Last December, when Caleb Chung, 12, from Durham, North Carolina, first heard from his father that he might be eligible for a local clinical trial of a Covid-19 vaccine, his reaction was a bit muffled . He was “interested,” he told me via Zoom. Not excited, exactly, not jumping for joy at the thought of joining the rarefied ranks of the immune. Interested. He had heard about Side effects, on the one hand, watching the news with his parents. More importantly, he just didn’t know what to make of the idea.
So Caleb and his father, a pediatrician who works with teenagers, started talking. They covered the science of vaccine creation and testing, and how testing has helped bring vaccines to vulnerable people in the past. Plus, Caleb missed seeing his friends inside, and the seventh grade Zoom school was slow. Getting photos to more people would end the boredom faster. So he signed up. At the end of December, he received his first injection of what was either the Pfizer-BioNTech vaccine or a placebo. Then, three weeks later, he received his second. Both times he kept a daily diary of his feelings, recording a slight fever and pain in his arm on the second day. He took it in stride. “I hope that means I got the vaccine,” he says.
At present, two Covid-19 vaccines have been greenlit for emergency use by the United States Food and Drug Administration, but both are only available to people older than Caleb. Moderna’s vaccine is licensed for people over 18, while Pfizer’s is licensed for people as young as 16, as people that age were included in its trials earlier. But that could change. Last week, Pfizer officials announced that they had completed recruiting more than 2,200 people in an expanded vaccine trial that includes children as young as 12, and Moderna is currently recruiting adolescents. This likely sets the stage for companies to include teens in their FDA approval applications, due later this spring.
In the difficult calculation of prioritizing who should receive rare vaccines and when, children occupy a strange niche. The death and hospitalization rate is much lower for children than for other age groups, and there is some evidence – albeit sometimes conflicting – that they can spread the virus at lower rates than adults. For a doctor faced with a decision between vaccinating an 80-year-old and a 15-year-old, the older person with the highest risk of serious illness would be the obvious choice, says Grace Lee, professor of pediatrics at Stanford’s School. of Medicine and member of the CDC Advisory Committee on Immunization Practices. But there are many reasons, she adds, why young people should get vaccinated.
One factor is that every 15 year old is different. Children with pre-existing conditions are prone to worse outcomes with Covid-19, as are adults, and many teens work outside the home in fields like restaurants, an industry that has among the highest rates of infection. More than three-quarters of child deaths are in Hispanic, Black and Native American children, and other effects of the disease, such as MIS-C, the immune disease that sometimes hang around as a result of Covid-19 infection in children, have similar disparities. “We naturally focus on deaths and hospitalizations, but we haven’t thought about the long-term effects yet,” says Lee. Without the ability to vaccinate children, a return to normal life – which will inevitably involve less protective distance and mask wearing than we currently have – would lead the virus to take calm but steady ravages on children, says -it. In October, the National Academy of Medicine recommended giving children the same immunization priority as some essential workers on the basis of a rubric that included equity.