As adults in the United States continue to offer their COVID-19 vaccinations, children and teens have been largely kept out of line. That may change soon.
The country’s leading infectious disease expert says it will have information by autumn showing that children and teenagers aged 12 to 17 can roll up their sleeves for COVID-19 shots. Younger children can follow in the first term of 2022.
“We plan that high school students are likely to be vaccinated by the fall period – perhaps not the very first day, but certainly in the early part of the fall for the fall education period,” said Dr. Anthony Fauci on Sunday told CBS’s “Face the Nation.”
Children were apparently spared the worst devastation from COVID-19, and they often had mild or minimal symptoms. And experts believe that students should not be vaccinated for safe reopening. Nevertheless, a large-scale vaccination of American children and adolescents can provide peace of mind for families – and provide welcome assistance in the effort to establish herd immunity against the coronavirus.
“If the vast majority of the population is vaccinated, the virus level in the community will be so low that the risk of infection will be low,” Fauci said this week during a virtual event hosted by Tufts University.
At present, no COVID-19 vaccine has been approved for use among children under the age of 16. However, several vaccines are already testing their shots in younger and some pre-teens, and others have committed to it.
It’s all an attempt to protect as many Americans as possible from the virus. And that may not be fast enough for many doctors.
The American Academy of Pediatrics late last year called on manufacturers to include children in their clinical trials because there is no other way to judge whether the vaccines are safe and effective for them.
‘If we do not add children to these research trials soon, there will be a significant delay when children can gain access to potentially life-saving vaccines. This is unscrupulous, ‘said Dr. Sara ‘Sally’ H. Goza, the then president of the academy, said in a statement late last year.
It is true that children are affected much less than adults, especially the elderly. Despite 22% of the U.S. population, children under the age of 18 accounted for 11.6% of nearly 22 million cases on March 9, and less than 0.2% of nearly 383,000 COVID-19 deaths, according to the Centers for Disease Control and Prevention . . (According to current data from Johns Hopkins University, the U.S. has more than 29 million cases and more than 527,000 deaths.)
But it still amounts to unnecessary suffering and tragedy, said dr. Robert Frenck, a pediatric infection specialist at Cincinnati Children’s Hospital Medical Center, said. Data from the CDC show that 428,502 children aged 4 and younger have been ill with COVID-19 since the onset of the pandemic, and 94 of them have died. Another 2,078,245 children between the ages of 5 and 17 had COVID-19 and 194 died.
“These are … healthy kids who should have had a normal life before them, and COVID changed that,” Frenck said.
In the journal Clinical Infectious Diseases, several doctors write that vaccinating children is a critical step in the fight against the pandemic – not to mention the most important thing to protect the youth from unnecessary suffering and danger of death.
“The direct COVID-19 impact on children is greater than that observed for a number of other pathogens for which we now have effective vaccines for children,” they wrote. “In addition, the role of children in the SARS-CoV-2 transmission has been clearly underestimated.”
The researchers pointed to several studies that suggest that children can be effective carriers of the virus. Among them: a number of studies comparing virus levels in the respiratory tract of children with those of adults; and a CDC study of a Georgia summer camp where 44% of the 597 participants, students, and staff were infected.
Frenck was one of the authors of the editorial. He pointed out that there are about 75 million people under the age of 18, and that we are struggling to achieve herd immunity without it.
“If you have not vaccinated the group, you will have a large portion of the population that has not been vaccinated,” he said in an interview.
Vaccines do not have to start all over again when testing their wares in children, as they will have the safety and efficacy of the vaccines in adults as a starting point.
To begin with, companies will start with teens, whose response to the vaccine is expected to be most similar to that observed in young adults. Then they will work in younger and younger groups, up to babies, said dr. Yvonne Maldonado, a vaccinator for infectious diseases in children at Stanford University, said.
Pfizer, which included 16- and 17-year-olds in its Phase 3 clinical study, has now fully entered the trial for 12- to 15-year-olds. Younger age groups would follow.
Fauci said in an information session last month that vaccine trials for 12-year-olds to 5-year-olds are likely to begin around April, although it is likely to take a year before the results come.
“This is how we do all vaccine trials,” Maldonado said. “We always start with adults and then we work with children.”
Although researchers do not expect any major surprises when it comes to the safety and efficacy of the vaccine in children, the data should be collected.
“Sometimes children respond the same to vaccinations as adults, but sometimes not,” Maldonado said. “It differs a lot for each organism, each type of disease, each vaccine. So there is no answer to the question, and therefore you have to do a test every time.”
The COVID-19 vaccines from Moderna and Johnson & Johnson have been tested in adults only; as such, they are only authorized for use at the age of 18 years and older. Like Pfizer, Moderna has started testing its vaccine in minors, while Johnson & Johnson is committed to doing so in the first half of 2021. (So does AstraZeneca, although the vaccine has not yet been approved for use in any age group in the US))
Dr. Richard Malley, a specialist in childhood disease infections at Boston Children’s Hospital, said the trials in minors would investigate whether the vaccines could elicit an immune response. In essence, researchers will vaccinate half of their minors and give the other half a placebo and then test their blood for the presence of coronavirus antibodies weeks later. These results will be compared with the antibody levels found in adults.
This is slightly different from the way clinical trials are conducted in adults, where tens of thousands of participants receive vaccines or placebos, and researchers simply watched and waited to see how many cases of COVID-19 emerged in each group. (The vaccines are considered to be effective because the people who get them are much less likely to get sick than the people who get the placebos.)
But it will take a long time to recruit enough kids for those kinds of trials and then wait for enough COVID-19 effects to draw conclusions about its effectiveness, Malley said. So-called immunogenicity tests are much more time-efficient, in part because they are based on the idea that if vaccinated children produce antibodies at about the same level as in the blood of vaccinated adults, it is reasonable to assume that children will have approximately the same level of protection. .
“It’s a bit of a leap of faith,” Malley said, “but it’s a reasonable leap.”
This story originally appeared in the Los Angeles Times.