What parents need to know about COVID-19 vaccines for kids

Children in Nova Scotia can expect to start receiving their first doses of a COVID-19 vaccine early next month.

On Friday, Health Canada approved the use of the Pfizer-BioNTech vaccine for children ages five to 11.

Jeff Douglas, host of CBC Radio's Mainstreet, spoke last week with Dr. Joanne Langley, a professor of pediatrics, community health and epidemiology at Dalhousie University, about the newly approved vaccine and what it means for kids.

Langley is also the head of the division of pediatric infectious diseases at Dalhousie and serves as the associate director of the clinical evaluation unit for the Canadian Center for Vaccinology.

This discussion has been edited for length and clarity.

Are you confident this approved vaccine is safe for children?

Yes. Based on the information we have from the clinical trial and also the fact that it's being rolled out already in the United States — they're few weeks ahead of us — there are no concerning safety signals that would be any different than the regular childhood vaccines that we give, such as sore aches and pains. Maybe a little general discomfort, and some children might have fever. 

What do we know about how effective this vaccine is? 

A clinical trial was done — a randomized, controlled, blinded trial — and they looked at the safety of how the children felt in the weeks following the vaccine compared to those who got the placebo. They also looked at their blood levels of antibodies and other immune responses, and then they looked at how well it works. 

Probably the most important thing is how well it worked. It was 90 per cent effective in preventing symptomatic COVID-19 illness compared to children who got placebo. So we know it works and there were no indications that it was anything but safe. 

Does that 90 per cent effectiveness consider the Delta variant?

Yes. Delta was circulating in some of the places where the study was done.

As someone who studies vaccines, how satisfied are you with the sample size and diversity of the study?

Very satisfied. Many eyes have been on this data, and regulators in multiple countries who are experienced at looking at new vaccines have reviewed the data and come to the same conclusions. 

So I think there's enough data here to roll out a program in a pandemic, and we have to keep all our partners, including parents and children, informed as we do that rollout to make sure we're all participating in gathering knowledge about it as we make it a public program and not just a clinical trial.

Is this going to plug a breach in our public health fortress that we've been building against this virus?

Yeah, absolutely.

I think you're partly referring to the community protection you get when all of us get vaccinated and we protect those who can't get vaccinated. 

But in this case, the vaccine provides the benefit to the children themselves. Although the absolute risk of a severe outcome if a child gets COVID is much less frequent than an adult; they're much, much less likely to require hospitalization for a lung infection, for example, but they still can get them, and over 700 children in the U.S. have died of COVID. 

We sometimes talk kind of glibly about it being less serious in children, but it can be a serious disease. It's just the absolute risk of that happening is less.

The dosage for this five-to-11-year-old cohort is 10 micrograms, one-third of what the rest of us are getting. Why do these little ones need a much smaller dose? 

Oftentimes, children will need smaller doses of the vaccine that you're giving them. Way back in 2009, when we had the H1N1 influenza pandemic, for example, children got half the dose and they only needed one dose.

They don't have that senescent or older immune system that, for example, people over 65 start to get. They can recognize invaders right away, and they will develop an immune response with a smaller [dose].

What kind of reactions or side effects can we expect in children?

Parents will have been vaccinated so they'll know how they felt so they can prepare for having a good pyjama day in the days after the vaccine and not planning to do your violin concert right after the vaccine or whatever. It is just accommodating feeling a little less than normal for a few days. 

The National Advisory Committee on Immunization's recommendation is that the spacing between doses be increased to at least eight weeks. What can you tell us about that?

Eight weeks between doses in five- to 11-year-olds is based on what we've learned during the pandemic about use of the vaccines in the field. You may recall last spring when we didn't have all the supply coming in a way that we could vaccinate everyone at the same time. It's also very difficult to do that, so NACI recommended providing a first dose to everyone and then when the second doses came online to provide it in the interval, then it was even out to four months. 

Ultimately, most people didn't get their vaccine with that spacing, they had it more like two months or three months apart. As we did those public health programs, we learned that people had very good responses and in fact had a better response than the very short interval. And in the United Kingdom, they also looked at the more lengthy period between doses — they used 12 weeks — and they had the same finding. 

They are also looking at the more delayed interval between the first and second dose of vaccine in this age group. So it's a program that other countries are using, and the rationale is that we would expect a better immune response with more time between those two doses. 

What's your message to parents who might feel hesitant about giving this vaccine to their young children? 

I guess I'd maybe reframe the hesitancy as curious and wanting to know everything I could know about that vaccine, and that's what parents do. They take care of their kids and they want to know everything about their health to make sure that they protect them. 

There is a lot of information that went up [on Friday] on the Public Health Agency of Canada website and really, everything the health-care providers learn is there for parents to see. So there will be more information, I'm sure, when Nova Scotia and other provinces start their program. But I would say, you've got lots of questions, make sure you get them answered. 

But I would ask them to plan on booking an appointment for their child so that they are protected against these rare but serious outcomes of COVID in young children.