Child vaccination effort underway in N.B.: Your questions answered

Now that kids aged five to 11 are eligible for a COVID-19 vaccine, parents are wondering if they should book  appointments for their kids.

Although the pandemic has made the choice extra pressing for parents, the conversation about vaccines is not new.

"Parents are always concerned about giving any vaccine or medication to their children," said Dr. Scott Halperin, director of the Canadian Centre  for Vaccinology, professor of pediatrics and microbiology and immunology at Dalhousie University, and head of pediatric infectious diseases at the IWK Health Centre. 

"They want to know whether it's safe. They want to know it's effective. We want to know if there's going to be side-effects and they want to know is it better to give them the vaccine or not?"

On Monday, CBC's Information Morning Saint John put some parents' questions to Halperin and Dr. Sarah Gander, a general pediatrician in Saint John and co-founder of the New Brunswick Social Pediatrics Research Program and Clinical Program. 

Q: People have concerns about the long-term research that's been done on the vaccine. How did this come together so quickly and how would you allay some of those concerns? 

Gander says the COVID-19 vaccine is a result of "all hands on deck" by governments, scientists and researchers toward a common goal.

"It feels fast because it happened quickly, relative to other technologies that we've experienced in medicine, but really, vaccines as a technology is not a new thing, as most people know," she said. "And so, taking the literature that we already knew and adapting it to a new antigen or a new virus really made a whole lot of sense."

In addition to this, the vaccine being made for children means that it's shown to be safe and effective in adults, says Dr. Halperin.

Medical experts test adults first then go down the age brackets to teens and school-age children. By separating children into groups, where some get a higher dose and some get a lower dose, then checking for an immune response and any  adverse reactions, researchers can determine if the vaccine is safe and effective.

"What you've seen here so far is just the usual way that we test the safety and make sure the vaccine is safe," Halperin said.

"While we know school-age children are approved now, those same types of studies are being done in children under five years of age, so that within several more months, we'll have the information [to] make a decision whether or not the vaccine will be available for children even younger [with] the full approval of Health Canada."

Q. Many parents have heard that children are largely unaffected by COVID-19. Is that true? And if so, do they really need the vaccine?

"I understand that people feel that when children contract the COVID virus, they don't necessarily get 'as sick' as what we've seen in some of the adult populations," Gander said. "I would disagree that they've been unaffected."

In the beginning of November, the Public Health Agency of Canada said Canadians under the age of 12 accounted for the highest number of new COVID-19 infections. 

More than 205,000 children from all over Canada have had COVID-19 and made up 11.6 per cent of all cases as of Friday, when figures from Health Canada showed 1,121 children 11 or under were in hospital because of the virus.

This amounted to 1.2 per cent of all COVID-19 hospitalizations. By comparison, 853 young people 12 to 19 were hospitalized.

"We just need to consider that COVID has effects on your body, which people might feel is a minor cold in the short term ... [but] there's emerging data about children potentially having some of this long-COVID or some of the after-effects of having COVID, even if the disease is minor. 

"So it's an important group, I truly believe, to offer the vaccine to and to support through that."

Q. The dosage for the five to 11 cohort is 10 micrograms — that's one-third of what adults are getting. What do you know about how they determined the dosage? 

Halperin said the clinical trials found that increasing the dosage doesn't necessarily equate to more protection.

"What was found is that with the higher doses, children get a good immune response, but they get an equally good immune response with giving less of the antigen or less of the vaccine," he said. 

"We always like to give as little as possible to maximize the effectiveness while minimizing any side-effects . … In fact,  [with] one-third of the dosage, children had a protection of over 90 per cent, which is equivalent to what was originally seen with the full dose in older individuals."

Q. If your child is about to turn 12 in early 2022, should you wait to give your child the adult dose or give them the kid dose right away, since that's what's available first? 

That depends, but generally it's best not to wait.

"If your child is turning 12 in the next couple of days, you might choose to wait," Halperin said. "But if it's in January, I would go ahead and get the vaccine for children. The vaccine for children, again, at that lower dose was 90 per cent effective. So you're not sacrificing anything by getting it now. So definitely get the vaccine as soon as it's available."

Gander said parents who want to get their kids vaccinated should do so as soon as possible to start getting immunity up.

"Especially with the holiday season upon us and whatnot, we want to get children protected as soon as possible."

Gander said the line between giving the adult dose to children over 12 and a smaller dose to those under 12 is arbitrary and centred on how the clinical tests were designed.

Q. Can or should an 11-year-old in the 95th percentile for weight be considered for the adult dose for the COVID vaccine?

Halperin said whether an 11-year-old child of that size gets the higher dose or a lower dose, "they're going to have a very good immune response. So it's not something to be concerned about."

Q. Are there any children who shouldn't get the vaccine? 

Gander said all parents should consider giving their children the vaccine unless there are individual considerations, such as allergies.

She noted that in older age groups, concerns about adverse effects, particularly myocarditis, were reported. 

But Health Canada has said the majority of affected individuals, even if hospitalized, "experience relatively mild illness, respond well to conservative treatment, and recover quickly." The risk of myocarditis has been shown to be "substantially increased after getting COVID-19, and that it is higher following infection than after vaccination."

From the clinical trials, Gander said, no allergic or adverse reactions to the vaccine have been reported to date.

"There are very few contraindications to the vaccine," she said. "But theoretically, if you had an anaphylactic reaction to your first shot, then you wouldn't necessarily be recommended to have your second shot. Or you should be talking to somebody before you plan that shot."

Q. Some parents still want to wait. What do you make of that strategy?

Gander said she understands why some might want to wait.

"People just need to weigh harms and benefits, they need to feel comfortable," said Dr. Gander. "It's one thing if you're going to do something to yourself and have a vaccine for your own body as an adult."

But despite reservations parents may have, the immediate response to the vaccine program for young children is promising, she said.

In New Brunswick, Public Health has said more than 10,000 pediatric appointments out of 54,000 children now eligible for COVID-19 vaccines were booked over this past weekend.

"I think as the data rolls out and we see the safety profile and more and more people are doing OK, then my hope is that people will feel comfortable and be able to make that choice for themselves."

Q. How long is it best to wait between a flu shot and COVID vaccine?

Gander said most people are waiting about 14 days between the flu shot and the COVID vaccine.

"I always like to do things a little bit separated because then if somebody has a reaction, you kind of know which it's coming from.

"And you can imagine that if you do a whole bunch of things at one time and then somebody has a reaction, then you don't know what to blame it on or how to proceed."

Q. Does the new omicron variant pose a threat to vaccine efficacy in children?

Since the variant is so new, there is not enough data to come to a conclusion on vaccine efficacy against it, according to Ganders.

Despite this, vaccination is the only form of strong protection against the virus and protects it from mutating further.

"I think all we know right now is that the delta variant has been quite a burden. And so if we can get vaccinated and learn more about how it's going to be efficacious [against] new variants, then we'll learn as we go for sure."

Q. What would you say to parents whose children are fearful of needles or even have voiced skepticism of the vaccine?

Halperin said a fear of vaccines is common among both children and adults, but there are distraction techniques that can be used. 

In both situations, he said, it's crucial for a family doctor or medical practitioner to be involved in answering any questions parents, children and families may have about the vaccine.

"One needs to have a discussion, depending on the age of the child and in an age-appropriate manner of what the vaccine's benefit is, and then relate it to other things in their life, that they have experience in in order to allay some of those fears."