Vaccines could be offered for kids as young as 5. What will parents do?

Sofia Rosenthal is shown here receiving her COVID-19 vaccination on Monday, her 12th birthday, from Phoena Mack at Dekalb Pediatrics in Decatur.  As a newly minted 12-year-old it was the first day Rosenthal was eligible.  Her mother, Kristen Rosenthal, sat next to her to comfort her, as Sofia was not looking forward to the shot.  But Sofia left proud of herself, said Dr. Jane Wilkov.   (PHOTO by STEVE SCHAEFER FOR THE ATLANTA JOURNAL-CONSTITUTION)

Combined ShapeCaption
Sofia Rosenthal is shown here receiving her COVID-19 vaccination on Monday, her 12th birthday, from Phoena Mack at Dekalb Pediatrics in Decatur. As a newly minted 12-year-old it was the first day Rosenthal was eligible. Her mother, Kristen Rosenthal, sat next to her to comfort her, as Sofia was not looking forward to the shot. But Sofia left proud of herself, said Dr. Jane Wilkov. (PHOTO by STEVE SCHAEFER FOR THE ATLANTA JOURNAL-CONSTITUTION)

This story has been updated to reflect that if Willy turned out to have the placebo, Dr. Lori Randall would withdraw him from the placebo arm of the Moderna vaccine trial, not from the trial itself, in order to get him vaccinated.

Willy Randall’s eyes held level and serious as the 6-year-old prepared to get vaccinated against COVID-19. Waiting out his observation period after the shot, he looked up at his mom with squints of happy pride.

Randall was participating in a vaccine trial after his mother, a doctor, fought for months to get him in. In the coming days, federal authorities will consider whether the Pfizer vaccine should be opened wide to millions of young children like him, from ages 5 to 11.

Children remain a crucial gap in health officials’ campaign to stop the pandemic. But experts fear that reluctant parents could stymie upcoming efforts to vaccinate the majority of elementary school aged kids, just as they have older adolescents.

Vaccines have been available to kids ages 12 and up since May. So far, 48.2% of children ages 12 to 17 are fully vaccinated nationwide. In Georgia, that number is lower, at 33.7%.

The challenge for public health authorities and physicians is helping parents understand the risks when kids aren’t vaccinated. Unvaccinated youngsters often carry the virus with few or no symptoms, though they can pass it along to those more at risk for serious illness. But the vaccines also offer protection the children themselves need.

With the more contagious delta variant, more children have become seriously ill themselves. Nationwide, the pandemic has made 23,000 children so sick they had to be admitted to the hospital, according to the American Academy of Pediatrics.

According to the CDC, 5,769 Georgia children were admitted to the hospital with COVID-19 since the pandemic began. During the delta surge, Georgia children’s hospitals have sometimes been so full they had to refuse patients that doctors wanted to transfer there.

With school already underway and holidays looming, public health officials hope that extending vaccines to younger children can hold down further spread of the virus.

ExploreComplete coverage of COVID-19 in Georgia

In Georgia, at least 27 children have died of COVID-19, from newborns to gradeschoolers to teens, according to death certificate data reviewed by the Atlanta Journal-Constitution. Of those COVID child deaths recorded, nearly half died during the recent delta surge, which peaked on the last day of August.

Studies already underway of the vaccine in children as young as 5 have shown promise. If approved by both FDA and CDC in meetings beginning Tuesday, the vaccine could arrive in time to protect children and their families for winter holiday gatherings.

“This does provide a tremendous amount of potential hope,” Dr. Evan Anderson, an Emory University pediatrician who is helping lead a study of the competing Moderna vaccine, said when initial data on the Pfizer vaccine was released. “Children really are substantially impacted by COVID-19.”

Even so, a campaign to vaccinate younger children will have its work cut out. “I do think that ... there will be some hesitancy that will be a major issue to potentially how impactful such a vaccine approval might be,” Anderson said.

Child deaths from COVID

Willy’s mother, Dr. Lori Randall, was thrilled to get him in the trial, and she’s seen promising signs that the shots he received contained vaccine and not the placebo. He felt ill for a day after the second shot, and got a red splotch on his arm that soon cleared up.

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Willy Randall, 6, is shown here after getting his shot in the Moderna COVID-19 vaccine trial. His mother, Dr. Lori Randall, is an internal medicine doctor and doesn't know whether he got the vaccine or a placebo. But she has high hopes he got the vaccine. (Photo courtesy of Lori Randall)

Credit: handout

Willy Randall, 6, is shown here after getting his shot in the Moderna COVID-19 vaccine trial.  His mother, Dr. Lori Randall, is an internal medicine doctor and doesn't know whether he got the vaccine or a placebo.  But she has high hopes he got the vaccine. (Photo courtesy of Lori Randall)

Credit: handout

Combined ShapeCaption
Willy Randall, 6, is shown here after getting his shot in the Moderna COVID-19 vaccine trial. His mother, Dr. Lori Randall, is an internal medicine doctor and doesn't know whether he got the vaccine or a placebo. But she has high hopes he got the vaccine. (Photo courtesy of Lori Randall)

Credit: handout

Credit: handout

As a physician, in 2020 she read the reports coming from abroad and understood the pandemic was poised to take a toll here even before it arrived.

