Francisco R. Velázquez, M.D.: COVID-19 vaccines for teens and children: What do we know?

Immunizations have been recommended for children for decades and have proven effective in decreasing the potential for disease. Thus, the practice of vaccinating younger adults, adolescents and children is well-established. Despite this fact, some parents and young adults have questions about the COVID-19 vaccine specifically. These questions can be usually summarized in three general areas: risk versus benefit, side effects and impact on a developing adult, and whether kids really need to get this vaccine. All good questions.

Before I dive into these general areas, let me first review the safety and effectiveness of the COVID-19 vaccines, as shown through the extensive trials and data reviews.

On May 10, the Food and Drug Administration authorized the emergency use of the Pfizer-BioNTech COVID-19 vaccine for adolescents between the ages of 12 and 15. This was followed by a meeting and vote by the Centers for Disease Control and Prevention‘s Advisory Committee on Immunization Practices on May 12, endorsing the safety and effectiveness of the vaccine and its use in 12- to 15-year-olds. In addition, the Western States Scientific Safety Review Workgroup recommended the vaccine for immediate use.

Before making their recommendations, each of the mentioned authorities reviewed the considerable research and data from the U.S. clinical trials, which enrolled 2,260 participants in a randomized, placebo-controlled trial. Among participants without evidence of prior infection of the SARS-CoV-2 virus, no cases of COVID-19 were documented, meaning the vaccine was 100% effective in preventing disease. The side effects documented were pain at the injection site, tiredness, headache, muscle aches, fever and some joint pain. These symptoms, lasting one to three days, are consistent with observations in the adult population and have been attributed to the expected reactogenicity elicited by a vaccine.

Despite assurances and authorizations from the FDA, the CDC and WSSSRW, questions continue to be asked. So, let’s address the first area of questions, Risk versus Benefit. One area of potential confusion is the rate of transmission in children. It is correct that transmission in younger children is less than in adults. This, combined with excellent safety practices in schools, is one of the reasons why younger children were able to safely go back to school earlier. As children get older, the transmission rate is the same as for adults. Almost four million children have tested positive for SARS-CoV-2 in the U.S. Children at a national level represent about 2% of all hospitalizations. In addition, a serious and potentially fatal syndrome known as Multisystem Inflammatory Syndrome in Children has been associated with active cases.

This brings us to our second area of common questioning. One of the concerns expressed by parents is whether the vaccine will be impacted by the hormonal environment of an adolescent or will the vaccine affect fertility. To the best of our knowledge, hormones related to puberty will not have an impact on the vaccine’s effectiveness or enhance its side effects. And there is no empirical evidence linking infertility to the vaccine. Coincidentally, some participants in the adult trials became pregnant.

Finally, the question of whether children need to be immunized at all against this disease is a critical one. The short answer is, “Yes.” As previously mentioned, children can become infected even with their lower transmission rate. They account for one in nine of all SARS-CoV-2 cases in the U.S. which can lead to more severe disease and even hospitalizations. Children, even if asymptomatic, can transmit the disease to someone more vulnerable such as an elderly relative, family friend or teacher. Lastly, children under 18 years of age are roughly 24% of the U.S. population and about 32% of the global population. It makes sense that for us to really control this disease, not immunizing roughly a quarter of the population is not the best strategy. Both the Pfizer-BioNTech and Moderna vaccines are currently in various stages of trials for the population between 2 months and 11 years of age. It is expected that perhaps by the fall, vaccines will be available to younger children.

I encourage parents and young adults to have a conversation with their pediatrician, family physician or trusted provider about these vaccines. The sooner we reach an adequate vaccination rate, the sooner we can all get back to a more normal time. And the sooner our children and young adults can fully participate in the educational process and enjoy team and group activities. Being back in school is not just about academic pursuits. It is a critical experience in the development and growth of a person. Vaccines will empower us against this disease.

Francisco R. Velázquez, M.D., S.M., is the interim health officer for Spokane Regional Health District.