It’s time for my healthy nine-year-old son to get vaccinated against COVID-19. In fact, it’s time for every kid aged five to eleven to get vaccinated.
An advisory committee to the Food and Drug Administration (FDA) has reviewed the data from clinical trials assessing the safety and efficacy of the Pfizer-BioNTech vaccine in children five to eleven years old. The experts voted unanimously to recommend authorization for this vaccine in children in that age range. As a next step, the Centers for Disease Control and Prevention (CDC) will decide whether all kids should have access to the vaccine, or only some. Some experts have proposed use in high-risk children only while we accumulate additional data.
Waiting to vaccinate all children would be a mistake. Based on the data we have, the right answer is clear: the CDC should recommend that all kids ages five to eleven should have be vaccinated as quickly as possible.
There is one thing all experts agree on: Vaccinating children should be based on rigorous evidence and we should set a particularly high bar for using vaccines in healthy children.
The Pfizer COVID vaccine has cleared that bar. Whether these vaccines work in kids is beyond dispute: they are extremely effective, reducing COVID infections by more than 90 percent. This number is based on data gathered during the Delta surge in the U.S., when vaccine breakthroughs among adults were becoming more common in the U.S. Such a high level of protection from the vaccine at a time when infection rates were extremely high is remarkable.
A common source of confusion, sewn largely by COVID-19 minimizers, is around whether we should be vaccinating kids because children are less likely to get sick than adults. This is true—but also not the point. The real question is how the risk of COVID in kids compares to other risks children face. Here, the data for protecting kids is compelling: COVID-19 was the sixth-leading cause of death among children ages five to eleven in 2020 and overall, has led to nearly 700 deaths among children. In a typical flu season, approximately 200 children die, an unacceptably high number for which we recommend universal vaccination. COVID remains far more deadly for children than the flu.
The next question is how the risks and benefits of the vaccine compare to the risks of getting COVID. Here, the calculation is also straightforward: the virus is a constant threat, to our children and all with whom they interact—including playmates, friends, and relatives. We have seen what COVID can do if we don’t control its spread. The worst of the Delta surge is behind us, but over 1000 Americans still die every day from the disease. Vaccines prevent infections and the spread of the virus, and save lives.
Like all vaccines, COVID vaccines can have the standard side-effects of a sore arm, fever or headaches, but these side-effects are mild and short-lived. There are also important concerns about one specific side effect that is crucial to recognize and fully understand: myocarditis—or an inflammation of the heart muscle.
Myocarditis in the pre-COVID era was a rare condition more commonly associated with infections from viruses such as influenza or coxsackie. These cases could occasionally be serious leading to long-term complications due to direct infection of the heart muscle by the virus itself or the intense immunologic response triggered by the infection. We see this myocarditis in unvaccinated children who have been infected by COVID, where some cases can be serious.
Vaccine-induced myocarditis is quite different. First, it is very rare. In fact, we know that the risk of getting myocarditis from COVID among 12- to 17-year-olds, for whom we have the best data, is about 1 per ten thousand children vaccinated. The side-effect occurs more often in boys, as often as 17 per 100,000 boys vaccinated. We don’t know why this difference exists, though there may be a role for the hormone testosterone. But these rare instances of vaccine-related myocarditis cases in teenagers were mild and the teens recovered in a week or two.
For children 5 to 11, no cases of myocarditis were detected in clinical trials. The trial included 2,000 children who received the vaccine so it is possible very rare side-effects could be missed. But it is clear that myocarditis is not a common side effect in five- to eleven-year-olds, and that the rates of myocarditis in this population of largely pre-pubescent children, particularly boys, is likely to be even lower than in teenagers.
We need to start preparing for a world in which SARS-CoV2 will be endemic, circulating for decades or longer, just like measles, whooping cough and the flu. I care about my child’s health over the long term, not just the brief window when side effects may occur. The benefits of vaccination, even if there is some waning, will last years. Beyond 6 months after vaccination, the risk of side-effects from a COVID vaccine is essentially zero. The benefits for my child will be substantial.
This is why essentially every expert on child health has come out in support of vaccinations. The American Association of Pediatrics, has been vocally supportive, as has the American Association of Family Practitioners, who represent physicians who care for millions of children.
I get it. Kids don’t like any vaccines. Needles are scary. My 9-year-old has asked if there is an option that doesn’t involve a needle. I wish there was. And, of course, for a parent, it can seem scary to you to give your child a new vaccine. We want to do the right thing, in frighteningly unfamiliar circumstances.
It is helpful to take a step back, and remember how vaccines have transformed our lives, and the life expectancy of our children. We give children dozens of vaccines, without which they would be vulnerable to potentially fatal diseases from measles to pneumococcal disease—diseases that continue to sicken unvaccinated children around the world. It is time for the CDC to continue its important work on protecting our children by adding another tool to the arsenal. We need COVID vaccinations for all children five to eleven years old so parents can get their children vaccinated and keep them safe. That’s what I’m going to do.
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Contributor: Dr. Ashish K. Jha