She was right. The pandemic has killed well over 600 children nationwide, according to federal data.

In the delta surge, children were more likely to get infected than other age groups in Georgia, the data showed. “That adage that was going around — that kids are somehow immune to COVID — is unfortunately not correct,” said Amber Schmidtke, a researcher who tracks Georgia COVID numbers.

Vaccinations for children

The following steps are needed before health care workers can begin to give out Pfizer’s vaccine to children ages 5-11.

  • Today, Oct. 26, the FDA’s Vaccines and Related Biological Products Advisory Committee will discuss whether to recommend Pfizer’s vaccine for use in children ages 5-11. FDA Acting Commissioner Janet Woodcock will decide whether to authorize the vaccine.
  • On Nov. 2-3, the Centers for Disease Control and Prevention will take up the question at a meeting of its Advisory Committee on Immunization Practices. CDC Director Rochelle Walensky, will issue the final recommendation.
  • If approved by both bodies, vaccines could be offered as soon as next week. Children will be given a smaller dose than adults, using smaller needles. They will receive two shots three weeks apart, meaning within five weeks of their first shot, they can be considered fully vaccinated.

People are more vulnerable to being hurt by COVID as they get older, and 17-year-olds make up the largest group of child deaths in Georgia. But no age group is safe. In Georgia, COVID-19 has killed three infants in the last four months, including a newborn who lived only one hour.

The Georgia Department of Public Health doesn’t know the full toll of COVID-19, and the true death count is likely higher. DPH doesn’t count deaths when the person didn’t have the right type of confirming test, even in cases when the death certificate lists COVID-19 as a cause of death.

After the AJC provided the state with four names of child COVID victims that appeared not to be listed in the state’s rolls, DPH added them. DPH spokeswoman Nancy Nydam said the state has been “overwhelmed” with new cases and has not had time to investigate all the discrepancies with data.

ExploreFrom August: Georgia hospitals stretched with influx of kids battling COVID-19, other viruses

COVID-19 is also associated with some conditions that can last long after the infection clears up: “Long covid,” and a condition called multisystem inflammatory syndrome in children or MIS-C. According to the CDC, more than 300 Georgia children have had reported cases of MIS-C, a number second only to California’s. The median age for those children nationwide was 9.

Yet as with adults, a sizeable chunk of parents are simply opposed to the vaccine, ever. A recent AJC story on the subject elicited social media responses including, “My kids will not receive it!” or “It’s totally unnecessary.”

ExploreThe latest on coronavirus in schools

But those who hesitate to vaccinate their children also include more measured parents, Randall said. “I think just that it’s new, in that everybody wants to be sure that something they do for their child is safe, even more so than they feel for something they do to themselves,” she said.

In Georgia, pediatricians have already been told to prepare to answer parent’s questions about the vaccine and to be ready to do the work of reassuring them about vaccine safety and the real risk posed by passing them up.

Decisions within days

An advisory committee of independent experts plans to meet today to tell the Food and Drug Administration whether they think it should open the Pfizer shot to young kids. After that, staff at the FDA and the Centers for Disease Control and Prevention will also need to weigh in. If the experts give the nod, the Pfizer vaccine could be offered to children ages 5-11 by next week, after a CDC advisory committee has a scheduled meeting.

The advisers are expected to review studies on how young children have reacted to the vaccine in clinical trials. They’ll compare that data to the risks kids face in not getting vaccinated.

ExploreModerna says its low-dose COVID shot works for kids 6 to 11

One issue likely to be discussed is myocarditis, a potentially serious condition where the heart muscle gets inflamed. It occurs in people including children every year even without the pandemic, most commonly in young men. And studies have shown that MIS-C and infections like coronavirus can also cause myocarditis.

Scientists have seen a number of myocarditis cases in people recently vaccinated. One such child, a 16-year-old boy from Georgia, died of myocarditis four days after his second shot. The doctors didn’t decide whether or not the shot caused the myocarditis. The incidence appears to be fewer than one in one million vaccine recipients.

As for Randall, she can’t wait. If Willy did get the placebo, she’ll be allowed to find that out as soon as Pfizer is authorized for kids like him. If it turns out Willy’s not vaccinated, the study leaders plan to allow her to withdraw him from the placebo group and give him the vaccine if she wants. She’ll says she’ll do that right away.

AJC staff writer Helena Oliviero contributed to this article.