Kim Hagood hates needles. But as a middle-aged adult with chronic conditions, she got vaccinated against COVID-19 without delay. “I never thought I’d be so excited to get a shot,” she told me, giddily, hours before her appointment. A single mother in Trussville, Alabama, Hagood is less certain about vaccinating her 10-year-old son when the time comes. The fact that the mRNA technology in Pfizer’s and Moderna’s vaccines hasn’t been used before in kids gives her pause. “I think everyone should be hesitant until the studies are done,” she said.
The decisive moment for parents like her is drawing near, as the first results from clinical trials in teens have started to come in. Just last week, Pfizer announced that its vaccine has so far been safe for children ages 12 to 15, and said that it plans to seek emergency-use authorization for this age group “as soon as possible.” Others will follow. “For adolescents, vaccines will probably be available in the fall,” estimates Paul Spearman, the director of the infectious-diseases division at Cincinnati Children’s Hospital. “For younger kids, it’ll probably be early 2022.”
The impending rollout of vaccines to children will be important for protecting kids from needless suffering, and pediatric vaccination will save lives in other age groups as well. In many places, adults are delaying vaccination, and surveys show that one-fifth are outright refusing it. If large numbers of people continue in the latter mindset, vaccinating children will be central to any hope of reaching herd immunity.
In Hagood’s county, vaccination rates are well below the national average. “Some people still don’t believe the pandemic is real, even after they’ve had COVID,” she said. Her son told her he wants to get vaccinated so he doesn’t transmit the virus to anyone. “If our pediatrician says it’s safe,” Hagood told me, “I’ll do it.”
Based on what’s been observed in adults, pediatricians already know that, in principle, the COVID-19 vaccines will be safe for children. Pediatric immune systems are different from adults’, but they share enough commonalities to expect similar outcomes. The lingering question is what dosage is ideal for which age groups, in order to elicit the most protective immune response with the fewest side effects. At this point, the clinical trials won’t need to wait to count the number of children who do or don’t contract the virus after vaccination. “You can connect the immune responses that you observe in children and the protective effects you see in adults,” Spearman told me. “If these immune responses protect adults, then they would very likely protect children too.”
Being certain that the dosages are extremely safe has been a key priority that has to be weighed against the urgent need for vaccines. Even a single story about a child who had a bad reaction can be terrifying to parents—especially those who are already hesitant, and under the mistaken impression that COVID-19 is almost never a serious disease in children. Once the appropriate dosages are known, the FDA will grant emergency-use authorizations. These may feel far off, Spearman reminded me, but the process is still unfolding many times faster than it would have in years past. “We are no longer in the norm. Since COVID hit, we’re in a completely new era.”
That newness is itself a major source of vaccine hesitancy, explains Bethany Robertson, a co-director of the nonprofit Parents Together, who has been researching how families are approaching this decision. “It’s not surprising that parents are still making up their minds, and wanting to make sure the vaccine is safe is important,” Robertson told me. Many parents are less likely to vaccinate their children than to get vaccinated themselves: A recent poll found that 70 percent of caregivers said either that they’d already been vaccinated or that they would probably get vaccinated, but only 58 percent said the same about their kids.
For those concerned about the mRNA vaccines purely on the basis of their relative newness, the adenoviral-vector vaccine from Johnson & Johnson might be a more appealing alternative. This approach had been successfully tested and approved in another vaccine, against Ebola, before the current pandemic even started. For others, concerns are rooted in systemic distrust and historical disenfranchisement. “We need to respond to legitimate concerns, especially among communities of color, even before the vaccines are available,” Robertson said.
Still, perhaps the leading reason for doubt among parents is a misunderstanding of the risks this virus poses to children. A kid’s chances of dying from COVID-19 are indeed much lower than an adult’s: Out of the known death toll of more than half a million Americans, children account for just a few hundred, or 0.05 percent. But pediatric deaths should not be seen in relative terms. In absolute, concrete terms, hundreds of children have died of a preventable disease, and thousands have become seriously ill. It’s difficult to know the exact number of children who have been hospitalized because of COVID-19, but some 14,000 have been counted across just the 24 states that publicly release those numbers. The total for the U.S. would be far higher. More than 3,000 have developed a serious complication known as multisystem inflammatory syndrome in children, or MIS-C, in the weeks after having had COVID-19. “The numbers of kids who’ve been hospitalized and died is significant and concerning,” Spearman said.
