When Will Kids Get COVID-19 Vaccine & What Happens Until Then?

vaccine injection

When Will Kids Get COVID-19 Vaccine & What Happens Until Then?

As of today, December 1st, 2020, the last few weeks have been filled with exciting news from vaccine makers like Pfizer, Moderna, and AstraZeneca. Their phase 3 trials have indicated extremely high efficacy in their adult volunteers. Now, these companies are seeking emergency use authorization so that vaccination might begin in certain high-risk populations as early as the end of 2020. Many of us are breathing a sigh of relief as we recognize this pandemic may have an end in sight. As this light at the end of the tunnel grows brighter, it begs a question even more intently for parents… “Will my child be able to get vaccinated against COVID-19?”

Will there be vaccine trials in children before they can be vaccinated?

All of the COVID-19 vaccine research thus far has been conducted in adults. In October, Pfizer began to include teenagers down to the age of 12 in their phase 3 trials. Though the efficacy data thus far is extremely reassuring, we do not know if the vaccine will produce the same level of effectivity in younger children and infants. 

When new vaccines are produced, they are generally studied in normal adult populations before being tested in vulnerable populations like children and pregnant women. The immune system of children is different. It can produce an immune response greater than or sometimes less than the response to the same agent in adults. Thus, it is important to study children’s immune response to the COVID-19 vaccine and establish appropriate dosing regimens before approving it for use in children. 

In normal circumstances, we would want a lot more safety & efficacy data to be available over a longer period of time before taking the next step of testing in children. Given the situation of a pandemic, however, there is the need to quell the spread & severity of COVID-19. The American Academy of Pediatrics has strongly encouraged vaccine researchers to begin necessary trials in children as soon as possible given the reassuring safety & efficacy results we have already seen in adult trials this far.

Will they have to enroll thousands of children like they did adults? 

The scientists are not anticipating a full-blown trial for kids like they performed in adults. We are beginning to understand how much of an immune response is required to protect an adult from the disease based on the trial data in thousands of adult volunteer participants. There also have been no major safety concerns with the adults in the trials thus far. Taking these pieces of information into account, the researchers should be able to create smaller trials big enough just to establish basic safety & immune response in children and then seek approval. 

This would be the equivalent of Phase 1 and 2 trials, but not the phase 3 trial. In a Phase 1 trial, small groups of children receive the vaccine to establish dosing safety in different age groups working down from older to younger ages. In Phase 2, researchers establish that the immune response created in the children is the same or better than that created in adults and sufficient to protect against COVID-19 infection. 

There will probably not be large volume phase 3 trials to establish efficacy & side effect profiles as were done in adults before the vaccine begins to be administered to children. They will be able to bridge that adult data and apply it to children. 

What does the timeline look like?

From the start of small trials to getting approval for vaccination in kids, it will still likely be months before children can start getting the COVID-19 vaccine. Though we’re probably not looking at another full year, this process hasn’t even begun yet. We must continue to be patient. 

What does this mean for kids when it comes to school?

Let’s review what we have learned thus far in the pandemic before considering what this wait time might mean for kids in relation to school attendance. Data until now indicates that community transmission rates don’t seem to be impacted by schools being opened or closed. Children under the age of 10 are less prone to getting symptomatic COVID infection and child to child transmission of COVID-19 is not prominent. Even child to adult transmission doesn’t seem to play a huge role in the spread of the virus. This makes us feel like elementary schools & daycares are comparatively safe.

On the other hand, older kids in middle school and high school are more susceptible to infection with Coronavirus than younger kids and can spread it to others even if they don’t have symptoms. After school activities, sporting events & social gatherings create an environment conducive to the transmission of the virus by being indoors for extended periods of time or in proximity with large numbers of people. 

The stark reality is that as of December 1, 2020, over 1.3 million of the 13+ million COVID-19 cases in this country are in children. In the last week alone, 154,000 children in America were diagnosed with COVID-19 infection. This is the highest weekly total of COVID-19 diagnoses in American children until now in this pandemic. The rising number of cases in children is alarming to me.

