Ask a pediatrician: do children really need the coronavirus vaccine?

A big question among parents and teachers as more schools reopen is when their children will be vaccinated against COVID-19. Some have questioned whether the vaccine is even necessary for children. There is news on this front. In a press release March 31, 2021, vaccine maker Pfizer has suggested that its vaccine is as effective in children ages 12 to 15 as it is in young adults. However, the results of Pfizer’s vaccine trials in adolescents have not been fully published or reviewed by the Food and Drug Administration, and it will take several weeks.

Dr James Wood, pediatrician and assistant professor of pediatric infectious diseases, explains what doctors know today about the risk of children contracting and spreading the coronavirus and the availability of vaccines.

Do Children Really Need the COVID-19 Vaccine?

The short answer is yes. Numerous studies have shown that COVID-19 is not as severe in children, especially young children – but that doesn’t mean children aren’t at risk of becoming infected and potentially spreading the virus.

Children under 12 who contract COVID-19 tend to have mild illness or no symptoms, while teens seem to have answers somewhere between what adults and young children have gone through. The Centers for Disease Control and Prevention found that teens were about twice as likely to be diagnosed with COVID-19 as children aged 5 to 11.

Researchers are still trying to understand why we see these differences between older and younger children. Behavior probably plays a role. Teens are more likely to participate in social or group activities, and they may or may not wear masks. Immune differences and biological factors may also play a role. Non-SARS-CoV-2 coronaviruses are common in children, often resulting in upper respiratory infection. Does their frequent exposure to other coronaviruses help protect them against severe COVID-19? It is a hypothesis. We know that the immune responses of young children in general are different from those of adults and probably play a role in protection.

It’s important to remember that while most children only have mild symptoms, they are still at risk. At least 226 American children with COVID-19 have died and thousands have been hospitalized.

The key to minimizing the risk is to make sure children end up getting vaccinated, following social distancing recommendations, and wearing masks.

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Do children spread the virus?

In an environment like a school where mask wear and social distancing are enforced, young children seem to not spread the virus much when rules and guidelines are followed. A CDC review found little difference in community cases in counties with open elementary schools and those with distance learning.

If precautions are not taken, children infected with the coronavirus could very well pass it on to adults. What is not yet clear is the extent of this risk.

In order to keep schools as safe as possible, it will be important to continue to enforce school-wide masking and social distancing policies. With adolescents in particular, the rules for masks cannot depend on whether the person has been vaccinated or not. Until collective immunity within the whole community is at a good level, social distancing and masking will always be the recommendation.

So when can children get vaccinated?

At present, the Pfizer vaccine is the only vaccine in the United States authorized for adolescents as young as 16 years old. Before children under the age of 16 can be vaccinated, clinical trials must be performed on thousands of young volunteers to assess the safety and effectiveness of the vaccines, and the results must be fully reviewed and then cleared by Food and Drug Administration.

Pfizer said it plans to submit the results of its adolescent trials soon. Vaccine maker Moderna also has ongoing trials with adolescents. If their vaccines are found to be safe and effective and regulators allow them, children 12 and older could be vaccinated before school starts in the fall.

In reality, young children are unlikely to be eligible for the vaccine until late fall or winter at the earliest. Moderna announced in mid-March that it had started testing its vaccine in children aged 6 months to 11 years. Pfizer said it is also starting tests in young children, but those tests take time.

What is different about the vaccines that children will receive?

The composition of COVID-19 vaccines for children is the same as that used in adults – the difference is that children may need a different dose.

The first step in vaccine trials is to determine the right dose. Companies want to find the lowest possible dose that is both safe and produces a target level of antibodies. For example, Moderna uses a dose of 100 micrograms in adults. It is testing three different doses for children under 2 years old – 25, 50 and 100 micrograms – and two doses for children over 2 years old, at 50 and 100 micrograms.

Once the company determines the optimal dose, it will launch a placebo-controlled trial to test its effectiveness, in which some children will be given a placebo and some will be given the vaccine.

Students are now more distant from each other in many schools. The CDC recently changed its recommendation from 6 feet between children in K-12 schools to 3 feet unless the community has a high rate of viral spread. AP Photo / Haven Daily

A rigorous pediatric vaccine testing system is well established in the United States. These trials are essential for evaluating the safety and effectiveness of vaccines in children, which may differ from those in adults.

I am optimistic that a safe and effective vaccine will be available for children. So far there have been no safety signals from studies in adults or adolescents that worry me as a pediatrician, but studies have yet to be done in children.

How can parents create safe play dates for children?

When I talk to parents, I explain that it’s all about the risk versus the benefits. Each family has a different tolerance.

From a medical point of view, the mental health of children and having them play with other children is an important part of childhood.

I would say that unvaccinated children playing indoors without a mask is still not a good idea. The risk is just too high at this point. As the weather warms, I encourage the children to play outside. Ride a bike, play and socialize – just do it safe.

We all have pandemic fatigue, including healthcare professionals. As the weather warms up I think everyone just wants to get back to normal. The worst thing we can do, just as we start to see a light at the end, is to step back again – because that would only prolong everyone’s task.