Kids may qualify for COVID-19 shot soon
Vaccine studies currently include children ages 12+
The COVID-19 vaccine rollout is accelerating nationwide, but there’s a big hole in the process: Kids and most teens are still not allowed to get the approved vaccines, though that could change soon.
Kids under 18 make up about 22% of the U.S. population and the Arizona population, meaning they need to be vaccinated if we hope to reach herd immunity, when enough of the population is immunized against COVID-19 to prevent future outbreaks.
The three approved vaccines are being tested on teenagers or younger kids. Some early results are promising.
The bulk of trials are still in the works. Officials with the American Academy of Pediatrics say it is “potentially achievable” that a COVID-19 vaccine will be available for at least some age groups of children and adolescents before the 2021-22 school year begins.
Public health experts in Arizona do not believe the COVID-19 vaccine, like other immunizations, will be mandatory for schoolchildren, at least for the time being.
But pediatricians and other medical experts say it’s important for kids to get the vaccine once it’s been safety-approved and is available.
The Pfizer-BioNTech vaccine has been approved for anyone who is 16 years of age and older.
The Moderna and Johnson & Johnson vaccines are approved only for those 18 years of age and older.
All three manufacturers have expanded their vaccine studies to children ages 12 and older, said Dr. Sean Elliott, an infectious disease pediatrician at Tucson Medical Center and the immunization representative for the Arizona chapter of the American Academy of Pediatrics.
Pfizer could get an emergency use authorization from the U.S. Food and Drug Administration for the 12-to-15-year-old age group in the next few weeks, Elliott said.
One reason why it’s important to vaccinate kids is that ... they can still effectively transmit the disease to others who may be more vulnerable to bad outcomes.
Moderna and Johnson & Johnson could soon follow, he said.
Pfizer’s early results suggest the vaccines are safe and very effective in young teens ages 12 to 15, perhaps even more effective than in adults.
A Moderna clinical trial for infants and children 6 months to 11 years old is underway, including at a Phoenix trial location. There is hope that approval of at least one COVID-19 vaccine for the youngest group of children will come in the summer, or if not, before the end of the year, Elliott said.
It’s particularly important to get kids vaccinated to prevent more transmissible variants of the virus, such as the B.1.1.7 strain first detected in the U.K., from causing another surge in cases, Elliott said. So far, evidence shows the available vaccines are effective against the B.1.1.7 strain.
“At this point, the data is still new, but the predictions and the safety studies so far are very supportive of the vaccine being made available to all ages of kids,” he said. “Now is the time to intervene. It needs to be done safely, of course . ... I really think that by summer, we’ll have a different ballgame.”
COVID-19 illness is shifting to younger people
One reason why it’s important to vaccinate kids is that even though they don’t usually get as severely ill from COVID-19, they can still effectively transmit the disease to others who may be more vulnerable to bad outcomes. In Arizona, 16% of identified cases have been in individuals younger than 20, although there are likely many more who were asymptomatic or not tested.
“Kids still ultimately are the spreaders of any kind of infectious disease,” said Jennifer Tinney, program director at the Arizona Partnership for Immunization.
“They don’t always wash their hands, they love to give grandma and grandpa kisses, so what we want is to make sure that we reach that community immunity level where enough people have antibodies and are protected from the virus so they’re not spreading it.”
Another reason to vaccinate younger populations is that they are increasingly assuming a larger share of COVID-19 illness.
“The experience in other countries and what we’re seeing here as well, is as more and more of our older population gets vaccinated, the illness is shifting to younger populations. Hospitalizations, severe outcomes in places like Israel, where they are very far along in vaccination, has shifted to younger people,” said Dr. Joshua LaBaer, executive director of Arizona State University’s Biodesign Institute.
LaBaer said he expects young people will tolerate the COVID-19 vaccines well.
“Once the vaccines are approved in young people, I would encourage them to get vaccinated,” he said.
Many Arizona parents are eager to get the vaccine for their children, Tinney said.
“We do know that a lot of people would like to have the whole family vaccinated, because I know there’s a lot of questions now about how do we take a vacation if parents are vaccinated and kids aren’t, that kind of thing,” Tinney said.
“And, of course, as we get back to a more normal school schedule, parents seem to be very excited and anxious for the vaccine to go down to the younger age.”
Survey: Vaccine hesitancy in parents differs by race, income
One recent informal survey suggests hesitancy among some U.S. parents when it comes to getting the COVID-19 vaccine for their children.
A survey of nearly 1,000 parents by the nonprofit ParentsTogether found that parents were mostly more hesitant to vaccinate their kids, once it’s approved, than they were to get the vaccine themselves. The poll of a random sample of 971 of the national organization’s members was conducted March 7 to March 12 via Facebook Messenger.
It was not a scientific study, but rather a random internal survey of parents affiliated with the organization.
While 70% of parents and caregivers said they would vaccinate themselves, only 58% said they would vaccinate their children against the disease.
The main concerns leading to hesitancy related to short-term side effects, unknown long-term side effects, the quick development of the vaccine and wanting more data and long-term studies.
