Kids and the Coronavirus Vaccine

As California and the nation haltingly roll out COVID-19 vaccines, many parents anxiously wonder when it will be their turn to receive the coveted shot. But other questions loom large for families desperate for a return to normalcy: When will kids be able to be vaccinated? And how necessary will vaccines be to reopen schools safely?
Currently, there are no COVID-19 vaccines approved for children. It’s typical in vaccine development that new drugs are tested for efficacy and safety in adults before trials can begin in younger populations, starting with adolescents and then moving on to younger kids. While some trials are underway, the timeline for approvals remains unclear. 
But Anthony Fauci, M.D., the federal government’s top infectious disease expert, said in late January that he hoped vaccinations of children could start by late spring or early summer. 
“I do think it’s really important” for kids to get vaccinated, says Grace Lee, M.D., the chief medical officer for practice innovation and an infectious diseases physician at Stanford Children’s Health. “While the burden overall in the U.S. population has been in adults, and especially older adults, we see kids get admitted (to hospitals) with COVID who get really sick, need to go to the ICU, need respiratory support and get MIS-C.” Multisystem Inflammatory Syndrome in Children is a serious condition in which different organs, including the heart, lungs and brain, become inflamed.
While half of those children have pre-existing conditions, “half of them are perfectly healthy kids,” she adds. “To have that tool (vaccines) for children would be tremendous.”
There are also growing concerns that emerging COVID-19 variants, including one that is widespread in Britain, are more contagious, including among children. 
Update on the Vaccines
Of the two vaccines that received emergency approval in the United States in December, both of which use messenger RNA technology, Pfizer-BioNTech’s was authorized for teens as young as 16.  Moderna’s was approved only for those 18 and older. 
Pfizer’s trial for 12- to 15-year-olds, which it began in October, was fully enrolled in late January with more than 2,220 participants. Lee says she is hopeful that some of that data may be available this spring when Pfizer is expected to seek full approval of its vaccine.
Fauci said if the trials are successful, testing would begin with children down to age 9.
Moderna started to give doses to volunteers between ages 12 and 18 in December, but reported that it was taking longer than expected to reach its goal of 3,000 participants. The company’s CEO, Stephane Bancel, told a health conference in January that he did not expect to have clinical data for kids 11 and younger until 2022.
Meanwhile, Johnson & Johnson is seeking emergency approval for its vaccine for adults and said it would test in children ages 12 and up as soon as possible, followed by younger children. Johnson & Johnson uses a different vaccine technology than the other two, and one which previously has been used in an Ebola vaccine given to children, infants and pregnant women. AstraZeneca is also testing its vaccine on children, but not in the United States.
While children have been less likely to become seriously ill or die from COVID-19, and young children are believed to spread the disease less than older ones and adults, pediatricians say it will be still be important for them to be vaccinated to end the pandemic.
Whether vaccines are necessary to safely reopen schools is a question up for debate, especially since widespread vaccination of children is not expected soon.
“We have seen that it’s possible to reopen (elementary schools) safely using all of our layers of protection: masking, social distancing, cleaning, hand hygiene, screening tools and testing programs,” says Lee. 
But opening high schools has proved to be more challenging, in part because it is more difficult to place students in small, unchanging cohorts, given the variety of classes. So vaccinating teenagers could help re-open high schools with confidence.
Getting teachers vaccinated also will go a long way.
“Everyone wants schools to be open,” Bob Wachter, M.D., chair of the department of medicine at UCSF, said during an Exploratorium webinar in January. “If we could get all the adults in schools vaccinated, schools could be safe enough that you wouldn’t need children to get vaccinated.”
How soon teachers will be able to be vaccinated is unclear as the country and state continue to struggle with more vaccine demand than supply. But California has prioritized teachers for the vaccine.
“It’s possible for kids to transmit to adults, but it’s more likely for staff or teachers (to transmit to each other) if not compliant, usually around eating and break rooms,” says Lee. “Having teachers and school staff vaccinated will be another layer of protection.”
She also emphasized that vaccines are the safest way to gain immunity from COVID-19, “far better than from infection” because it’s unknown how sick one will get if infected.
Even though the vaccines have been developed quickly, Lee says the data show they are safe, and that their safety continues to be monitored.
“Parents will have questions, and they should, about the risk-benefit balance. I encourage everyone to ask questions,” she says. But “as soon as we get the vaccine supply, all of us (pediatricians) are ready to vaccinate. We’re excited and ready.”
 
Important Resources
American Academy of Pediatrics Vaccine FAQ
American College of Obstetricians and Gynecologists COVID-19 Vaccines and Pregnancy
CDC Vaccine Considerations for People who are Pregnant or Breastfeeding