Here are some things that I worry about as a Pediatrician when I think of the rapidly rising COVID cases in children:  

  • What might this mean if asymptomatic children take the virus home to susceptible elderly relatives or those with underlying health conditions like diabetes? Though not big players in the transmission of the virus, children can still pass it along. Would we propagate the pandemic in spite of getting closer to ending it with the vaccine? 
  • We know that minority populations like Blacks, Latinx & Native Americans are being disproportionately affected by COVID-19. Will the exposure of school-going children in a minority community with increasing COVID transmission be too much of a risk for household members in these populations? 
  • We know winter is approaching. Respiratory viruses thrive & spread in cold temperatures. Children are prone to getting illnesses like flu, colds, strep throat, and this season, maybe COVID too. If community transmission of COVID is rising in the winter, doesn’t it behoove us to be aware of the possibility of double infections & their potential effects on how one’s immune system might be overstretched fighting two serious infections at once? 
  • We don’t know enough about the potential long-term effects of COVID-19 infection on our kids. With so many children having mild or completely asymptomatic cases that may go undiagnosed, what if they end up having long-term consequences of inflammation in their heart, lung, or nerve tissues without us ever having known they had COVID-19? Will that impact their livelihood & lifestyle in the future? Numerous studies are underway to follow the consequences of “long COVID” in adults. They are finding that many adults with “long COVID” symptoms had mild cases of COVID-19 and didn’t necessarily require hospitalization. Is it just a matter of time before we have the same findings in children? We must remain vigilant that our actions now may lead to unwanted consequences later. 

I am not oblivious to the challenges families have faced with schools closing down. Some families have had a lack of resources when it came to technology, food & supervision. Educators have had difficulty providing special services for our children who depend upon them. I am sadly aware of the increased anger, anxiety, depression, and violence that has occurred in households with the loss of familial routines. We were used to kids going to school and parents going to work. Everyone would come together for an evening after being exhausted from the rituals of the day and wind down together for the night before doing it all over again. Things have been different for a very long time & we yearn for normalcy again, but we must first look at the big picture and ensure safety above all. This means keeping a close eye on our community virus transmission trends and continuing to mask & social distance while we await protection by vaccine before we venture back to our much-missed normal. 

How can we help our kids deal with the wait? 

If there is one thing human beings are capable of, it’s evolution and adaptation. Now more than any other time, we must shift our focus. 

Though these holidays may not be how we are used to celebrating them, there is something very special about what these holidays mean. Being able to celebrate Thanksgiving, Christmas and bring in a New Year is a testament to the fact that we are surviving this pandemic & that we are setting examples for our children on how to manage uncertainty, challenges & stress while moving forward day by day.

Now is the time for us to be thankful for our family members who are still with us, for the jobs that we still have, and the food that is on our table. This is also a time to help our children see that while we are thankful for what we have, there are many who have lost everything they’re familiar with. They have lost parents and loved ones, they’ve lost their jobs, they’re on the verge of being evicted from their homes. This is the time to remember the holiday spirit of giving. This year, December 1st was Giving Tuesday across the globe, calling for world-wide generosity to help those in need. 

Engage your children in helping you write that check to send to charity. Have your kids select toys they’d like to donate or help you make a basket for a friend or neighbor who has lost someone to COVID. Talk to your children about how as human beings we are social creatures who thrive on taking care of one another. Shifting our focus to what we can do not only for ourselves but for those around us helps us recharge our batteries. It gives us solace & strength to continue in the toughest of times.

In Conclusion

With the vaccine race moving at breakneck speed to bring some form of an end to this chaos, now is the time to focus on the light that has been lit by the recent news of spectacular phase 3 results by Pfizer, Moderna & AstraZeneca. The vaccine is a big part of ending this pandemic and now it is finally feeling like we’re getting somewhere real. Now is the time to look forward to the normalcy that is in sight once again. As we get excited, let’s share that excitement with our children on their level. Let them also feel the hope we are beginning to feel inside again. Together, we have the strength to push through this pandemic safely & cautiously while we give it “a shot” to come to an end. 

 

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