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Younger Children and the COVID-Vaccine

October 26, 2021

Children aged 5 to 11 will soon be able to get a COVID-19 vaccine at their pediatrician’s office, local pharmacy and potentially even their school, the White House announced on Wednesday as it detailed plans for the expected authorization of the Pfizer shot for younger children in a matter of weeks.

So what does this mean for families and the fight against COVID-19?  Here’s what Dr. Richard Besser, former acting CDC director and president of the Robert Wood Johnson Foundation, told “Face the Nation.”

As both a pediatrician and a parent, I’m looking forward to having a safe and effective COVID-19 vaccine for young children. While we can all be grateful that they are at less risk of severe disease, the impact of the pandemic on children has been profound.

Children who haven’t gotten COVID-19 directly have still been hit hard by this virus. More than 140,000 children have lost a parent or caregiver, while long-term school closures and lockdowns have negatively affected children’s social, emotional, and mental health. Across the board, children of color and those from low-income families have suffered disproportionately from COVID-19.

Fortunately, we’re moving closer to a vaccine for younger children. Here’s how it works: On October 26th, the FDA’s independent advisory committee on vaccines, known as VRBPAC, will meet to decide whether to recommend a vaccine for kids in this age group. If the FDA ultimately authorizes that vaccine, the CDC’s independent advisory committee, known as ACIP, is scheduled to meet on November 2nd and 3rd to make recommendations on who should get it; the CDC director, Dr. Rochelle Walensky, would then need to announce her official recommendations before any vaccines for children are administered. If that timeline holds, and both the FDA and CDC give the green light, we would probably see the first shots going in kids’ arms within days of the CDC’s official recommendation being announced.

It is critically important from both a health and trust standpoint that we allow this process to play out rather than simply assuming the vaccine will be authorized. The FDA, the CDC, and their respective independent agencies must undertake a thorough and independent review to determine whether the vaccine is safe and effective for children in this age group. The data that have been released to date are promising, but independent scientific review must guide this process.

The Biden administration is planning to push vaccines out through many channels including doctor’s offices, local pharmacies, and schools. They aren’t planning on doing mass vaccination clinics like we saw for adults. Will this do enough to ensure vaccines go to the most vulnerable or needy of school aged children?

I’m excited about the approach that is being taken. The Biden administration has announced that it has purchased enough vaccines for the 28 million children in the U.S. who are in the 5-11 age group. They are working with states and localities to plan for vaccines to be distributed to all communities. It makes a lot of sense to provide shots in settings where children are used to being vaccinated, such as their doctor’s offices where trust levels are high. As a pediatrician, I am used to vaccinating children and answering questions from caregivers every single time I’m in the clinic. But we also know that many children do not have health insurance or their own healthcare provider: the latest figures show that 5.6% of children were uninsured in 2020, but the uninsured rate is nearly twice as high for children in poverty. That’s why vaccination clinics at other places, such as hospitals, pharmacies, health centers, and schools, are all essential to reach children in all neighborhoods. Moreover, it is critical that public health officials collect data on race, ethnicity, and neighborhood so that any disparities in vaccine uptake can be documented and addressed.

We also need to make it as easy as possible for parents to get their children vaccinated and stay home with them if side effects keep some kids out of school for a day. Unfortunately, in the United States, people’s access to paid leave benefits largely depends on their job and income level. We are the only wealthy nation that does not guarantee any paid leave for new parents or to care for a sick family member. Black, Latino and Indigenous people are much more likely to work in minimum wage jobs that don’t provide paid leave. Emergency legislation passed by Congress has incentivized more employers to offer paid leave benefits, including time off for vaccination, but temporary tax credits for that purpose have expired and approximately 100 million workers remain without any paid leave at all.

The idea that any parent would have to choose between earning a paycheck and getting their children a potentially life-saving vaccine is just wrong. It is well past time for the United States to establish a national paid leave program that covers all workers while taking meaningful steps to ensure working families have quality and affordable child care options.

What would you tell parents who are still unsure about the COVID-19 vaccine?

