Health · June 21, 2022

Covid vaccines for children under 5 are coming, but many parents have questions

It’s a moment many parents have been eagerly awaiting for months: Children under the age of 5 are now eligible for a vaccine against the coronavirus and are among the last Americans to qualify.

Without access to vaccines, parents of young children have faced near-impossible choices since the pandemic began. Many children have been kept away from schools, family gatherings and other activities and deprived of their normal childhood experience. Now that could all change.

On Saturday, the Centers for Disease Control and Prevention recommended the Moderna and Pfizer-BioNTech vaccines for children 6 months and older. The decision means these young children will be given shots for the first time, perhaps as early as Tuesday.

Sunny Baker, 35, a mother of two in Oxford, Mississippi, said she vaccinated her older daughter Hattie Ruth, 5, at the earliest opportunity and has been eagerly awaiting her 2-year-old daughter Alma Pearl to qualify.

“Yes Yes Yes! We would like to come first,” she said.

But Ms. Baker could well be in the minority: A recent survey by Kaiser Health found that just one in five parents get their young children vaccinated right away. Many want to wait and see for now.

As the pandemic stretches into a third year and Americans weigh the risks they are willing to live with, the CDC’s decision embarrasses parents of young children.

Vaccines have lost some of their effectiveness against infections with new variants, although they continue to offer protection against serious illness and death. And large numbers of Americans became infected during the Omicron wave, which helped lead many to mistakenly believe the fight was over.

Switching advice has also contributed to a lack of enthusiasm. Daryl Richardson, 37, of Baltimore, said he has no plans to vaccinate his three children, partly because of the constant changes in the recommended dose.

“First it was a shot, and then it was a booster and another booster,” he said.

After nibbling with their children through the dangers of the pandemic for so long, parents are now faced with new questions, some so complex that even regulators and experts are baffled. Which vaccine is better? How well and how fast will they work? And why bother when the majority of young children have already been exposed to the virus?

Both the Pfizer-BioNTech and Moderna syringes are considered safe for young children, and both give blood levels of protective antibodies similar to those seen in young adults. But neither offers the wonderful protection that adult vaccines offered in the early days of the pandemic.

Moderna’s vaccine appears to elicit a strong immune response in young children, and its protection is complete within 42 days of the first dose. But the vaccine causes a fever in one in five children, and fewer vendors are likely to offer it as an option over Pfizer’s vaccine.

The Pfizer-BioNTech vaccine is better known and causes less fever, but children need to get three doses to be protected from the virus. While it takes 90 days to reach maximum protection, the effects can last longer than Moderna’s regimen.

“Executing these two rollouts will be incredibly challenging,” said Katelyn Jetelina, a public health expert and author of the widely read newsletter Your Local Epidemiologist.

“There’s going to have to be a lot of proactive communication about the difference between the two and the implications of emphasizing one over the other,” she said.

A head-to-head comparison of the two vaccines might provide some answers for parents, but that’s neither possible nor advisable, experts said in interviews. There are simply too many differences in the way the vaccines have been formulated and evaluated.

“It’s really impossible to say that one is better than the other,” said Dr. William Towner, who led the vaccine studies for Moderna and Pfizer at Kaiser Permanente in Southern California.

The choice could depend more on whether parents are willing to go for three or two doses and what vaccine their providers have on hand, he said.

Many vendors are unfamiliar with Moderna and have so far only relied on Pfizer-BioNTech’s vaccine. Overall, Americans have been given about 350 million doses of this vaccine, compared to 223 million doses of the Moderna vaccine and about 19 million doses of the Johnson & Johnson vaccine.

For young children, states have so far ordered 2.5 million doses of the Pfizer vaccine and 1.3 million doses of the Moderna vaccine. These numbers are lower than expected given the 18 million children in this age group.

Uptake was slow, even in older children. The Pfizer-BioNTech vaccine was approved in November for children ages 5 to 11, but less than 30 percent in that age group have received two shots.

Overall, the vaccines have proven to be very safe, but many parents are hesitant for a variety of reasons. Some are cautious because the vaccines are relatively new or because they believe the risk of Covid-19 to their children is negligible.

Some parents may be uninterested because their children were among the 75 percent thought to have already been infected. However, vaccination offers stronger and more consistent protection even if a child has already been infected, CDC scientists found Saturday.

Still other parents have emerged from the pandemic.

In Middletown, Ohio, some parents were more concerned about staying cool during the summer heatwave than the risks posed by the coronavirus. Tori Johnson, 25, is unvaccinated and said she has no intention of vaccinating her two daughters, 7-year-old Liliana and 9-month-old Rosalina.

