Vaccines + Kids in 2022: Getting the Facts and Weighing the Risks

By: Dr. Jay Harvey

Pediatrician and American SPCC Board Member

June 21, 2022

    For many parents and children, the COVID-19 pandemic has been fraught with uncertainty and fear. Decisions about masking, social distancing and schooling have become a daily part of life. And now, vaccines are on the top of mind for many parents, with the CDC authorization of the COVID-19 vaccine for children aged 6 months to 5 years.

    There’s also no shortage of polarized opinions and information on the topic of vaccines, making it difficult for many parents and guardians to feel confident in their decision of whether or not to vaccinate their child.

    As a pediatrician, I’ve heard these growing concerns firsthand. After all, parents want what’s best for their kids, and we all have a natural instinct to keep kids safe from physical harm.

    To help parents and families weigh the risks and make an informed decision about COVID-19 vaccines, I’m answering some of their most common questions below. Ultimately, parents and caregivers must decide which risks they’re willing to take, because during this pandemic, there’s no way to avoid it. But what we can do is make a decision based on the best possible, reliable information available.

    Common Questions

    Related to Covid-19 Vaccines

    Q: The COVID vaccine approval, even for adults, seemed rushed. Should I be concerned?

    While it’s true the COVID-19 vaccine received approval faster than any other vaccine in the more than 100 year history of the FDA, there are reasons the decision was expedited while still meeting strict safety standards. 

    The COVID-19 vaccines are what’s called Messenger RNA (mRNA) vaccines, which work by training the cells in our body how to make a protein, leading to an immune response. While this type of vaccine is newly available to the public, it has actually been studied by researchers for decades, meaning we already understood much of how this type of vaccine could be safely designed before the pandemic began. 

    Additionally, companies across the globe were incentivized by government agencies to take unprecedented steps to share research information with one another during the development of these vaccines. Doctors and researchers around the world were working around the clock to design vaccines with a level of cooperation and expediency rarely seen.

    It’s also important to note the vaccines still followed the rigorous safety evaluation process required by the FDA before becoming available to the public. You can learn more about the process vaccines must go through before receiving final approval in the U.S. here.

    Q: Why did it take so long for the approval to come for young kids under 5 years old? Should I be concerned?

    There are likely several reasons why it took longer to approve the vaccine for kids under 5.

    First, it is difficult to find parents who are willing to enroll their infants, toddlers, or young children in any clinical study or trial – whether it involves a new vaccine, new medication, new medical device or new therapy. Since children were not part of the original clinical trials for the COVID-19 vaccine (Pfizer and Moderna), it took time to acquire enough eligible children to study, so that results would be considered valid.

    Second, due to the fact that young children are vulnerable and cannot consent “of their own free will,” there were elevated concerns regarding the safety and efficacy of the vaccine in the younger age group. That, combined with the significant public perception that the original vaccines were perhaps approved “too quickly,” resulted in additional pressure on vaccine manufacturers to produce sufficient data that would be able to overcome vaccine hesitancy and enable the majority of parents to feel comfortable allowing their youngest to receive the vaccine.

    Finally, the Pfizer vaccine for children under 5 years old was initially considered for approval by the FDA months ago, but was rejected because they did not produce convincing data regarding the efficacy of their vaccine after two doses. They subsequently added a third dose, reapplied to the FDA in June 2022, and then received approval.

    Q: Are COVID vaccines for young kids less effective than vaccines for adults?

    The answer depends on your definition of “effective.” In short, the vaccines for young kids are just as effective as the vaccine for older kids and adults when it comes to preventing severe COVID-19 disease (i.e. hospitalization) and death.

    They are not particularly effective at preventing the transmission of COVID-19 from person to person, at least not in their current form. Work has been underway for some time now to create updated versions of the Pfizer & Moderna vaccines made available in June 2022, to cope with the seemingly endless emergence of virus subtypes that can elude antibodies produced by the existing vaccines.

    Q: My family already had Covid and I'm worried about giving my young kid a new vaccine. How do I know what decision to make?

    That is not as easy a question to answer. In its simplest form, if your primary goal is to ensure that your child is protected against the worst possible versions of COVID-19 illness (hospitalization and death), then getting them vaccinated is a “no brainer,” in my professional opinion. This is because all of the data accumulated and reviewed by independent experts to date suggests that the vaccines are even safer in younger children than they are in children over 12 as well as adults. The only caveat to that point is that the data references approximately 8,000 children studied to date. It is possible that with time and many more doses administered, significant side effects could be discovered, although there is no indication of that at this time.

    There are those who argue that if their child has already had COVID-19 disease, they are protected and do not need to be vaccinated. There is likely some truth to that argument, as there is a growing sense that “natural immunity” may be stronger and longer lasting than immunity induced by vaccination.

    Still, no one is certain how much “stronger” nor exactly how long that “natural immunity” is protective. As a pediatrician, I have also seen data that suggests that the “best immunity” results from having had COVID-19 disease AND being vaccinated.

    The bottom line is that we still have a lot to learn regarding COVID-19 disease and its many subtypes, in terms of its short and long-term effects on children and adults. What we do know is that it has killed millions across the globe, but also that children, thankfully, have continued to be less severely affected compared to adults.

