Vaccines for Young Children?


Do young children need to be vaccinated? That is the question on the minds of millions of parents as pharmaceutical companies push for authorization of vaccines for the very young.

Pfizer has announced plans to seek emergency use authorization (EUA) from the FDA soon for vaccines for youngsters ages 5 to 11. The FDA has promised to move quickly on the application and expects to make a decision by the end of the month. Previous FDA approval was given first to those over age 16, and later for those ages 12 to 15. Is it time to begin vaccinating children as young as age 5?

Although Covid is generally mild in children, the latest data shows the Delta variant has resulted in more than 30,000 children being hospitalized since August. According to the American Academy of Pediatrics, nearly 5.9 million Americans younger than 18 have been infected with the coronavirus. Of the roughly 500 Americans under 18 who have died, about 125 were ages 5 to 11. That’s a tiny fraction of the numbers affecting older Americans, but it is still a significant number, especially if it is your child.

“It really bothers me when people say kids don’t die of Covid,” said Dr. Grace Lee, an associate chief medical officer at Stanford Children’s Health who also leads a key advisory committee to the C.D.C. “They die of Covid. It’s heartbreaking.”

Pfizer anticipates giving young children one-third of the adult dose of the vaccine. Just as in adults, two shots will be necessary, spaced three weeks apart. The Wall Street Journal says school districts and public-health officials have begun preparations for vaccinations, though the work remains in early stages. Health and vaccine experts expect the vaccines to be administered at certain schools, pediatrician offices and some pharmacies.

Schools and public-health departments are experienced with childhood vaccines unrelated to Covid-19 because they routinely administer them, although the cold-storage requirements of the Pfizer-BioNTech vaccine may pose some challenges, according to the experts.

Pediatrician offices and other administration sites won’t be able to vaccinate the children with existing supply on hand because doses for children are smaller and prepared differently than for adults. Pfizer said it would start shipping the pediatric doses, if authorized, as soon as it is cleared to do so by U.S. health authorities.

Many parents are eager to have their children vaccinated so they can resume many activities that have been restricted due to the pandemic. Others parents are wary of exposing their children to a new vaccine. According to a recent survey conducted by the Kaiser Family Foundation, roughly a third of parents of children between ages 5 and 11 said they would wait and see before allowing their children to receive the shot.

Dr. Walt A. Orenstein, an epidemiologist at Emory University and a former director of the U.S. immunization program, said that given the competing pressures on the F.D.A. to make vaccine decisions quickly but carefully, public discussion was essential. He said many parents were wavering between fear of Covid-19 and fear of side effects from a pediatric vaccine. If they were less worried about the consequences of coronavirus infection, he said, concerns about possible side effects would be their top priority. If they were more worried, the vaccine’s effectiveness would matter more. As with other vaccines, Dr. Orenstein said, pediatricians would play a critical role in easing parental anxiety.

I am old enough to remember when vaccinations for young children first became available for poliomyelitis. Polio is a devastating disease that crippled many children and killed some. The polio fatality rate is 2 to 5% in young children and 15 to 30% in adolescents. The introduction of the polio vaccine in 1955 changed all that. The graph below shows the impact of the polio vaccine.

By contrast, recent data in young children indicates 5.9 million have tested positive for Covid 19 according to the American Academy of Pediatrics. There have been 520 deaths recorded in children. Of these, only 125 under the age of 12 have died – and there is no crippling effect as was commonly seen in polio. The AAP reports a fatality rate of 0.01% of all child Covid 19 cases, but this includes children up to age 18. The fatality rate for young children, under age 12, is only 0.002%. So, polio takes the life of 2 to 5 children in every 100, while Covid-19 takes the life of about 2 in every 100,000. That means the chances of your child dying from Covid are more than 1000 times less than polio. As a parent, you’ll have to weigh these figures compared to the risks of a serious vaccine side effect in your child. That data is currently unavailable.

There is no doubt Covid-19 is not the scourge that polio was in the 1950s. Whether or not it is serious enough to have your child vaccinated is a question every parent of small children will soon have to decide.

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