Life has already returned to normal, she said.

Simone Williams, 32, said she was hesitant to vaccinate her 1-year-old twins, Caidon and Arissa, and 4-year-old Bryan. “I’d get you one if it was necessary, but other than that I’m in no hurry,” Ms. Williams said.

Some pediatricians were preparing to explain the benefits of vaccination to parents. Routine vaccinations are also a sensitive issue in many parts of the country.

Pediatricians “have struggled with this for many, many years with the influenza vaccine and the standard dosing for measles, mumps, rubella and chickenpox,” said Dr. Lindsey Douglas, pediatrician and medical director of quality and safety at Mount Sinai Kravis Children’s Hospital in Manhattan.

“There’s certainly a lot more information out there in the last two and a half years,” added Dr. Added Douglas. “But there’s a lot more misinformation out there.”

In a way, the odds against using the vaccines in the youngest children were stacked.

The Moderna and Pfizer-BioNTech vaccines both offered spectacular estimates of efficacy in adults that far exceeded expectations, raising hopes for a virus-free future.

But as the vaccines were gradually tested on younger children, the virus was evolving rapidly, each new form more elusive and challenging than the previous ones.

The latest versions of the Omicron variant have evolved to partially evade not only the two-year-old vaccines, but even the immunity generated by infection with the form of Omicron that was circulating just a few months ago.

Original estimates of efficacy in adults were in the order of 95 percent. That number has now fallen to 51 percent for two doses of the Moderna vaccine in children aged 6 to 23 months and just 37 percent for children aged 2 to 5 years.

As low as that may seem, two doses of Pfizer’s vaccine didn’t even meet the Food and Drug Administration’s benchmark for an immune response, which justified the agency’s February decision to delay evaluating the vaccine until the company had tested three doses .

“As a mother, I find it unacceptable that it has taken so long for our little ones to get the vaccine,” said Dr. Jetelina. But “as an epidemiologist, I also know how important it is to conduct clinical trials rigorously and to find the right dosage.”

Based on the data, the FDA this week approved two doses of the Moderna vaccine and three doses of Pfizer-BioNTech as a “primary series” for young children.

If officials determine that even the youngest children need booster shots against future variants, children must be given a third dose of Moderna and a fourth dose of Pfizer.

In press releases and data reported to federal agencies, Pfizer has estimated 80 percent efficacy for three doses of its vaccine. But that calculation was based on just three children in the vaccination group and seven who received a placebo, making it an unreliable metric, CDC advisors noted at a meeting Friday.

“We should just assume that we don’t have efficacy data,” said Dr. Sarah Long, an infectious disease expert at Drexel University College of Medicine. But dr Long said she was “comfortable enough” with other data showing the vaccine’s effectiveness.

Parents of the youngest children may be more willing to choose a Covid vaccine if it can be offered alongside other routine vaccinations. dr Towner said any vaccine is better than none, but he predicted more parents could choose Moderna.

“To be honest, giving three doses instead of two can be a bit difficult for some parents,” he added. “If they have a choice and both are available, that could push some parents to Moderna.”

Some parents don’t need convincing. In Alexandria, Virginia, Erin Schmidt, 37, said the news was “life-changing” because her family lived in a “kind of alternate, isolated reality.” After vaccinating her 2-year-old daughter Sophia, she plans to open a bottle of champagne, take Sophia to a museum and “blow her mind about the world”.

Brendan Kennealy, 38, of Richfield, Minnesota, said after his daughters, 4-year-old Hazel and 1-year-old Ivy, were vaccinated, he and his wife Jocelyn, 35, would drive them to the lake town of Duluth, where they met new ones want to try restaurants and attend an open air concert by a local folk band called Trampled by Turtles.

The family have had to avoid spending time indoors with his mother, who has lupus and is vulnerable to severe Covid. His children missed the folk festival, dropped out of swimming lessons and gave up gymnastics.

“I’ve been very, very lucky a few times in the past, and then they pulled the rug out again,” Mr. Kennealy said of the FDA’s faltering progress on pediatric vaccines.

“These surges of hope were so unnecessarily devastating,” he added. “Until we get to Walgreens or wherever we take them to get their nudges and band-aids, I’m trying to keep that in check.”

Adam Bednar contributed reporting from Baltimore, Christina Capecchi from Richfield, Minnesota, Kimiko de Freytas Tamura from New York, Ellen B Meacham from Oxford, Miss., and Kevin Williams from Middletown, Ohio.