It’s time for my healthy nine year old son to get vaccinated against COVID-19. In fact, it’s time for every child between the ages of five and eleven to get vaccinated.
An advisory committee to the Food and Drug Administration (FDA) has reviewed clinical trial data evaluating the safety and effectiveness of the Pfizer BioNTech vaccine in children ages five to eleven. The experts voted unanimously in favor of a recommendation for approval of this vaccine for children in this age group. As a next step, the Centers for Disease Control and Prevention (CDC) will decide whether all children should have access to the vaccine or just some. Some experts have only suggested using it on high-risk children while we are collecting additional data.
It would be a mistake to wait to have all children vaccinated. Based on the data we have, the correct answer is clear: the CDC should recommend that all children between the ages of five and eleven should be vaccinated as soon as possible.
All experts agree on one thing: vaccination of children should be based on rigorous evidence and we should set the bar particularly high for the use of vaccines in healthy children.
Pfizer’s COVID vaccine has exceeded that bar. Whether these vaccines work in children is beyond dispute: they are extremely effective, reducing COVID infections by more than 90 percent. This figure is based on data collected during the US delta surge, when vaccine breakthroughs became more common in adults in the US. Such a high level of protection afforded by the vaccine at a time of extremely high infection rates is remarkable.
A common source of confusion, mainly caused by COVID-19 minimizers, is whether we should vaccinate children, as children are less likely to get sick than adults. That’s true – but neither is the point. The real question is how does the risk of COVID in children compare to other risks for children? Here that Data for the protection of children is convincing: COVID-19 was the sixth leading cause of death in children between the ages of five and eleven in 2020 and has resulted in a total of almost 700 child deaths. About 200 children die in a typical flu season, an unacceptably high number for which we recommend universal vaccination. COVID remains far deadlier for children than the flu.
The next question is how the risks and benefits of the vaccine compare to the risks of contracting COVID. Again, the math is simple: the virus is a constant threat to our children and anyone they interact with – including playmates, friends, and relatives. We have seen what COVID can do if we don’t control its spread. The worst of the Delta Wave is behind us, but the disease still kills over 1,000 Americans every day. Vaccines prevent infection and the spread of the virus, and save lives.
Like all vaccines, COVID vaccines can have the usual side effects of arm pain, fever, or headache, but these side effects are mild and short-lived. There are also important concerns about a specific side effect that it is important to identify and fully understand: myocarditis – or inflammation of the heart muscle.
Myocarditis in the pre-COVID era was a rare condition that was more commonly associated with infections from viruses such as influenza or Coxsackie. Occasionally, these cases can be serious and result in long-term complications due to direct infection of the heart muscle by the virus itself or the intense immunological response triggered by the infection. We see this myocarditis in unvaccinated children infected with COVID, and some cases can be severe.
The situation is very different with vaccination-induced myocarditis. First, it’s very rare. In fact, we know that the risk of developing myocarditis from COVID in 12-17 year olds, for whom we have the best data, is around 1 in every ten thousand children vaccinated. The side effect is more common in boys, up to 17 in 100,000 boys vaccinated. We don’t know why this difference exists, although the hormone testosterone may play a role. But these rare cases of Vaccine-related myocarditis Cases in teenagers were mild and the teenagers recovered in a week or two.
No cases of myocarditis were found in clinical trials in children between 5 and 11 years of age. The study enrolled 2,000 children who received the vaccine, so it is possible that very rare side effects may be missed. But it is clear that myocarditis is not a common side effect in five to eleven year olds, and that myocarditis rates are likely to be even lower in this group of predominantly prepubescent children, especially boys, than in teenagers.
We need to prepare for a world where SARS-CoV2 will be endemic and will circulate for decades or more, just like measles, whooping cough, and flu. The health of my child is important to me in the long term, not just the short window of time in which side effects can occur. The benefits of vaccination, even if something wears off, will last for years. Beyond 6 months after vaccination, the risk of side effects from a COVID vaccine is essentially zero. The benefits to my child will be significant.
For this reason, practically every child health expert has voted in favor of vaccinations. The American Association of Pediatrics was made vocally supportive, as well as the American Association of Family Practitioners, which represents doctors who care for millions of children.
I get it. Children don’t like vaccinations. Needles are scary. My 9 year old asked if there was an option that didn’t involve a needle. I wish there was. And of course, giving their child a new vaccine can seem scary to a parent. We want to do the right thing under terrifyingly unfamiliar circumstances.
It is helpful to take a step back and remember how vaccines changed our lives and the life expectancy of our children. We give children dozens of vaccines without which they would be susceptible to potentially fatal diseases from measles to pneumococcal disease – diseases that continue to get sick with unvaccinated children around the world. It is time the CDC continued its important work of protecting our children by adding another tool to the arsenal. We need COVID vaccinations for all children aged five to eleven so that parents can vaccinate their children and protect them. I will do that.
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