Teenagers being vaccinated for Covid
Dr. Stephen Thomas, an infectious disease expert who led a clinical trial of Pfizer’s Covid vaccine, explains why it’s important for children to be vaccinated.
On Monday, the U.S. FDA granted emergency use authorization for the Pfizer / BioNTech Covid-19 vaccine for children ages 12-15 years. On Wednesday, the Advisory Committee on Immunization Practices, an independent review board that advises the CDC, reviewed the available data and recommended it for this age group. Meanwhile, the vaccine continues to be tested in children down to 6 months of age. All of these activities make the once hypothetical scenario of vaccinating our children against SARS-CoV-2, very real. The question now is not whether we can we vaccinate our kids against Covid-19, but, rather, why wouldn’t we?
As an infectious diseases physician who has been battling the Covid pandemic since it arrived here in the U.S. and investigator in the Pfizer Covid-19 vaccine trials, I absolutely plan to ensure my children are vaccinated. Here’s why:
Children get infected, they get sick, and they can die from Covid-19
While it is true that most children who are infected with SARS-CoV-2 do not become seriously ill, a small percentage do, and when you consider the U.S. has over 75 million children under the age of 19, even a small percentage becoming sick can represent a significant public health problem.
According to the American Academy of Pediatrics, children made up just 2% of all US Covid-19 cases in April 2020. Today, children account for more than 14% of all Covid-19 cases. In the U.S. alone, there have been over 3.8 million documented Covid-19 infections in children, more than 3,000 cases of the severe hyperinflammatory syndrome (MIS-C), over 15,000 hospitalizations, and more than 300 deaths. For perspective, the 2019-2020 US influenza season was considered one of the worst for kids - there were 198 deaths.
In the Pfizer trial, there were zero cases of Covid-19 among more than 1,100 vaccine recipients between the ages of 12-15 years, and 16 cases among an equal number of placebo recipients. This translates into 100% efficacy, the best of any age group tested thus far. Vaccine recipients also had very high levels of vaccine-induced antibodies.
We don’t know the frequency of children becoming Covid-19 ‘long haulers’
There is also the concern that infected children may become Covid-19 ‘long haulers,’ who experience Covid-like symptoms for months, or even longer. The true frequency of this syndrome in kids is unknown. But the fact that numerous hospitals have had to open Covid long haul clinics for children suggests the problem is real. Congress has provided over $1 billion dollars to research the prolonged health consequences of Covid-19, so we’ll know more in the months to come.
Children get infected and can transmit the virus to others
Once you are infected with SARS-CoV-2, the virus begins to replicate in your body. Large amounts of replicating virus not only increase the severity of your illness, but also makes you more infectious to other people. Vaccines reduce illness by blocking and/or reducing viral replication, thereby raising the possibility vaccines could also reduce a person’s transmission potential. Real world data indicates the Pfizer Covid-19 vaccine may be doing just that, not only reducing rates of asymptomatic infection, but also reducing the viral burden in those who do get infected. Bottom line: vaccinated people are less likely to make other people sick.
People argue this indirect benefit is insignificant because children do not play an important role in SARS-CoV-2 transmission. Relative to adults, this may, or may not, be true. It is important to remember, however, studies and simulation models addressing child transmission of Covid-19 were made prior to the introduction of more infectious variants into the U.S. In addition, until recently, in-person gathering, like school and sports, were uncommon, the economy was largely closed, and social distancing and masking were being more strictly implemented. Today, the situation is much different, and the opportunities for kids to be infected, and to infect others, are greater.
Covid-19 has secondary effects on our children and families
Despite the relatively low burden of Covid-19 disease in children, the pandemic has had other profoundly negative effects on our kids. More than a year of complete, or partial, remote learning was not only concerning academically. Social isolation, reduced delivery of special education and related services, loss of meal assistance, and the challenge of finding child care to support working parent(s) impacted millions of families. But not equally. Covid-19 disruptions in our education system impacted low income and at-risk youth much more profoundly.
Once in a while, a colleague or patient will share with me how their child has “thrived” in the remote learning environment. Far more often, I am hearing stories about A students becoming C students, children socially withdrawing, becoming depressed and worse.
It is expected that when Covid-19 vaccines receive full FDA approval, vaccination will become mandatory for many college and university students who want to attend in person classes. Whether similar mandates will extend to K-12 schools remains ambiguous. What does appear clear is that large scale Covid-19 vaccination of school-aged children will provide the most direct pathway back to the classroom, track, field, gym, lab or stage, and end the frequent and disruptive cycle of mass student and teacher quarantines.