It may be getting worse as the virus evolves and the disease changes. A January study found that the rate of hospitalization among people under 19 had increased more than eightfold over the course of the pandemic. The risk to teenagers and children remains significant, according to Jill Foster, a professor and pediatric-infectious-disease specialist at the University of Minnesota Medical School, and “we’re finding that teenagers are transmitting the virus at rates similar to adults.” Younger children don’t seem to transmit as well, possibly because their smaller lungs and airways spew smaller quantities of viral particles shorter distances. But Foster is concerned that many people don’t appreciate that children getting sick can be quite a terrible experience, even if relatively few end up requiring hospitalization or dying.
Of those kids who do require hospitalization, roughly one-third go to the intensive-care unit. And the percentage of hospitalized COVID-19 patients who are children has been steadily rising throughout the pandemic, from 0.8 percent in May to 2 percent now. Foster believes that now-widespread variants are more likely to infect young people than the strains that predominated last year. (They’re more likely to infect everyone—and kids are no exception.) At the same time, she told me, many people are throwing caution to the wind and misunderstanding the risk to and from teenagers and children. “Kids are not like vaccinated adults. This is a myth that keeps coming up,” Foster said. “There are kids on chemotherapy and with cystic fibrosis who are victims of transmission from healthy kids.”
I asked how the myth that unvaccinated children are like vaccinated adults could be combatted. She said: “Talk to any pediatrician.”
Pediatricians are sure to be central to many parental decisions. Hesitancy is a rational default position on any new medical treatment, and clinical trials are vital. But none of the doctors I’ve spoken with have any question whatsoever that vaccinating kids will be important, for the children’s own health as well as others’.
They are also clear that the social isolation of the past year has been damaging to kids. The sooner children can be back in school and socializing without restriction or concern, the better. This won’t happen as long as the virus is spreading in communities. “I think it’s been well shown that opening schools in person can be done safely,” Spearman said. “Yes, there will be some spread among kids. And that will contribute to ongoing spread in the community, to anyone who has not yet been vaccinated. So there’s an advantage to society when kids are vaccinated.”
This message of interconnectedness tends to get lost in discussions of vaccines’ effectiveness. Headlines about whether a vaccine is, say, 75 or 90 percent effective at preventing symptomatic illness don’t reflect the broader context. A person’s risk of being infected, whether or not they’ve gotten a vaccine, will be contingent on how many other people have been vaccinated, and how widely the virus is circulating. Each vaccinated person helps lower the risk to everyone else.
It will be many months before kids can be vaccinated in large numbers, so for people who would like schools to resume normal operations, as soon as possible, the most important step is to get vaccinated themselves, and make sure their family and friends do the same. That’s true not just for those who work in school systems or have young children. It’s true for everyone.
“Herd-immunity protection is about protecting others,” Dane Snyder, the chief of primary-care pediatrics at Nationwide Children’s Hospital, told me. “There will be some people whose immune systems don’t mount a response after vaccination. There are people who can’t get vaccinated, because of age, like infants,” he said. “It may be a personal decision, but it’s a collective effect.”
The matter is made more urgent by adults who forgo vaccination because they don’t understand—or don’t care—that their decision puts others, including children, in harm’s way. The disease that has killed millions of people around the world, and continues to kill almost 1,000 Americans each day, could hypothetically be nearly eradicated if every adult underwent vaccination. But as of now, in some areas, many people remain unwilling. Nationally, about 20 percent of adults say they either will not get vaccinated or will do so only if required. “The hope is the more adults that get vaccinated, the fewer people the virus has to bounce around in,” Snyder said. “But we just don’t know if that’s going to happen yet.” The better the adults do at vaccinating ourselves, the more stress we can alleviate for families and kids who don’t have the same luxury.