Vaccines for Young Children Are Coming, but Many Parents Have Tough Questions

It’s a moment many parents are anxiously awaited for months: Children younger than 5 are now eligible for vaccination against the coronavirus, among the last Americans to qualify.

Without access to vaccines, young children of parents have confronted almost impossible choices since the pandemic began. Many children were kept out of schools, family gatherings and other activities, and were deprived of normal childhood experiences. Now all that could change.

On Saturday, the Centers for Disease Control and Prevention recommended the Moderna and Pfizer-BioNTech vaccines for children as young as 6 months. The decision means the shots will be administered for the first time to these young children, probably as early as Tuesday.

Sunny Baker, 35, a mother of two in Oxford, Miss., Said she was vaccinated with her older daughter, Hattie Ruth, 5, at her first chance, and has been waiting eagerly for her 2-year-old daughter, Alma Pearl. qualify.

“Yes, yes, yes! We would love to be first in line, “she said.

But Ms. Baker may very well be in the minority: A recent Kaiser Health poll found that only one in five parents would get their young children vaccinated immediately. Many plan to hold off for now.

As the pandemic stretches into a third year and Americans weigh the risks they are willing to live with, the CDC’s decision puts parents of young children on the spot.

Vaccines have lost some of their potency against infection with new variants, though they continue to offer protection against severe illness and death. And huge numbers of Americans were infected during the Omicron surgeon, contributing to a mistaken sense among many that the battle was over.

Shifting advice has also contributed to a lack of enthusiasm. Daryl Richardson, 37, of Baltimore, said he had no plans to vaccinate his three children, in part because of constant changes to the number of doses recommended.

“First it was a shot, and then it was a booster, and another booster,” he said.

After navigating the perils of the pandemic with their children for so long, parents now face new questions, some so complex they have stumped even regulators and experts. Which vaccine is better? How well, and how soon, will they work? And why bother, if the majority of young children are already exposed to the virus?

Both the Pfizer-BioNTech and Moderna shots are considered safe for young children, and both yield blood protective antibodies similar to those seen in young adults. But neither delivers the miraculous protection provided by the adult vaccines in the pandemic’s early days.

Moderna’s vaccine seems to produce a strong immune response in young children, and its protection is completed within 42 days after the first dose. But the vaccine causes fevers in one in five children, and fewer providers are likely to offer it as an option over Pfizer’s vaccine.

The Pfizer-BioNTech vaccine is more familiar and produces fewer fevers, but children will need to get three doses to be protected from the virus. While it takes 90 days to achieve peak protection, the effect may be last longer, compared with moderna’s regimen.

“The implementation of these two rollouts is going to be incredibly challenging,” said Katelyn Jetelina, a public health expert and author of the widely read newsletter, “Your Local Epidemiologist.”

“There’s going to be a lot of proactive communication about the difference between the two and the implications of taking one over the other,” she said.

A head-to-head comparison of the two vaccines might provide some answers to parents, but that is neither possible nor advisable, experts said in interviews. There are just too many differences in the way the vaccines are formulated and evaluated.

“It’s really going to be impossible to say one is better than the other,” said Dr. William Towner, who led vaccine trials for both Moderna and Pfizer at Kaiser Permanente in Southern California.

The choice may depend more on whether parents are willing to go for three doses versus two, and which vaccine their providers have at hand, he said.

Many providers are unaccustomed to Moderna, having relied so far on the Pfizer-BioNTech vaccine. About 350 million doses of vaccine are administered to Americans overall, compared with 223 million doses of the Moderna vaccine and about 19 million of the Johnson & Johnson vaccine.

For young children, states have so far ordered 2.5 million doses of the Pfizer vaccine and 1.3 million of the Moderna vaccine. Those numbers are lower than expected, given the 18 million children in this age group.

Uptake has been slow even for older children. The Pfizer-BioNTech vaccine was authorized for children ages 5 to 11 in November, but less than 30 percent in that age group received two shots.

The vaccines are overall proven to be very safe, but many parents remain hesitant for a range of reasons. Some are wary because vaccines are relatively new, or because they are at risk from Covid-19 to be negligible for their children.

Some parents may be uninterested because 75 percent of their children are already infected. But vaccination provides more powerful and consistent protection even if a child has already been infected, CDC scientists noted on Saturday.

Still other parents have moved on from the pandemic.

In Middletown, Ohio, some parents were more concerned with staying cool during the summer heat wave than the risks from the coronavirus. Tori Johnson, 25, is unvaccinated and said she didn’t intend to immunize her two daughters, 7-year-old Liliana and 9-month-old Rosalina.

