COVID-19 Vaccines for Kids

“There can be no keener revelation of a society’s soul than the way in which it treats its children.”

- Nelson Mandela

“[O]ver the last 20 months, COVID has been one of the top 10 killers of our pediatric population. We know that we have seen over 700 pediatric deaths over the last year-and-a-half.”

- Rachelle Walensky, M.D., Director, U.S. Center for Disease Control and Prevention

On October 29, 2021, the U.S. Food and Drug Administration (FDA) gave Emergency Use Authorization (EUA) to the Pfizer-BioNTech COVID-19 vaccine for children ages 5 to 11. And on November 2, the Center for Disease Control and Prevention (CDC) formally accepted their recommendation paving the way for implementation this week. This is a major milestone in the war against SARS-CoV-2. As CNBC News healthcare reporter Berkeley Lovelace, Jr. stated this is “a critical step in getting some 28 million more kids in the U.S. protected against the virus as the delta variant spreads.” This Germ Gems post, the third on the topic of COVID-19 in kids, puts this step in perspective.

Impact of COVID-19 on kids. Children are relatively spared of the most devastating aspects of COVID-19. Older people with underlying medical conditions, whether vaccinated or not, are the ones who bear the brunt of severe and fatal COVID-19. Nonetheless, according to the American Academy of Pediatrics (AAP), as of October 21, 2021, 6,295,648 childhood COVID-19 cases were reported in the U.S. representing 16.5% of all COVID cases. And the number of cases in children is increasing fueled by the SARS-CoV-2 Delta variant.

Data from the AAP report also shows that the number of hospitalizations of children with COVID-19 remained low (0.1%-2.0% of all the child COVID-19 cases resulted in hospitalization) as did deaths (<0.03% of all child COVID-19 cases). A serious immunologic disorder triggered by SARS-CoV-2 called multisystem inflammatory syndrome in children (MIS-C) that primarily affects children between the ages of 5 and 13 years, seems to be increasing. As of October 4 the CDC recorded a total of 5,217 MIS-C cases. Also children aren’t spared of the long-term sequelae of COVID-19 infection. Like adults they can develop the debilitating illness called long Covid, although the number of kids suffering with this disorder is not yet clear.

Given the growing impact of COVID-19 on children, the May 10, 2021 FDA EUA of Pfizer’s vaccine for children 12- to18-years old was heralded by pediatricians as a breakthrough. An analysis of the vaccine’s use in this age group published on October 19, 2021 showed that the vaccine is 93% effective in preventing hospitalization of adolescents with COVID-19. This is good news.

Benefits of COVID-19 vaccines in children 5-11 years-of age. To date nearly 2 million children ages 5-11 have been infected with the virus, and 8,000 have been hospitalized. One-third of those hospitalized were admitted to intensive care units, and at least 170 died. Also, the toll of the COVID-19 pandemic on child development and mental health due to quarantining, school closures, and loss of contact with friends is harder to quantitate, but it is profound.

It is with this background in mind that the announcement of an FDA EUA of the Pfizer/BioNTech COVID-19 vaccine for children 5-11 years-of-age was momentous. Yet, a survey released by the Kaiser Family Foundation on October 28 found that scarcely 1 in 3 parents will permit their children in this newly eligible age group to be vaccinated immediately. According to an October 30 article in the New York Times, “Do parents fear virus or shot more?,” “Even many parents who are themselves vaccinated and approved the shot for their teenagers are churning over whether to give consent for their younger children, questioning if the risk of the unknowns of a brand-new vaccine is worth it when most coronavirus cases in youngsters are mild.”

What parents need to know about Pfizer’s COVID-19 vaccine for kids ages 5 to 11. Clinical trials of the Pfizer COVID-19 vaccine in the younger age group used a lower dose of vaccine (one-third of the dose in the adult vaccine) to avert side effects. The FDA said the data showed the shot was both safe and prompted strong immune responses in children. The most common side effects were fatigue, fever and headache. Also, smaller needles were used for inoculation. (This was likely comforting for kids who, like me when I was their age, suffer from trypanophobia—an extreme fear of medical procedures involving injections of hypodermic needles.)

It appears that one side effect in particular of the COVID-19 mRNA vaccines that worries parents the most is myocarditis or pericarditis (inflammation of the heart muscle or its covering membrane). This side effect is rare but has been observed with both the Pfizer and Moderna vaccine. (Data from clinical trials of the Moderna mRNA vaccine are likely to be reviewed by the FDA by the end of this year; Pfizer plans to request a COVID-19 EUA for ages 2-11 in this same time frame.)

According to an October 6 analysis by the CDC of 877 cases of myocarditis associated with these vaccines, there has not been an increased rate of the condition among children ages 12 to 17. And no cases were observed in the vaccine trials in 5 to-11-year-olds. Many experts also say that the condition usually improves quickly and that COVID-19 itself presents a far greater risk of severe myocarditis than does the vaccine.

How can parents prepare their kids for the vaccine. The shots are extremely safe, but they can have typical side effects like redness and tenderness at the injection site, fever, or fatigue for a day or two. Parents should be aware of these potential side effects and, depending on the child’s age, may want to mention them to the child. More important, parents should be emphasizing the benefits of getting vaccinated to children. Once vaccinated, it will be easier for children to go to school, play sports, and do the normal things kids want to do.

In a recent article in The Atlantic, senior associate editor, Caroline Mimbs Nyce proposes that “having kids vaccinated means there’ll be fewer places for the virus to set up shop and travel to other people, including adults who haven’t yet gotten vaccinated or who might not be fully protected by their shots. So certainly, the hope is that vaccinating kids will have huge community-level benefits.”

The effects of the Pfizer and Moderna vaccines on stopping the spread of SARS-CoV-2 by children are not yet established. But it seems to me that suggesting to your kids that by getting vaccinated they may help others in the community is an idea worth sharing with them. We’re all in this battle together—even our 5-to-11-year-olds.