COVID-19 Vaccination Consideration for Children

Summary: The ongoing pandemic with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) that causes coronavirus diseases (COVID-19) has its footprint across the globe. Despite efforts from public health initiatives and the modern medical apparatus to control the advance of coronavirus, it has now engulfed the entire world, with > 255 million COVID-19 positive cases, and with >5.13 million confirmed casualties. Undoubtedly, we are facing the most difficult times experienced in this century. The true consequences of the current outbreak are unimaginable and yet to come. However, effective vaccinations have helped reduce the severe effects of SARS-CoV-2.

With the vaccines for 5 to 11-year-old children approved in USA, Israel, and Canada, many parents are considering the risks and merits of having their children get vaccinated. 

On the surface, many will observe that few children have severe outcomes associated with COVID-19. According to the Alberta Health Services, out of 100 COVID-19 positive five to nine years old children, only 0.2 cases have been hospitalized and of 100 COVID-19 positive 10 to 19 years old individuals, 0.5 cases have been hospitalized so far. In both categories, an extremely low number of COVID-19 positive individuals have been admitted to the intensive care unit (ICU). Nationally, the trend is very similar as well.

Therefore, parents often ask themselves many questions. Since almost all children recover from COVID-19 infection and develop no severe outcomes, is vaccination necessary? Are vaccines safe for my child? If my child has been previously exposed to COVID-19, should they still get vaccinated?

These are reasonable questions. But they are questions that are increasingly hard to answer due to the vast amount of information (and misinformation) parents are exposed to through conversations with others and on social media. Parents should seek evidence-based information from healthcare professionals and experts.

One of the most important pieces of information parents should consider is that the clinical studies (conducted by Pfizer-BioNTech) demonstrate COVID-19 vaccine in children is 90.7% efficacious! Based on this evidence, on Oct 29th 2021, the Food and Drug Administration (USA) authorized the emergency use of Pfizer-BioNTech vaccine for children aged 5 to 11 years consistent with other approvals (on 14th November, Israel also approved the same vaccine for children aged 5 to 11). Subsequently, Health Canada approved the same vaccine for childer on Nov 19th, 2021.

These data are remarkable, considering that Pfizer-BioNTech conducted their clinical studies with one of the most infectious variants identified so far, the delta variant of SARS-CoV-2. Similar outcomes are being expected for Moderna COVID-19 vaccines for children as well. 

One of the reasons children should be fully vaccinated, despite them developing no severe outcomes upon catching COVID-19, is the fact that we live in a society that includes the elderly population, as well as the population at risk due to complications with the immune system. Although ~90% of Canadians aged 60 and above are fully vaccinated, many elderly community members may not be able to develop a sustained immune response to combat future exposures to COVID-19. Therefore, a gathering involving children who may carry the virus, with the elderly population may result in the spread of the virus to the at-risk populations.

This is increasingly relevant given that cases among children is on the rise. As observed in the United Kingdom, the number of COVID-19 positive cases for children aged 7 to 11 increased by 7.8 % from 5th Sep to 16th Oct. Similarly, in the USA, a rapid increase in COVID-19 cases for children aged 5 to 11 is being observed, with about 1.9 million Covi19 positive cases, accounting for 5.4% of COVID-19 confirmed cases. With the rapid surge in delta variant globally and the return to in-person schooling and other activities, everyone should be encouraged to promote the safety of all community members. 

Simply, although children almost always recover from COVID-19, they might spread the infection to others. 

The concern of negative health outcomes in children due to receiving the COVID-19 vaccine is one parents are thinking about. Vaccines are safe. In Canada and globally, children receive many vaccines since their birth. Some parents may question the speed at which COVID vaccines were created and produced, but an aggressive strategy was of course necessary given the historic nature of the pandemic. Conducting multi-year studies traditionally used to evaluate the safety and efficacy of vaccinations, would lead to severe consequences and will put a big dent in our goal of preventing COVID-19 infection spread. Even though parents may have concerns about this vaccine, in USA, about 900,000 children from 5 to 11 years of age received their first dose of the COVID-19 vaccine within the first week of approval!

But this work is ongoing. Current studies are indicating the Pfizer-BioNTech COVID-19 vaccine for children may cause pain at the injection site pain, fatigue and headache and, risk of vaccine-induced myocarditis, which is observed due to the vaccination against many viral infections (e.g., smallpox, polio, influenza, etc.). 

While the question of possible negative effects of vaccination makes sense, parents should also consider possible long-term consequences of a COVID-19 infection. A recent US study based on COVID-19 patients hospitalized from March 2020 to Jan 2021 indicated that individuals with COVID-19 have approximately 16 times the risk of myocarditis. Moreover, globally, millions of mRNA-based vaccines (Pfizer-BioNTech and Moderna), have been delivered, reflecting the confidence of healthcare agencies across the world. Overall, based on this emerging evidence, FDA concluded that the many benefits of COVID-19 vaccination for children outweigh the risks. 

Emerging evidence also suggests that COVID-19 infection causes organ damage, which can impose severe health outcomes in the future. Many individuals have reported shortness of breath, chronic kidney impairment, cardiovascular complications, and Guillain-Barre syndrome, etc. Although rare, multisystem inflammatory syndrome has also been observed in children. The long-term implications of COVID-19 in children remain to be a major unknown challenge. 

Vaccinations for children are being proven to be low-risk and will protect children from long-term health effects. Further, it is becoming increasingly clear that vaccination across all age groups is necessary for protecting all of the vulnerable in our society as well as preventing future waves of infection. 

The authors led the relaunching efforts of in-person experience of the University of Lethbridge for the Fall 2021 semester.