Life had already returned to normal, she said.

Simone Williams, 32, said she was hesitant to vaccinate her 1-year-old twins, Caidon and Arissa, and 4-year-old Bryan. “I would get it for them if it were necessary, but otherwise I wouldn’t be in a hurry,” Ms. Williams said.

Some pediatricians were preparing to explain to parents the merits of the vaccine. Even routine immunizations are a fraught topic in many parts of the country.

Pediatricians “have struggled with this for many, many years with the influenza vaccine and the standard dosing for the measles, mumps, rubella and varicella,” said Dr. Lindsey Douglas, a pediatrician and medical director of quality and safety at Mount Sinai Kravis Children’s Hospital in Manhattan.

“In the past two and a half years now, there is definitely a lot more information out there,” Dr. Douglas added. “But there’s a lot more misinformation out there, too.”

In some ways, the odds were stacked against the vaccines in the youngest children.

The Moderna and Pfizer-BioNTech vaccines both offer spectacular estimates of efficacy in adults, far beyond expectations, and raised hopes for a virus-free future.

But while the vaccines were constantly being tested in younger children, the virus rapidly morphed, making each new form more elusive and challenging than the ones before.

The newest versions of the Omicron variant have evolved to partially dodge not just the two-year-old vaccines, but even the immunity produced by an infection of the Omicron that circulated just a few months ago.

The original efficacy estimates were in adults for 95 percent of the order. That figure has given way now to 51 percent for two doses of Moderna’s vaccine in children 6 to 23 months, and just 37 percent for children ages 2 through 5.

As low as it may seem, Pfizer’s vaccine did not meet the Food and Drug Administration’s bar for an immune response, justifying the agency’s decision in late February to evaluate the vaccine until the company had tested three doses.

“As a mom, I think it’s unacceptable that it took so long to get our little ones on the vaccine,” Dr. Jetelina said. But “as an epidemiologist, I also know the value of doing clinical trials rigorously, and finding the right dosage.”

Based on the data, the FDA authorized two doses of the moderna vaccine this week and Pfizer-BioNTech as the “primary series” for young children.

If officials determine that even the youngest children need booster shots against future variants, children will need a third dose of Moderna and a third of Pfizer.

In news releases and data reported to federal regulators, Pfizer has estimated an efficacy of 80 percent for three doses of its vaccine. But that calculation was based on just three children in the vaccine group and seven who received a placebo, making it an unreliable metric, as the CDC’s advisors noted at a meeting on Friday.

“We should just assume we don’t have efficacy data,” said Dr. Sarah Long, an infectious diseases specialist at Drexel University College of Medicine. But Dr. Long said she was “comfortable enough” with other data supporting the vaccine’s potency.

Parents of the youngest children may be more willing to opt for a Covid vaccine if it can be offered along with other routine immunizations. Dr. Towner said either vaccine would be better than none, but he predicted that more parents might opt ​​for Moderna.

“I’ll be honest, that might be a little difficult for some parents to do as three doses as opposed to two,” he added. “If they have a choice, and if both are available, that might sway some parents to the Moderna.”

Some parents will need no convincing. Erin Schmidt, 37, of Alexandria, Va., Said the news was “life-changing” because her family was living in a “sort of alternate isolated reality.” After vaccinating her 2-year-old daughter, Sophia, she plans to open a bottle of champagne, take Sophia to a museum and “blow her mind about the world.”

Brendan Kennealy, 38, of Richfield, Minn., Said after his daughters, 4-year-old Hazel and 1-year-old Ivy, were vaccinated, he and his wife, Jocelyn, 35, would drive them to the lake town. Duluth, where they plan to try new restaurants and attend an outdoor concert by a local folk band called Trampled by Turtles.

The family has had time to avoid indoors with his mother, who is lupus and is vulnerable to severe Covid. His children missed the state fair, quit swim lessons and gave up gymnastics.

“I’ve gotten very, very happy in the past, and then they pulled the rug back out,” Mr. Kennealy said the FDA’s halting progression on vaccines for children.

“Those jolts of hope were so unnecessarily defeating,” he added. “Until we’re at the Walgreens or wherever we take them to get their pokes and their Band-Aids, I’m trying to keep that at bay.”

Adam Bednar contributed reporting from Baltimore, Christina Capecchi from Richfield, Minn., Ellen B. Meacham from Oxford, Miss., and Kevin Williams from Middletown, Ohio.

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