When can we expect the Covid-19 vaccine to be available for kids under 12?

Likely not until the fall. There are several reasons for this. One is that the dosage is different for kids due to the immaturity of their immune system. There is more study time needed because they had to start at Phase I. Phase II/III is now underway. Another is that in order to get statistically significant numbers, we need to have a certain number of the kids in the studies to be covid positive. The parents that are enrolling their kids in the studies tend to be cautious anyway with social distancing, masking, vaccination themselves, so the time it takes to have the significant positive participants verses negative comparisons is longer. For the safety follow up data, the FDA has asked for 4-6 months of data instead of the 2 months that we had for adults. Hopefully, this will help those parents who are hesitant to get their kids vaccinated to feel safer about it because of the safety follow up alone. They have been following a scientific protocol and this piece just can’t be rushed.

Is the covid-19 vaccination for kids going to be effective?

The preliminary date from Pfizer and Moderna is looking good so far!

Are we seeing the rate of pediatric infections increase?

Yes, unfortunately the increase in pediatric infections of covid-19 is increasing along the national trends of increasing cases for adults due to the Delta variant.

How is the Delta variant making infection cases worse?

The Delta variant has made the covid-19 infection 200% more transmissible. The primary mode of transmission is still direct contact and inhaled particles. The Delta variant also has a much higher viral load (1000% higher) which means kids will test positive more quickly after an exposure. They will also be shedding a lot more virus which increases the likelihood of infecting others if they become infected themselves. We still don’t know if the Delta variant is making the symptoms more severe. More studies are needed to clarify this.

Yesterday, the American Academy of Pediatrics recommended masking indoors for all kids regardless of vaccination status- why?

  1. A significant portion of the student population is not yet eligible for vaccination.
  2. Masking is proven to reduce the transmission of the virus.
  3. Many schools do not have in place a system for monitoring vaccination status of the students and teachers (It is not a HIPAA violation to ask someone if they have been vaccinated. They are allowed to refuse to answer however).
  4. Some communities have overall low vaccination uptake and the chance of getting the virus is increased in those communities with vaccination hesitancy.

The recommendations of masking are different than the CDC, right?

Yes, the CDC hasn’t really addressed the Delta variant and breakthrough cases among the vaccinated. The US is not tracking the data of asymptomatic cases or mild breakthrough cases. We are dependent on other countries that have a better surveillance system in place. The UK is responsible for 40% of the world’s Covid-19 sequencing (testing the positive cases for particular variants and mutations). They make the data public on a weekly basis which helps us make real-time informed decisions on population health matters.

So those of us that have been vaccinated can still get Covid-19? Remind me what the point of getting vaccinated was?

Vaccines reduce the rate of transmission from infected individuals to non-infected individuals. But they are not 100% even pre-Delta variant. They also reduce the severity of disease and hospitalization should a breakthrough case occur. So, a vaccinated parent could give the infection to one of their kids if they had an asymptomatic infection and weren’t aware. However, there is much less of a chance of this occurring if more people are vaccinated. In areas where there is a high number of populations vaccinated, we are seeing less hospitalizations and less community transmission. Vaccines work, they are doing the job that they are supposed to!

Should I ask those around my kids if they have been vaccinated?

Yes, you can ask. They don’t have to answer. However, for the protection of your kids, it is in everyone’s best interest that those they are in close contact with such as camp instructors, teachers, sports/coaches be vaccinated. You don’t have to be confrontational about it, but it is okay to advocate for your kids’ health.

I heard there was a closed-door meeting between Pfizer scientists and the CDC/FDA, what was that about?

Since it was not public, we can only guess. However, they likely were discussing the need for a booster shot (kind of like we get a flu booster shot every year because of the low efficacy rate of the influenza vaccine around 60%). Pfizer started at a very high efficacy rate of 94% so even though there are studies through Israel that antibodies are waning against the vaccination (a normal occurrence), this isn’t taking into account other antibodies that are harder to study like T-cells and memory B-cells. These hold the key to long term immunity. For now, there is still a good antibody response even with the Delta variant.

They also probably discussed the need for a booster due to the highly infectious Delta variant. However, we know that so far, the vaccination is still protecting against symptomatic disease and also severe disease.

An important topic they probably also discussed was the need for a booster in certain immunocompromised patients such as those with cancer, organ transplants, or are immunocompromised for other reasons. For now, we know that a third dose/booster helps a little, but not by a lot. This would be a nuanced discussion involving the need to get first and second shots to the global community and vaccine equity to end the pandemic. As the studies continue, it could change that a third shot or booster is recommended, but for right now, it is not. Pfizer will likely apply for an EUA (Emergency Use Authorization) for the booster shot, but that doesn’t mean the FDA/CDC will approve it.

Bottom line, vaccinations are the key to ending the pandemic. Those that are not vaccinated are at more risk for getting infected, getting severe disease, and spreading the virus among those around them, thus perpetuating the continuing cycle. The longer the Covid-19 has to spread and be active, the more mutations and variants it will make. We need to get as many people vaccinated as possible to stop the cycle and prevent the virus from making more mutations.

In the meantime, if there is a question about vaccination uptake or high community transmission, then masking, social distancing, and washing your hands is still a good practice even if you are vaccinated.