Should Children get the COVID Vaccine?

The FDA recently approved the COVID vaccine under the Emergency Use Authorization for children 12 and over. So as you can imagine, I am being asked frequently if I recommend it for children. My answer is mostly yes, but with some nuance. It is not for everyone.

My recommendations are based on my clinical observations from the past year of this pandemic combined with some common sense. I also want to preface my comments by saying not everything is all or none. Nothing related to COVID is 100%.

First things first, let me start by saying COVID does not appear to be a pediatric illness as much as it is an adult illness. There are some rare cases of severe COVID in young children, but the overwhelming majority of kids who get COVID have a mild illness. Kids under the age of 14 are not the transmitters of COVID, for the most part. They are the recipients and adults are the spreaders.

When children go to school with COVID, they generally do not give it to the other students or the teachers. And they are not bringing it home to their parents or grandparents. When I see a child with COVID, 95% of the time it is from the parent, 4% from the teacher, and 1% is unknown. I have heard of cases where it looks like the kid brought COVID home to the family or spread it, but that is definitely in the minority of cases. These observations are true for kids from infancy to middle school.

High schoolers are a little different. I definitely see high school kids transmitting COVID to each other, bringing it home, and giving it to adults. This is pretty common.  Why does it affect high school kids more? Is it related to how they are acting when they are not in school? Does it have something to do with their ACE receptors? Or the time lapse from the MMR vaccine? Unfortunately we just don’t know.

As a pediatrician, I am obviously very pro-vaccine and can conclusively state that vaccines have saved more lives in the past 100 years than any other medical invention. The mRNA vaccines (Pfizer and Moderna) are incredible. The concept is simple and the efficacy is almost unimaginable. To achieve 95% effectiveness is unlike any other vaccine we have. Researchers have been studying the platform for over a decade and it is safe. For COVID they just insert the genetic code for the spike protein. To me it seems simple, safe, and wildly successful.

However, there are a few words of caution and things to consider with the COVID vaccine and younger children (younger than high school age). First, we don’t have a lot of data on the vaccine and children. But I do believe it to be safe for kids and I don’t think it will affect puberty or anything like we are hearing rumblings about right now. Second, if kids are not generally the spreaders of COVID, why do we need to vaccinate them to prevent what often seems to be a relatively mild disease? If we had more information on who gets complications from COVID and how often it really happens, as well as more information on the safety of the COVID vaccine in children, then I think it would be more clear as to whether younger children need the vaccine. Third, the number of COVID cases is dropping drastically. We are at the lowest levels since the start of the pandemic. We can almost say the pandemic is over in the US (thanks to the vaccine).

Now that we’ve addressed younger children, the question is would I recommend the COVID vaccine for any pediatric age group. And my answer is yes, I would recommend it for all high school kids. I would not currently recommend it for elementary school kids (if they ever approve it for that age group). And I am lukewarm on middle schoolers getting it.

I have seen enough spread of COVID in high schoolers that I feel the benefits of the vaccine outweighs any risks. For the middle school age kids, I think if your kid is going to sleep away camp this summer that maybe it is worth getting the vaccine. I know how important it is to get our kids back to some semblance of a normal life and summer camp is one ideal way for that to happen. If our kids are away and sleeping in a bunk with 15 other kids or so, it makes logical sense that the more kids who are vaccinated, the less likely COVID will spread and the camp can have a successful session.

There are a few other situations to consider regarding middle schoolers, as well. If you, your child, or a family member are high risk, then I think getting your child vaccinated makes sense. If you or your child has an overwhelming fear of COVID, then I think you can get your child vaccinated (there are some people who have really not left their house in over a year except for a handful of times). But if you do not have a compelling reason to get vaccinated, I might recommend waiting on the middle school age kids a little longer to see where the pandemic goes. If COVID becomes an annual infection like the flu, then I would get them vaccinated. But I am not sure if that is going to happen as of right now so I would still hold off.

The real push with the vaccine should be to get adults vaccinated. Adults are the spreaders of COVID, so we need to work to overcome the vaccine hesitancy in the adult population. I applaud the messaging that just came out from the CDC that fully-vaccinated people can take off their mask. That is what the science has been showing, and I think it will be a nice incentive to get the vaccine.

In summary, I definitely recommend the vaccine for high schoolers, I’m lukewarm on middle schoolers, and I do not recommend it for elementary school age kids as of now. The vaccination push should not be on the children as COVID is not as common, as severe, or spread by them as much as with adults. The adult population is where we need to focus our efforts.

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