What will a Covid-19 vaccine for younger kids mean? An expert weighs in

By Katia Hetter, CNN

A US Food and Drug Administration advisory committee recommended Tuesday that the agency grant emergency use authorization for the Pfizer-BioNTech Covid-19 vaccine for children ages 5 to 11. Next, the FDA decides whether to authorize the vaccine, and then the US Centers for Disease Control and Prevention’s vaccine advisory committee will meet to consider whether it should be recommended for that age group. If CDC Director Dr. Rochelle Walensky signs off on that recommendation, younger children could be getting vaccinated next week.

Many parents and children have questions about what having this vaccine will mean. Do vaccinated kids still have to mask in schools? Can they see more friends and have sleepovers now? And do young kids really get that sick from Covid-19?

I discussed these and more questions with CNN Medical Analyst Dr. Leana Wen, an emergency physician and professor of health policy and management at the George Washington University Milken Institute School of Public Health. She is also author of a new book, “Lifelines: A Doctor’s Journey in the Fight for Public Health,” and the mother of two young children.

CNN: What do we know about the effectiveness of the Covid-19 vaccine for children ages 5 to 11?

Dr. Leana Wen: According to the data reviewed by the Food and Drug Administration, the Covid-19 vaccine is more than 90% effective against symptomatic illness for children in this younger age group. That’s very good, and it provides a lot of reassurance for parents that their younger kids will have an excellent layer of protection once the vaccine is authorized and they can get vaccinated.

CNN: Does that mean once kids are vaccinated, they can stop wearing masks in schools?

Wen: The CDC has said that kids should remain masked in schools, even after they are vaccinated. I believe that this is a position that should be modified over time, depending on local circumstances.

We can think of all the protective measures as layers — just like you wear layers when it’s cold outside. The colder it is, the more you have to wear to stay warm. Some layers are better than others.

If there is a lot of virus in the community, the risk is high, and we need a lot of layers of protection. If the level of virus is low, we need fewer layers. The vaccine is the best layer we have, so once younger kids are vaccinated, it would be reasonable to discuss which other layers it can replace. In areas of low community transmission, and especially if other layers like testing are in place, it might be reasonable to reconsider masking. This is particularly true if all kids in a class are known to be vaccinated.

That said, it will take a while for kids to get the vaccine. There are also many parts of the country that have high community transmission. I wouldn’t expect that masks can suddenly go once vaccines for younger kids are made available. Some schools already do not require masks, and, of course, just because masks aren’t required doesn’t mean that kids have to take them off.

CNN: What about other social activities — can vaccinated younger kids participate in more activities, including going to sleepovers and the movie theater?

Wen: That depends on the parents and the level of risk tolerance in the family. A lot of families have not been allowing younger children to participate in higher-risk activities because the kids are not yet vaccinated. Once kids are fully vaccinated, many parents might decide to add back certain activities. Remember that being fully vaccinated requires two doses, and then waiting until two weeks after the second dose.

Perhaps parents had pulled their kids out of basketball or soccer because these sports practices were being held indoors. Once kids are vaccinated, they might decide that the risk of exposure is now much lower and is therefore worth the benefit to the child.

If the child is vaccinated and is going to a sleepover with other vaccinated kids, that would also be much lower risk now than before the kids were vaccinated.

In fact, after vaccination, all activities — including going to the movies — will be much safer. Parents should evaluate the medical risks of their household and have a conversation with their children about what everyone can do once they are vaccinated.

A family that has babies or kids 4 and younger, or lives with an immunocompromised elderly relative, may still decide to continue precautions, including avoiding crowded indoor settings with people of unknown vaccination status. On the other hand, a family that is now all fully vaccinated and generally healthy can choose to bring back many pre-pandemic activities.

CNN: Is the vaccine safe for kids ages 5 to 11? What kinds of side effects should they expect?

Wen: In a study of more than 2,000 children ages 5 to 11 years old, the vaccine has been found to be safe, with the same kinds of side effects as seen in adults. These side effects include sore arm, redness at the injection site, fatigue, fever, chills and headache. They generally are worst during the 24 hours following the vaccine, and they go away in a few days.

Importantly, there were no instances of myocarditis, or inflammation of the heart muscle, in the study. However, myocarditis is rare and may not be seen in a study of this size. It’s possible that as more children are vaccinated, there may be some cases of myocarditis detected, as the inflammatory disease has been linked to the Pfizer vaccine, primarily among younger men under the age of 30.

It’s crucial to note that myocarditis also occurs with Covid-19, and the potential risk of myocarditis associated with the vaccine has to be weighed against the benefit of the vaccine in preventing a whole host of problems associated with the disease.

CNN: What about long-term side effects of the vaccine?

Wen: The Covid-19 vaccines have been given to hundreds of millions of people around the world since December. Side effects are seen in the first few weeks of administration, not months afterward. We also have experience with many other childhood immunizations, which follow the same pattern. Therefore, there is no scientific or physiological reason to believe that the vaccines would cause long-term side effects. On the other hand, we know that the coronavirus itself does result in long-term problems, including in children.

CNN: What about kids ages 5 to 11 who live with younger siblings who still aren’t eligible for the vaccine? How should they still handle risk?

Wen: Parents should make a decision about what level of risk they are willing to tolerate. Many might continue to take additional precautions, but knowing that their vaccinated kids are better protected, they could decide to allow for some extracurriculars to return and some indoor activities to occur again, especially if their vaccinated kids are associating only with others who are fully vaccinated, too.

CNN: What would you say to parents who are still hesitant to give their kids the vaccine?

Wen: I understand! We as parents all want the best for our children.

I think it’s important to point out that children can and do get very ill from Covid-19. According to data presented at the FDA meeting on October 26, there have been 1.8 million cases of Covid-19 in the age group of 5 to 11 years old. More than 8,000 children in this age group have been hospitalized and, tragically, 143 have died. While many have had underlying conditions, about one-third of those kids with severe illness were generally healthy.

Everything we do for our kids is about weighing the risks and benefits. Consider the known risks of Covid-19 along with the benefits of the vaccines. For my family, we are very eager to get our young kids vaccinated when it’s authorized for them, so that we can resume many activities we have put on hold out of concern for our kids. For many other families, there will be so much relief once their kids are able to be vaccinated and receive this excellent level of protection against a potentially deadly disease.

If you are unsure, it’s always a good idea to speak with your pediatrician — and, in the meantime, let’s make sure that all the adults and older children who are eligible to be vaccinated do so, too.

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