Do kids need the COVID-19 vaccine urgently? The short answer, according to some experts, is no.
But the question is a complex one – whichmembers of the Food and Drug Administration’s Vaccine advisory committee grappled with on Thursday. At the end of the 7 hour meeting, there was no consensus on whether criteria should be established to pave the way for Emergency Use Authorization for the vaccines to be given to children under 12 years old.
Members of the Vaccines and Related Biological Products Advisory Committee (VRBPAC), a panel of more than 15 independent experts, all agree children should have access to a COVID-19 vaccine at some point.
But that’s where the unanimity ends.
Dr. Cody Meissner, a VRBPAC member and director of Pediatric Infectious disease at Tufts University, argued there simply isn’t an emergency when it comes to children, pointing to coronavirus hospitalization rates that are now hovering around four per million in those under 18 years old.
“It is a very low hospitalization rate. The rates are also falling pretty dramatically among adults and children,” Meissner said, adding: “I do not feel we can justify an EUA including children.”
As countries like Israel and the U.K. weigh whether it makes sense to vaccinate children under 12, doctors across the United States are also considering the pros and cons.
Dr. Monica Gandhi, an infectious disease physician and professor at The University of California San Francisco, agrees there should not be a rush to vaccinate younger children, pointing to an 84% drop in cases among children since adult vaccinations began – and a nearly 70% reduction in child hospitalizations.
“Children have a threefold less chance of getting COVID with the same exposure, than adults,” Gandhi said. “They are essentially half as likely to spread. So if they have it in their nose, they can't spread it as well as adults because of lower viral load. Then on top of it, they are more likely to not have any symptomatic infection or at least not severe infection, which is just a blessing with COVID.”
Gandhi is not a member of VRBPAC, but she and Meissner both express concern with a small but sizable group of vaccinated teens and young adults diagnosed with myocarditis or pericarditis – which is inflammation of the heart – after receiving the mRNA COVID-19 vaccines. A majority of the 573 cases occurred days after receiving the second dose of the vaccine.
“I’m worried about myocarditis. I’ve spoken to a number of cardiologists about this,” said Meissner during the VRBPAC meeting. “Will there be scarring? Will there be a predisposition to arrhythmias later on? Will there be an early onset of heart failure? We think that’s unlikely, but we don’t know that. So before we start vaccinating millions of adolescents and children, it is so important to find out what the consequences are. Because the COVID-19 disease is disappearing in adolescents and children.”
There are, though, plenty of physicians, pediatricians in particular, who see things very differently.
Dr. Jennifer Lighter, a pediatric infectious disease doctor at NYU Langone Health, said the cases of myocarditis among vaccinated teens and young adults is similar to numbers seen in the general population. “Other viruses cause myocarditis— can trigger myocarditis,” said Lighter. “Usually the enteroviruses can do that. And we’re in enterovirus season right now.”
When it comes to the coronavirus vaccine, Lighter said younger children should gain access to it as soon as possible.
“Part of the reason we're doing so great with cases coming down is not only because of vaccination, but there is a seasonality to COVID,” said Lighter. “I would not be surprised in the fall if there is an uptick in cases among people that are not vaccinated. Children represent 22 percent of the population, if you have this large reservoir of people that are not vaccinated, you know, you're just contributing to an uptick.”
Several experts echoed similar concerns during the FDA’s advisory meeting Thursday.
“I'm very concerned that as children return to school, as things continue to open up, and as we go into fall and winter, that we could have a very different epidemiological situation, and really need the tool of a vaccine for children,” said Dr. Melinda Wharton, Director of the CDC’s Immunization Services Division of the National Center for Immunization and Respiratory Diseases.
Dr. Prakriti Gill, a third year pediatric emergency medicine fellow at Mount Sinai, and her colleagues published one of the first case reports in the U.S. on multisystem inflammatory syndrome in children with COVID-19 (MIS-C), after caring for patients struck with the condition during the height of the pandemic.
“Even though relatively lower numbers of children get COVID-19 in general and relatively low numbers of children get really, really sick, and even lower numbers of those children get MIS-C and end up in the ICU, when you work as a pediatric emergency medicine doctor, every single child who gets sick with that, that's an important number. And those numbers are not nothing," Gill said. "So I think our best method of making it through this is going to be through primary prevention and that's through your vaccinations."
The CDC considers MIS-C to be a rare consequence of a COVID-19 infection in children. Depending on the state, the incidence rate is anywhere from 0.2 to 6.3 per 100,000 people 21 and younger. Those figures though are from March 2020 through January 2021.
Gandhi argues much has changed since then. She said she supports vaccinating children against the coronavirus, but said now public health authorities should consider taking time with pediatric COVID-19 immunizations. It may help restore trust in the midst of high rates of vaccine resistance.
“What we should say is we understand that you want to vaccinate your child. If this is safe, we're going to do due diligence on the safety,” said Gandhi. “It behooves us to be truthful, always stating the facts, never exaggerating.
As the world waits for more data to come in from the vaccine trials in children, Gandhi believes kids should be able to regain some normalcy, particularly in states with high vaccination rates.
“The vaccination of children should not determine the normalcy of their lives, including in the fall school year,” said Gandhi. “It is important to say that adult vaccination protects kids, that having a lower rate in the community will protect children, children who have not had normal lives at all.”
“I would be surprised if the guidance changes by the fall to say people that are unvaccinated do not have to wear masks. I think that guidance will stay and then children will just fall into that bucket if they're not vaccinated,” Lighter countered.
Ultimately, Lighter said the focus for now should remain on getting as many people as possible – kids included – vaccinated before fully returning to normal.
Lighter said with now over a year’s worth of data on the safety and efficacy of the vaccine in adults, “I think the the safest and prudent and most logical thing to do are for parents to vaccinate their kids, to keep their child safe from COVID, but to protect the family and to protect the community.”
CDC experts will present the latest data on the potential link between the mRNA vaccines and heart inflammation in teens and young adults during another emergency meeting of its Advisory Committee on Immunization Practices on June 18th.
Vaccine manufacturers Moderna and Pfizer are recruiting children between the ages of 6 months and 11 years old for vaccine studies, in the hope that they can apply for Emergency Use Authorization in the coming months.