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

TORONTO -

Health Canada announced on Friday that it has green-lit Pfizer-BioNTech’s COVID-19 vaccine for kids aged five to 11 years.

The first doses are scheduled to arrive on Sunday. The National Advisory Committee on Immunization is recommending an interval of eight weeks or more between the first and second doses

But Canadian parents have been divided on whether they would vaccinate their eligible children.

Prior to the vaccine's approval for young children, CTVNews.ca asked parents whether they were planning on vaccinating their children aged five to 11 and also invited readers to submit any questions they had about the COVID-19 pediatric vaccines.

Pediatrics and infectious disease specialist Dr. Jesse Papenburg, pediatrician Dr. Shazeen Suleman, family physician Dr. Tali Bogler and pediatrics professor Dr. Upton Allen 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.

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 children's’ 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.

• Watch CTVNews.ca's Facebook Live conversation with Dr. Tali Bogler and Dr. Upton Allen

Dr. Bogler: It's interesting because the kids actually had less of those systemic side effects than adults, so they actually had less fever and chills, which is great. So those side-effects, we expect them to happen. That's how we know the vaccine is working.

Myocarditis, inflammation of the heart muscle, or any multi-system inflammatory syndrome in children (MIS-C), they did not see these more serious side effects in this trial with kids, which is also very reassuring. These are very rare side effects. Many of us say we wouldn't expect to see it in a trial when it's 3,000 kids. You need a huge number of kids to see very rare side-effects, but still very reassuring that we didn't see those more serious side-effects in this trial.

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.

Dr. Allen: When we look at the development of the COVID vaccines, people often think this all started in 2020. But what really happened was that in 2003 and 2004, we had an entity called SARS-1 and research started on a SARS-1 vaccine. But SARS-1 went away.

When COVID came along, COVID benefited from all of that work. The SARS-1 virus happens to be very closely related to the COVID virus. They're about 80 per cent identical. So all of that work, though, directed at the original SARS-1 virus, the scientists were able to use that to inform the development of the COVID vaccines.

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.

Dr. Bogler: We easily jump to how many kids have died. Well, not that many kids have died. But … really, no kids should die from a vaccine-preventable infectious disease.

It is important to remember that the kids that are hospitalized with COVID-19, one-third of them didn't have any underlying conditions. And so, I hear some of my patients say, "Well, my kids are healthy, but why do I really need to get the vaccine? Because if they were to get sick, they'll probably be fine." But the bottom line of what we've seen about the virus in general, throughout the pandemic, is how unpredictable it can be and so even a healthy child can get quite sick.

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?

PARENTS VIEWS DIVIDED ON VACCINATION FOR KIDS  

When CTVNews.ca put the call out to parents, we received hundreds of emails and comments. Here is a roundup of the responses, highlighting some of the most common questions and concerns:

SEEKING PROTECTION, RESUMPTION OF REGULAR LIFE 

The main reasons people said they plan to vaccinate their kids when possible include protecting their children against COVID-19 and hoping to resume regular life and activities.

“It has been unnerving sending my five year old to kindergarten this year relying on inadequate public health measures to keep him safe,” wrote Tamara Mendez in an email to CTVNews.ca.

Lauren Crane, in southern Ontario, shared similar views in an email. “I have been trying so hard to (keep) both of my asthmatic kids safe from COVID and I feel that after they are vaccinated I will finally be able to breathe a sigh of relief,” the email said.

“For our family, this feels like the final step to feeling ‘safe’ again around people. We also have high-risk friends and family and want to do everything to protect everyone around us.”

Nandini Raj, from Calgary, said she hopes that the vaccine might help her 10-year-old daughter, who she said contracted the Delta variant of COVID-19 at summer camp. Nandini said her daughter still has “fluctuating chest pains,” despite recovering from her other COVID symptoms.

“She has always been active, cheerful and with high spirits,” she wrote in an email. “Her life took a detour in which we cannot predict which direction she goes each day. I am very hopeful that the vaccine will help her.”

Other respondents said they had faith in the scientific review process and noted that they have vaccinated their kids against other illnesses including measles, mumps, rubella and polio.

“My child is afraid of vaccines and my wife and I approach this subject through compassion and understanding,” scientist Bruce Doran wrote in an email from Sudbury, Ont.

“We remind her that the vaccine will protect her from COVID-19, will protect her grandfather, her family her friends and she will be able to do her after-school activities.”

FEAR OF SIDE EFFECTS, QUESTIONS ABOUT COVID-19 RISK IN KIDS

Some of the primary reasons people said they aren’t planning on vaccinating their children include a fear of side effects, and a belief that the risk of COVID-19 in children is smaller than the risk of giving them the vaccine.

“While both my husband and I chose to be vaccinated, when it comes to our children, we have concerns and we need more information,” Pam Andreasen, from Calgary, wrote in an email. “With the extremely low risk that COVID-19 continues to pose to children, we do not feel that vaccinating our children is necessary.”

Liz Levac, from Puslinch, Ont., said she is “extremely” concerned about the possible side effects of vaccinating her kids, in particular her 15-year-old son who has a heart condition.

“We don’t know the long-term effects and new information keeps coming out,” she wrote. “I will not be getting this vaccine for my children and I think it’s completely wrong mandating it for children. They are not flooding our hospitals and have young healthy bodies to fight this virus. Leave our kids alone!”

Jennifer Small, from Toronto, had similar feelings. “Hard no to vaccinate 5-11 year olds,” she wrote. “The risk is minimal for kids in relation to COVID. Why would I inject them with a vaccine that we still don’t know the long-term effects of?”

Shawna Chicilo wrote: “What is wrong with Canada? In children who do not fall ill from COVID anyways, the risk to benefit equation of the vaccine does not add up to me as their mom. “The entire concept of natural immunity is being ignored.”

Many readers pointed to the recent change in Ontario vaccination guidelines for people between the ages of 18-24. Now, Ontario is prioritizing the Pfizer vaccine for this age group, due to an observed increase of the rare heart condition myocarditis associated with the Moderna shot.

Many said they did not feel comfortable with the 2,268-participant sample size of the Pfizer vaccine trial for children 5-11, or the speed at which the trial was conducted. Many also said they felt there isn’t enough data on the long-term effects of the vaccine.

“I do not plan on vaccinating my children,” wrote Amy Steuernol in an email. “To be honest, I simply don’t trust the government or the pharma companies at this point.”

Derek Woodford, from Sudbury, Ont., wrote in an email: “There is no way I would even consider vaccinating my child with the COVID-19 vaccine. We have no information on long-term effects of the vaccine and will not for at least a decade.”