    This is why my professional opinion is that parents of children should talk with their pediatrician about their family’s individual circumstances if they have any questions regarding whether COVID-19 vaccine is in their child’s best interest.

    Q: I’m concerned about COVID, but also about the effects of the vaccine for my child. How do I know what decision is best?

    It’s true that vaccines are never 100 percent effective or completely free of side effects. But when deciding whether to receive them, it’s a matter of getting informed with reliable information and deciding where the greater risk lies. Even in children, when it comes to the probability and severity of getting the vaccine compared to having COVID-19, according to the vast majority of pediatricians and child health experts, the vaccine is still the safer choice. 

    Below are some data points that parents can use to make an informed decision. 

    Children COVID-19 Hospitalizations and Deaths

    • According to the AAP in late October, cumulative child COVID-19 cases across the U.S. saw a 4% increase since the beginning of the pandemic. 
    • Among all reporting U.S. states, 0.1% to 2.0% of all child COVID-19 cases resulted in hospitalizations.
    • 0.00% to 0.03% of child COVID cases have resulted in death.
      • As of November 2021, this equated to 680 COVID-19 deaths of children 18 years and younger, according to the CDC.
    • Cases of multisystem inflammatory syndrome in children (MIS-C), a condition where different parts of the body become inflamed, have also seen an increase in reports since the beginning of the pandemic. 
      • While the cause of MIS-C is unknown, many children with MIS-C had the virus that causes COVID-19 or had been near someone with COVID-19.  
      • From mid-May 2020 to early October, 2021, there have been 46 confirmed multisystem inflammatory syndrome deaths among children in the U.S.

    Children and COVID-19 Vaccines

    • As of mid-July 2021, approximately 8.9 million U..S. children aged 12-17 received a COVID-19 vaccine. 
    • In that same timeframe, the CDC reviewed 14 reports of death in children who received the COVID-19 vaccine. Of those, the cause of death were determined to be the following:
      • Pulmonary embolism (two), suicide (two), intracranial hemorrhage (two), heart failure (one), hemophagocytic lymphohistiocytosis and disseminated Mycobacterium chelonae infection (one), and unknown or pending further records (six).
    • Among children receiving the COVID-19 vaccine, there has also been an increase in reports of myocarditis (the inflammation of the heart muscle) as well as pericarditis (inflammation of the outer lining of the heart). This rare side effect has most commonly occurred in males aged 16-23 years old, usually after the second dose (~1 in 100,000 doses) and all cases were mild and resolved quickly. Of note, there were zero cases of heart inflammation detected in the nearly 3,000 5-11 year old children studied.

    Given this data, the vast majority of doctors, pediatricians and public health officials have recommended children receive their COVID-19 vaccine, seeing the benefits far outweigh the risk of severe vaccine side effects.

    Q: How do the possible side effects of the COVID-19 vaccine compare to other vaccines?

    The vast majority of side effects reported after the COVID-19 vaccine are similar to other vaccines routinely administered to children. These include arm soreness, low-grade fever and fatigue. Other routine vaccines have also been linked to more rare, serious side effects.

    Q: It seems that even if my child gets COVID, the effects would be mild. Why would I want to have them vaccinated then?

    Many parents have said they’d like to wait and see how the vaccine rolls out and what side effects are reported in the long term. That is, of course, a parent’s prerogative to do so. 

    But it’s also important to think about the community benefits of higher vaccination rates. Simply put: vaccines help reduce the spread of COVID-19. Just like adults, children can transmit COVID-19 even when they have no symptoms. Reducing the spread of COVID-19 in communities is an important part of lowering hospitalizations and even death rates among all age groups, especially the elderly or those with underlying health conditions. 

    Q: Does my family still need a flu shot if we have a COVID-19 vaccine?

    Yes, children and adults are encouraged to receive both vaccines this year. The vaccine for influenza is designed to treat four different strains of the flu only. Meanwhile, the COVID-19 vaccine offers protection specific to COVID-19. Fortunately, the CDC says people can receive the COVID-19 and flu vaccine at the same time. 

    Q: Why is there so much misinformation and conflicting advice out there about COVID vaccinations? Why is it so hard to feel good about my decision?

    Unfortunately, discussions around COVID-19 vaccines have frequently become polarizing and controversial. This is largely being fueled by a consistent stream of misinformation being shared with the public, particularly on social media. Recent news reports also suggested that misinformation campaigns surrounding COVID-19 vaccines are expected to increase after the FDA’s recent vaccine approval for children ages 5 to 11. 

    For many adults and caregivers, the continuous stream of conflicting vaccine information has been agonizing. Knowing who to listen to, which information is accurate, and whether enough information has been gathered all complicate the decision about whether or not to vaccinate. 

    My advice to parents wanting additional information about the COVID-19 vaccine beyond their pediatrician’s advice is to ensure their information source is credible, and based on reliable, cited research with the best available evidence. Online sources like the American Academy of Pediatrics (AAP), the CDC, and are all sources I’d recommend, in addition to discussions with a trusted local pediatrician.

    Q: Will we be dealing with COVID vaccines each year, just like the flu?

    It’s too soon to know if we’ll be dealing with COVID-19 vaccine on an annual basis, and if so, for how long. Researchers will continue to study COVID-19’s global impact and make recommendations for vaccination schedules based on how the virus and public immunity evolve.