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What You Need to Know About Kids and the COVID-19 Vaccines

We spoke with a pediatric infectious disease expert about where we're at with distributing shots to kids, reasons for them to get inoculated, and the best resources for understanding vaccine efficacy.

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As of this week, more than 40 percent of Colorado’s population has been fully vaccinated for COVID-19. But while that figure is cause for optimism, it’s still a mere benchmark on the way to herd immunity. And nearly all of those immunized folks are older than 18.

The Pfizer inoculation was recently authorized for kids as young as 12, and more vaccines will likely be approved for use on children in the coming months, which means younger Coloradans are about to start receiving shots in larger numbers. The breakneck speed at which the doses have been rolled out, however, has left many parents with more questions than answers when it comes to their kids and vaccines. To help respond to some of the most common queries, we enlisted the help of Dr. Sean O’Leary, a professor of pediatrics at the University of Colorado School of Medicine and the vice chair for the committee on infectious diseases for the American Academy of Pediatrics.

5280: Broadly speaking, where are we when it comes to distributing the COVID-19 vaccines to kids?
Dr. O’Leary
: The Pfizer vaccine is the only one that’s currently authorized for children, and it’s authorized down to age 12. That just happened. Moderna will probably submit its application for an emergency-use authorization for kids as young as 12 in the coming weeks, which means we may have another vaccine for children as soon as June. And for the next age group down, Pfizer announced that they expect clinical trials to be done and to be able to submit for an emergency-use authorization for ages two to 11 in September. But that is probably the earliest we would see that.

What does it actually mean to have an emergency-use authorization?
It means the clinical trials conducted were basically identical to the types of clinical trials that you would do with any other vaccine, except instead of those happening over, you know, a period of years, they happened over a period of months. But the process for the emergency-use authorization was almost identical to the process for a full licensure. It just had to happen on a compressed timeline because of the pandemic.

At this point, what are the known risks for children getting COVID-19 vaccines?
The vaccines have looked incredibly safe and far more effective than even our wildest dreams—both Pfizer and Moderna. Safety issues in the 12-to 15-year-olds look very similar to what we saw in people ages 16 to 25: some local reactions, soreness at the site, some kids got fevers, some kids got chills, some fatigue, but nothing particularly severe.

You may have seen the New York Times article a few days ago, and then I think Reuters has covered it as well, about reports of myocarditis [in kids who got the vaccine]. (Editor’s note: Myocarditis is an inflammation of the heart muscle that occurs following certain infections. The Centers for Disease Control and Prevention said they were looking into reports that a small number of teenagers got the disease after their second vaccine shot.) We don’t know if it’s coincidental or causal right now. So, we don’t know if it has something to do with the vaccine. That is very rapidly being worked out. If that turns out to be real, it’s going to be a very rare thing. My understanding of the cases at this point is that they have been mild and most of the kids have gotten better within a few days.

Why should kids get vaccinated?
First, we have these more transmissible variants circulating. And kids are the group that is least protected. That means we’re seeing more kids getting infected than we had relative to the rest of the population. Second, vaccination offers us a ticket back into doing lots of other things that we’d like to do. A perfect example is school. If a child is vaccinated and they’re exposed in school, they don’t have to quarantine. And then the third thing, which is probably the most important, is just protection of the child. We’ve had a number of pediatric deaths in Colorado and about 600 in the entire United States. That is actually in the top 10 causes of death in children on a yearly basis.

Will children get the same dose as adults?
For most vaccines, the dose is the same for kids and adults. There are a few vaccines where there are differences. [With the COVID-19 vaccine] they found that it was safe, effective, and produced a good immune response in 16- to 25-year-olds. They did a study and found that the vaccine was highly effective in that [younger] population as well, but [the dose] wasn’t primarily what they were looking at. They are looking at that now in the younger ages, and it may be that they can use a lower dose. But we’ll see.

Could there also be a different schedule for doses? Like, say, more time in between shots?
Potentially. The other thing I’ll mention is there aren’t usually many differences in safety between age groups. There are rare exceptions. If the vaccine induces high fevers, that becomes more of a concern for kids under the age of two. But for older age groups, I don’t usually think of vaccine safety in different terms.

Are there things that we have learned from previous vaccine rollouts for kids? Maybe from something like the polio vaccine?
There are a million directions I could go with that, but there’s not a great analog. This is a once-in-a-century pandemic. We’re in sort of uncharted waters. But one of the things that a lot of parents don’t realize is that there’s a very robust safety surveillance system that’s always working behind the scenes to make sure our vaccines are safe. It’s been in place for decades. Probably the two most important pieces are the Vaccine Adverse Event Reporting System and the Vaccine Safety Datalink. But there are dozens of others that are also working behind the scenes. I think you could use the example of how quickly we picked up the issue of clotting with the Johnson & Johnson vaccine. We found these very rare side effects very quickly.

We hold vaccines to a higher safety standard than any other medicine we give because we are giving them to a healthy population. With other medicines that treat specific conditions, we’ll tolerate side effects. With vaccines, we can’t have more significant side effects. Vaccines are safer than pretty much any medicine you can get.

Do you expect school will look different for kids this fall based on continued vaccination efforts?
In the older classrooms, middle school and high school, hopefully most kids will be fully vaccinated. For the younger kids, unless we are really at extraordinarily low rates of transmission, there may still be a need for masks and other mitigation measures in those settings. That’ll still be the case for a few reasons. One, we don’t want a lot of virus circulating, even if it’s milder in kids. The concern is the emergence of variants that could potentially escape the vaccine. There is also the potential to transmit the virus to people in the household who don’t mount a good immune response to the vaccine. Those folks would still be at risk. In terms of teachers, my understanding is more than 90 percent of teachers and staff in schools are vaccinated, which is great.

Is there anything else you want parents to know about vaccines?
Be really careful about your sources of information. Children’s Hospital has good FAQs. The American Academy of Pediatrics has good information. The Centers for Disease Control and Prevention has reliable information. Once you start getting outside of academic institutions and big children’s hospitals, that’s where you can get into finding really bad stuff.

Editor’s note: This conversation has been edited for length and clarity. 

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