COVID-19 vaccines for children: Experts answer parents' biggest questions

kidsvax

As Health Canada reviews Pfizer-BioNTech’s application to approve its COVID-19 vaccine for kids aged five to 11, Canadian parents are divided on whether they would vaccinate their eligible children if they could. 

CTVNews.ca asked parents whether they were planning on vaccinating their children in the event the vaccine is approved for use, and also invited readers to submit any questions they had about the COVID-19 vaccine for children aged five to 11.

Dr. Jesse Papenburg, a pediatric and infectious disease specialist and medical microbiologist at the Montreal Children’s Hospital and McGill University Health Centre, and Dr. Shazeen Suleman, a pediatrician at Unity Health and an assistant professor at the Temerty Faculty of Medicine at the University of Toronto, answered some of the most frequently asked questions.

Here are their responses, which have been condensed for length:

CONCERN#1: POTENTIAL SIDE EFFECTS

Dr. Papenburg: What we know so far is really limited to what information Pfizer has highlighted in the press release: that it appears the vaccine is immunogenic - in other words it elicits the same amount of antibody response as the vaccinated recipients who are adolescents or adults. And it appears to be safe, or in fact, the side effect profile might be even better than for adolescents or adults.

The study includes a follow-up of over two months that was requested by the FDA. In vaccinology, what we know is that the vast majority of side effects occur within the first week. There are some somewhat delayed side effects that can occur, usually within six weeks, two months max.

These first results which the FDA and Health Canada are going to be basing their decision on include follow-up for two months. Really, that is certainly a standard, reasonable amount of time for any expected side effect that would be associated with a vaccine.

The FDA also asked for an additional follow-up of up to six months within this study, looking specifically at safety, which is ongoing.

The other thing about this vaccine (for children 5-11) is that it’s 1/3 of the adult or adolescent dose. It’s not uncommon to have a pediatric formulation of exactly the same active ingredient or active vaccine product that is in a smaller dose compared to the shot for adolescents and adults. The same thing is true in Hepatitis A and Hepatitis B, as well as in other vaccines.

The reason for that is we know that younger childrens’ immune systems can provide a more robust response to a stimulus, such as an antigen in a vaccine. Therefore we can “get away with a smaller dose” and yet have the same type of levels of protection as you need in higher doses for adults and adolescents.

This is potentially beneficial, because when you have a smaller dose then you’re also likely dealing with less side effects, especially the side effects that tend to occur within a few days after the shot is administered.

Dr. Suleman: I first want to validate that a parent always wants what’s best for their child and I know how scary COVID has been for families. I would encourage every single family that does have a concern to talk to their child’s healthcare provider. They will be able to help you make a decision that’s best for you. Every parent is coming from a place of love and concern, and we want to help families make decisions they’re comfortable with.

CONCERN #2: THE TRIAL WAS RUSHED

Dr. Suleman: It’s important to remember that anything that is going to be approved by Health Canada is going through the same process that any other medication or vaccine has gone through. They are not cutting any corners, with respect to reviewing the evidence.

For COVID, it was a larger global collaboration that allowed for work to be done quickly. We can see the power of collaboration, when we actually work across countries, we share data with one another, how quickly things can happen when we do that. In the past, that has not always happened.

Dr. Papenburg: The amount of scientific and public health scrutiny that the COVID-19 vaccines have been under is unprecedented.

From a scientific perspective (mRNA vaccines) are still a young and emerging tool, but in other ways not really, at all. I don’t think anybody in the lay public knew about them before COVID, but Moderna had already been working on mRNA vaccines for a decade before the pandemic. The mRNA technology is something that has been studied in humans for two decades.

CONCERN #3: THE RISK OF COVID FOR KIDS IS SMALLER THAN THE RISK OF THE VACCINE

Dr. Suleman: With newer variants of concern, physicians are seeing more cases of children with COVID. Some of those cases are asymptomatic and some of those cases are mild. But some of those cases are children who do get severely ill. Even if it’s only one or two cases, you don’t know if it will be your child.

There is also the multi-system inflammatory reaction to COVID called MIS-C, and some children have died from that. We also know vaccination against COVID reduces the spread in the community for people who are at risk for severe COVID (the elderly, people who are immuno-compromised and people who can’t get vaccinated).

Vaccination also helps stop the spread of other variants of concern from emerging, and we don’t know if there will be a variant of concern that does affect children. I would ask that families also consider this when thinking about their individual risk-benefit and their community risk-benefit.

CONCERN #4: SHOULDN'T CHILDREN BUILD A NATURAL IMMUNITY TO COVID? 

Dr. Suleman: I remember a time when we used to think about chicken pox that way. Although most children who got chicken pox via natural immunity were fine, there were some children who died and there were some children who got severely ill. There were also other immuno-compromised individuals who got extremely ill when exposed to a child with chicken pox.

Now we have a vaccine (for chicken pox) and we can keep more people safe, and that doesn’t have to happen. Again, I would ask people to look at their communities, and think about how our health is all connected.

CONCERN #5: MY PARTNER AND I DISAGREE ON WHETHER TO VACCINATE OUR CHILD/CHILDREN

Dr. Suleman: I want to recognize that this is a difficult situation. I want to reiterate that both parents are coming from a place of concern. Recognizing that can help open up conversations to understand where each parent is coming from.

My guidance would be for families to think about their child’s healthcare provider as someone who can help answer questions and be involved in these discussions. I would encourage being open and receptive to hearing different perspectives, and remember that everyone is coming from a place of love. Parents care about their child, and if someone is concerned, that is love manifesting as concern, so how can we help understand and help unpack that?

-- with files from CTV News --