It is understandable that parents would have questions and concerns about any new vaccine. Polling shows that parents are split on COVID-19 vaccines for children: some plan to get their children vaccinated right away; some have no intention of doing so at all; and some prefer to take a “wait and see” approach. We have seen these divergent viewpoints play out with vaccines for both adults and adolescents, so it is not a surprise to see it with younger children as well, especially since the clinical trials for children at this age level were far smaller than those conducted for adults.

As a pediatrician, I’ve spent many hours counseling parents on vaccines for children. Just a few days ago, in the clinic where I still see patients, I talked with a mother about vaccines for her teenage sons. She wants to see more data before she makes her decision. We had an open and respectful conversation. In my experience, pressuring and berating people doesn’t work. The first step is to listen; it’s important that we give people the time and space to ask questions and have their concerns heard. Parents should bring those questions or concerns to a health care provider or others they trust to get accurate information.

Vaccine misinformation is rampant and its continued spread ultimately disrespects and endangers those who may have legitimate questions for which they’re seeking honest answers. The approach that is being planned for administering COVID-19 vaccines to younger children will make it easier for these conversations to happen.

While kids are at a lower risk of COVID complications, how should parents of young children, infants and up to 5 years old, approach the virus?

While it is cause for optimism that caseloads have dropped significantly in recent weeks, they remain extremely high, and the U.S. is still averaging approximately 1,500 deaths per day. I don’t believe we will truly get a handle on this pandemic unless and until safe and effective vaccines are available for all age groups and until more adults decide to get vaccinated. It’s important to remember that even if vaccines are authorized for children ages 5-11, children under age 5 still won’t be vaccine-eligible, and they are likely to remain ineligible until early 2022 at the earliest.

One of those most important steps we can take to protect children ineligible for vaccination is to ensure that the adults around them are fully vaccinated. There are currently about 66 million vaccine-eligible people in the United States who remain unvaccinated. In places where vaccination rates are particularly low, those communities remain especially susceptible to additional cases, hospitalizations, and deaths. Achieving a higher vaccination rate across the board is the most important step we can take to save lives.

There are other steps we can take to keep our youngest children safe. The CDC recommends that everyone age 2 and up in schools and child care facilities wear masks. That’s an essential component of keeping kids, teachers, and staff safe, and increasing the chances that these facilities will be able to operate safely and stay open. The CDC also recommends that everybody ages six months and up gets a flu shot. That is incredibly important. In a typical flu season, thousands of young children are hospitalized from the flu, and we’re already starting to see some respiratory viruses circulate earlier than usual this year with kids back in schools and child care facilities. Flu shots save lives and ease the strain on hospitals and other health care providers.

Do you envision a future of a COVID vaccine or booster being part of routine childhood immunizations like the polio vaccine any time soon?

Vaccines have been a part of my professional career for decades. There is nothing I do as a pediatrician that has more proven health value than working to ensure that all of my patients are fully vaccinated on time. Every state requires vaccinations for children to attend school. Vaccination rates for required immunizations, such as measles, mumps, and rubella, tend to be extremely high. We have seen a growing number of vaccine mandates in workplace settings across the country, which I think is the right move. We’re even seeing this among younger populations; some schools already require COVID-19 vaccines for certain older children, such as high school student-athletes.

While all three COVID-19 vaccines available in the U.S. are extremely effective at preventing severe disease, hospitalization, and deaths, only Pfizer’s COVID-19 vaccine has been granted full approval by the FDA to date, and only for those ages 16 and up. Over time, as the evidence base around vaccine efficacy and safety continues to build, we may see more full approvals granted by the FDA, and for younger age groups. Additional full approvals may well lead COVID-19 vaccines to eventually being recommended as part of the CDC’s routine childhood immunization schedule, and would likely lead to greater numbers of states and localities adopting COVID-19 vaccine requirements.

Stay tuned for additional updates about younger children and the vaccine. And, talk to your Starling pediatrics provider who will be able to answer your questions.