CDC's Advisory Committee on Immunization Practices (ACIP) on Tuesday unanimously voted to recommend the Pfizer-BioNTech Covid-19 vaccine for children ages five to 11, a move that experts say could help reduce the spread of the coronavirus but raises daunting logistical and outreach challenges.
During ACIP's meeting, CDC Director Rochelle Walensky told the panel that 745 children have died of Covid-19 during the pandemic, including 94 children between the ages of five and 11. In addition, the New York Times reports that at least 2,300 children ages 5 to 11 have developed multi-system inflammatory syndrome as a result of a coronavirus infection.
Alejandra Gurtman, a VP at Pfizer, presented data from the company's trial in children ages five to 11 that found the vaccine was 91% effective at preventing symptomatic Covid-19. Some of the children in the trial reported side effects including fever, headache, and fatigue—similar to the side effects identified in adults.
CDC staff also presented data on occurrences of myocarditis related to the vaccine. They found the condition is less frequent in younger children than in older children, arising approximately once for every 10,000 to 20,000 children ages five to 11 who receive the vaccine.
"Getting Covid, I think, is much riskier to the heart than this vaccine, no matter what age or sex," Matthew Oster, a CDC scientist who presented the data, said.
Many panel members voiced their support for the vaccine, with Grace Lee, a professor of pediatrics at Stanford University School of Medicine and chair of ACIP, saying the vaccine "could have a huge impact on [children's] health, their social and emotional well-being, their educational outcomes, and their long-term trajectory."
Similarly, Pamela Rockwell, a liaison from the American Academy of Family Physicians, told the panel that vaccinating children "will not only help prevent Covid-19 infection and serious consequences of infection in this age group, but will also help children emotionally and socially."
ACIP ultimately voted 14-0 to recommend a two-dose regimen of the vaccine, with the two shots given 21 days apart—a recommendation that Walensky later signed off on. The recommended dose for young children is 10 micrograms, lower than the 30-microgram dose given to older individuals.
Vaccinating children not only protects the vaccinated individual from developing Covid-19 but also could stem community spread of the coronavirus, experts say. Modeling from ACIP suggests that vaccinating children ages five to 11 will lead to an 8% reduction in coronavirus transmission between November 2021 and March 2022.
With many children back in schools and more people gathering indoors as the weather gets colder, childhood vaccinations will play a key role in limiting Covid-19 rates in the winter, according to Kawsar Talaat, an associate professor at the Johns Hopkins Bloomberg School of Public Health.
"We're seeing that in places with high vaccination rates, transmission is lower than in places with low vaccination rates," Talaat said.
Vaccinating children will also help prevent them from developing severe Covid-19 later in life, according to Monica Gandhi, a professor of medicine and associate division chief of HIV, Infectious Diseases, and Global Medicine at UCSF/San Francisco General Hospital.
Gandhi predicted that, within two to three months of children starting to get vaccinated, most Covid-19 restrictions could start winding down in the United States.
President Joe Biden on Tuesday said the country has "reached a turning point in our battle against Covid-19" following CDC's recommendation. He added the vaccine will put an end to "months of anxious worrying" for parents.
Still, there are likely to be challenges in getting children vaccinated. A recent poll from the Kaiser Family Foundation reported that only about three in 10 parents said they will get their child vaccinated "right away," while another three in 10 parents said they will definitely not get their child vaccinated.
"Uptake will definitely be slower," Paul Offit, a pediatrician and member of FDA's vaccine advisory committee, said. According to Offit, if half or less of children ages five to 11 get vaccinated, that likely won't be enough to significantly impact the spread of the coronavirus.
Some experts also expressed concern that schools will roll back mask mandates too quickly now that children are authorized to get vaccinated.
If that happens, Julie Swann, a professor at North Carolina State University who analyzes the impact of Covid-19 on children, projects that hospitalizations and deaths could rise by as much as 20%.
Carlos del Rio, an infectious disease expert at Emory University, urged school boards to pay attention to coronavirus transmission within their community.
"If the rate of cases in my community is below 10 cases per 100,000 people, and I have a high vaccination rate, I think you can drop masking and other nonpharmacological measures," del Rio said.
Supply could also be an issue at the start, as Pfizer-BioNTech's vaccine for children requires different packaging, vials, needles, and a smaller dose.
"Vaccination for 5 to 11 is different than vaccination for adults," Jeffrey Zients, the White House Covid-19 response coordinator, said. "This is a new program designed from the ground up specifically for kids."
As such, hospitals could struggle to meet demand. Jermaine Monroe, co-chair of a Covid-19 task force at Texas Children's Hospital, said his hospital started booking appointments for vaccinations on Friday and was "averaging 120 appointments per minute."
To address potential supply issues, the Biden administration Monday announced it had started assembling and shipping Covid-19 vaccines for children ages five to 11 in anticipation of CDC's recommendation.
According to Zients, the government is "in great shape on supply" and should have enough of the Pfizer-BioNTech vaccine for the 28 million eligible children to get shots.
"We've been planning and preparing for this moment and are ready to execute, pending CDC's decision," Zients said. "And starting the week of Nov. 8, our vaccination program for kids ages 5 through 11 will be running at full strength."
The vaccines are being distributed to pediatricians' offices and school-based clinics, and the government also intends to send vaccines to pharmacies and community health centers directly, Zients added.
"This will give parents a broad range of options to get their kids vaccinated and ensure all children, including those without primary care doctors—those most at risk—have easy and convenient access to vaccines," Zients said. (Walker, MedPage Today, 11/2; Mandavilli, New York Times, 11/2; Saric/Fernandez, Axios, 11/2; Fernandez, Axios, 11/3; Gardner, Politico, 11/2; Branswell, STAT News, 11/2; Neergaard/Stobbe, Associated Press, 11/3; Hubler/LaFraniere, New York Times, 11/3; Gandhi,
The Atlantic, 11/3; Irfan, Vox, 11/2; Jeong/Suliman, Washington Post, 11/3; Cohen, Roll Call, 11/3; Parker-Pope, "Well," New York Times, 11/2; Alonso-Zaldivar, Associated Press, 11/1; Beachum/Knowles, Washington Post, 11/1; Weixel, The Hill, 11/1; Coleman, The Hill, 11/1)
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