“The path to higher vaccine acceptance is clear: Parents need more education and information to make them comfortable before deciding to vaccinate their child,” the report says. “Parents report anxiety about unknown side effects as their top concern, say they want to know more about the research, and need more evidence of the vaccine’s safety.”
The survey of group members indicated that race and income levels also impacted parents’ vaccine hesitancy for their children.
About one in four of Black parents surveyed said they would probably not or definitely not vaccinate their child against COVID-19, compared with 15% of white parents and 13% of Hispanic parents.
Twenty-three percent of households with incomes under $35,000 said they probably or definitely won’t vaccinate their children, compared with 8% of households with incomes over $75,000.
The survey suggests that as more people get vaccinated, more parents may decide to vaccinate their children once the vaccines are approved. The early polling found that about 44% of parents who know someone who got the vaccine plan to vaccinate their children, compared with 22% of parents who don’t know anyone who has gotten the vaccine.
Elliott, the Tucson pediatric specialist, said pediatricians are uniquely positioned to have fact-based conversations about vaccine safety with parents and guardians because of their experience explaining childhood vaccines to families.
That’s why pediatricians and family physicians are eager to get vaccine supply into their offices, and move away from the larger vaccine sites operated by the state and counties, he said.
“We know the language, we have practice with the messaging,” Elliott said. “Who better to have a conversation about safety and efficacy than someone who has been doing it their entire career.”
Parents usually want to talk to their pediatrician or their family practice clinician about what’s right for their child, concurred Tinney from the Arizona Partnership for Immunization.
“I do believe that this is going to be the same as what we see with any new vaccine recommended for kids,” she said. “They probably need to hear a little bit more about it, and of course their trusted clinician’s going to be the one they turn to for that information.”
Schools are unlikely to mandate COVID-19 vaccine, at least for now
Tinney said she doubts vaccines will be required at schools, at least not right away.
She said it’s not often vaccines that are still under emergency-use authorizations rather than full FDA approval are mandated.
“I have not heard of any discussion of having it as a requirement for school at all,” Tinney said. “Our mandates for school haven’t changed in a long time in Arizona, so it’s not something that happens quickly, typically. It’s a long process to have requirements for school changed.”
The American Academy of Pediatrics says decisions about whether the COVID-19 vaccine is mandated at schools could vary state to state depending on what state governments decide, and depending on FDA approval status.
Elliott also predicts Arizona schools will not mandate the COVID-19 vaccine and said that even nationally, requirements may be unlikely until there are more long-term safety studies.
It’s possible the COVID-19 vaccine may never be required in schools, he said.
“Case in point: Schools do not require influenza vaccines either to come to school. It’s a good idea, but not required,” Elliott said.
Whenever the COVID-19 vaccine is available for younger kids, parents likely won’t be able to group it together with school-required immunizations, or with the flu shot.
The Centers for Disease Control and Prevention is recommending that the COVID-19 vaccine not be grouped with other vaccines. It needs to be administered with a minimum interval of 14 days before or after any other vaccines, the federal agency says.
While there are very few vaccines that cause a problem when they are administered at the same time as another immunization, administration of the COVID-19 vaccine at the same time as other childhood or adolescent immunizations has not yet been tested, CDC officials say.
One of the reasons to perform vaccine trials in children is to make sure that they do not have any side effects that are pediatric-specific, the American Academy of Pediatrics says.
“This is really far more about safety and tolerability of the vaccine in kids,” Elliott said. “Kids in general are a protected and at-risk population, so studies involving any intervention with kids of course need to be conducted with very thorough, very transparent safety mechanisms in place to protect the kids.”
The COVID-19 vaccine may prove beneficial for children and young adults affected by a rare inflammatory illness that’s associated with COVID-19 called
Multisystem Inflammatory in Children, Elliott said.
“There’s no known scientific reason or safety reason not to vaccinate those kids,” Elliott said. “Part two of that is what might be the impact of vaccinating those kids if they are still having some clinical disease left over from their MIS-C? There are kids with heart disease, cardiac dysfunction caused by their MIS-C who might actually benefit from the vaccine in getting over the last bit of their disease.”
The evidence for speculating that COVID-19 could help with MIS-C are early studies that have shown that people with persistent post-COVID-19 symptoms, often known as “long-haulers,” are having some clinical resolution of their symptoms after getting vaccinated, Elliott said.
“This is not just anecdotal experiences. It goes back to studies,” he said. “That is an indication that a child who is an MIS-C survivor with persistent
Syndrome symptoms would also likely have benefit from vaccine.”
The Arizona Department of Health Services did not immediately respond to a request for information about the COVID-19 vaccine in kids younger than 16.
What’s key for parents and guardians to know is that the news about kids and the COVID-19 vaccine so far appears to be positive.
“We’re still learning a lot of information about the vaccine, and as we’ve now been able to vaccinate so many millions of people across the country, they’re getting data really fast,” Tinney said.
“And the studies do look like they’re going to be safe in kids, and I certainly look forward to when my 12-year-old can have his vaccine, and so is his grandmother, she really wants to see him.”