Should young kids get COVID-19 vaccination when it’s available?

As any child will tell you, adults like to complicate things. And they rarely miss an opportunity to argue about things.

A case in point: the COVID-19 vaccination for children aged 5 to 11.

The U.S. Food and Drug Administration issued an emergency use authorization for child-sized doses of the vaccine made by Pfizer and BioNTech, and the Centers for Disease Control and Prevention subsequently recommended widespread use of the vaccine among the nation’s 28 million elementary-age children.

The action was recommended by two panels of independent experts who advise the FDA and CDC on vaccines. Now shots go into little arms.

When it comes to adults and older children, groups like this have almost always said everyone should get vaccinated. This time, however, it was different: Several members of the FDA advisory panel made it clear that they don’t think the vaccine should be given to as many young children as possible, at least now.

The CDC’s Advisory Committee on Immunization Practices did not share those reservations, especially given data suggesting the vaccine was more than 90% effective in preventing COVID-19 in 5- to 11-year-olds.

“Based on our expertise and the information we have, we are all very enthusiastic,” said committee member Dr. Beth Bell, Professor of Global Health at the University of Washington.

Here’s a closer look at the infant vaccination debate.

Why all the fuss?

You may be wondering why there is even a question about vaccinating children against COVID-19.

The danger of the disease seems clear: at least 94 children aged 5 to 11 have died from COVID-19 since the pandemic began, and 8,300 have become so ill that they have required hospitalization.

Even some who had only mild symptoms developed MIS-C, a condition in which the immune system goes haywire and starts attacking perfectly healthy parts of the body. By early October, 5,217 children had developed MIS-C, including 2,034 between the ages of 6 and 11. Between 1% and 2% of them died.

There is also a possibility that they could develop “Long COVID”. In the UK, around 8% of children who knew they had coronavirus infection suffered symptoms that lasted for months. They had fatigue or muscle pain or breathing problems or difficulty concentrating at school.

There’s another important reason to consider vaccinating young children: a return to normalcy.

Nobody likes to wear a mask all day or have to spend two weeks in quarantine after being exposed to an infected person. If most children were vaccinated, many pandemic restrictions would likely be lifted and children would be able to resume normal life.

What’s not to like?

Not everyone sees it that way. Some parents are still unwilling to vaccinate their children, and not all experts are sure that every child needs to be vaccinated. Throughout the pandemic, the odds that a child of any age would die from COVID-19 never rose above one in two million (and was typically much lower). That’s four times less than the odds of being struck by lightning in any given year.

Also, more than half of young children with coronavirus infections have virtually no symptoms at all. The children who were least likely to get sick or die were those between the ages of 5 and 11. Babies and teenagers got sick more often when they contracted it, and more of them died.

Given all of this, these skeptics ask, why would you take the risk of vaccinating every young child with a COVID-19 vaccine — especially when there are safety issues that researchers don’t yet understand?

A scary heart problem

One of the key arguments made by FDA advisors was a rare vaccine side effect that may not even affect children under the age of 12 after receiving this COVID-19 vaccine. The side effect is called myocarditis and it irritates the heart muscle, causing swelling and often chest pain.

Myocarditis after mRNA vaccination is definitely uncommon: if you vaccinated 1 million 16- or 17-year-old boys and gave them the adult version of this Pfizer vaccine, about 70 of them would experience some form of the disease. It seems to go away on its own, but if you get it, you’ll likely spend several days in the hospital. When these patients come out, they’re advised to stop exercising for three to six months just to make sure they’re okay.

The problem is that no one is certain that myocarditis will permanently damage a child’s heart. They also don’t know if younger children who haven’t hit puberty could even get it. They reckon the child-sized dose is too small to elicit such a response.

How are we going to find out?

This is one of the problems encountered when assessing the safety of a new vaccine during a public health emergency. To speed up the task of making sure this vaccine works safely in young children, government experts drew on some of the safety data from previous studies and asked Pfizer to test smaller doses in a few thousand children in the 5 to 11 age group.

Even if myocarditis is as common in young children as it is in teenagers, you would need more than 14,000 children in your test group to have one case of myocarditis. With a test group of fewer than 3,000 children, chances are you won’t see any cases.

But that doesn’t mean they won’t happen — and no one will know until millions of children start vaccinating.

The prospect of marching millions of children into such an unsafe situation is troubling to some experts. But the government has a system in place to keep tabs on reports of possible side effects from vaccinations. The FDA assured its advisers that if cases of myocarditis emerge, they will hold off vaccinations while they find out if there’s a link and let people know what they find.

Do children already have some protection?

Maybe. Children in elementary school can easily contract the coronavirus. Even if it doesn’t make them sick, their immune systems learn to recognize it so the next time the virus calls, their natural defenses can act quickly to shut it down.

A study by researchers at the CDC found that at least 40% of children fall into this category. But since the coronavirus is new, no one is sure how long a child’s immune system will remember it or how strong the protection will be.

Given all of this, does it make sense to vaccinate them all? Some experts don’t think so.

Is it over yet?

A lot of adults were sure the pandemic was just over, and boy have they been proved wrong. Four separate times we’ve seen infections and deaths rise and then decline. And every time they’ve risen again so far.

But when considering whether most younger children need the vaccine, what really matters is whether the end is in sight. If the virus simply can’t spread as quickly because so many people are immune, most children may not need more protection – especially since there can be risks in vaccinating all children in this age group.

On the other hand, if another rise is on the horizon, taking this risk could be a really good way to avoid it.

Does the vaccine do more to protect young children or those around them?

Although most young children with coronavirus infections don’t get sick themselves, they’re good at spreading the virus — and it can be hard to tell it’s happening because they seem perfectly fine with it. This is a real problem when they live or go to school with people who could get very sick if infected.

This includes other children with asthma, diabetes, or obesity, as well as parents or grandparents who have had cancer or chronic heart problems. The young children in these situations should probably get vaccinated to break the chain of transmission before it reaches those at risk.

The children with these higher-risk health conditions should also get vaccinated to protect themselves, experts say.

Why does someone get vaccinated?

Mostly to protect ourselves. But also to protect each other.

The more people get vaccinated, the more protection there is for the most vulnerable among us. For many people, it would be worth taking a small risk of a vaccine side effect — even one like myocarditis — to protect a classmate or grandparent.

One thing is clear: children should be protected

Here’s the last thing worth saying about adults: They love their young children and—no surprise—will fiercely defend them against any harm. Because of this, some adults who have been vaccinated against COVID-19 themselves may need more information before having their children vaccinated, while others take their children directly to the pediatrician for the first dose.

It’s complicated. Should young kids get COVID-19 vaccination when it’s available?

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