus to immunize against for that reason. Children and adults can get it again and again for the same reason, hence why we get the cold so many times in our lives, unlike chicken pox or measles infections that don’t happen a second time for most people. That’s why kids need several doses of some vaccines. And that’s why 11 year olds need a booster dose of Tdap against whooping cough before they go to 7th grade, and why moms should get a Tdap booster with each pregnancy. Flu is also difficult to protect against, which is why we have to get a new flu vaccine each year to target the strains that are likely to be circulating, and why it sometime works and sometimes doesn’t. Even if it’s not a great fit, though, even a decent fit offers some protection, making it a more mild illness than it would have been otherwise.

Vaccines also work their best when a high enough percentage of people within a community have immunity against that germ, making it harder for that germ to spread within that community. It’s an additive effect that comes from strength in numbers. One person with 75% protection against the flu is more likely to get it in a crowd of unvaccinated people, but if everyone in the crowd has 75% protection, that person actually has a much lower chance of getting the flu than 25%. This is the reason why any vaccine for COVID-19 would likely need to be given to a significant portion of the population in order to be effective. This is also the reasoning behind the strategy we call “cocooning” for protecting babies against whooping cough, which can cause apnea and asphyxiation in newborns. Moms, dads, grandparents and siblings being protected creates a “community of immunity” to keep baby safe.

The importance of that “community of immunity” can not be overstated in a time like this. We can’t let the feeling of panic lead to an erosion in the perception of the importance of routine immunizations. A significant enough decline in our vaccination rates will undoubtedly lead to a breakdown in that community of immunity. It could be enough to allow vaccine-preventable diseases to make a come back, as we have seen in recent years. Obviously, this could be especially problematic for the healthcare system and our society during a pandemic.

There has always been misinformation circulating about health, including immunizations, but now that misinformation has become a pandemic of its own. (See my previous post on Where to Get Information on COVID-19 During a Pandemic of Misinformation.) Experts have warned us that the anti-vaccine movement could impair our ability to control the pandemic. Now more than ever, we need to listen to good science and consider the source of information. As my college mentor taught me “In God we trust, let all others bring good data.”

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