The White House Wednesday detailed plans to vaccinate younger children against COVID-19, a mission that infectious disease specialists say has the potential to dramatically tamp down the pandemic that has gripped the country for the last 20 months.
Nationwide, some 28 million youngsters, ages 5 to 11 — roughly 8 percent of the country’s population — would be eligible for the shots if authorized by federal health regulators at their upcoming meetings starting next Tuesday.
Yet many parents are hesitant, as on the one hand, studies show that kids can harbor high levels of coronavirus as well as transmit the lethal disease to others, yet on the other, they are unlikely to become seriously ill themselves. Heightening anxiety are reports of a very rare but concerning risk among teens of myocarditis, or inflammation of the heart, and pericarditis, an inflammation of the outer lining of the heart, after getting vaccinated.
Still, infectious disease experts say the benefits of the shots greatly outweigh those small risks — preventing thousands of children from being hospitalized with COVID, as well as further limiting the spread of the virus. They also say that the United States is unlikely to beat back the pandemic without vaccinating a sizeable portion of young children.
“This [pandemic] is a marathon and this is mile 20 and getting vaccinations for 5- to 11-year-olds will help us get closer to that finish line,” said Dr. Michael Koster, director of the division of pediatric infectious diseases at Hasbro Children’s Hospital in Rhode Island.
Advisers to the Food and Drug Administration are scheduled to meet Tuesday to review safety and efficacy data for Pfizer’s vaccine in these younger children and make a recommendation to the agency. Then, advisers to the Centers for Disease Control and Prevention meet Nov. 2 and 3 to discuss the findings. FDA authorization, followed by a final sign-off by the CDC, is expected shortly thereafter.
But the White House on Wednesday said it is already pushing ahead with rollout plans. Doses will begin shipping after CDC approval to pediatricians’ offices, pharmacies, and other providers nationwide, along with the smaller needles necessary for injecting young children.
“We know millions of parents have been waiting for COVID-19 vaccine for kids in this age group, and should the FDA and CDC authorize the vaccine, we will be ready to get shots in arms,” White House COVID-19 coordinator Jeff Zients said in a press briefing.
Zients said that over the past several weeks, the White House has been working closely with governors, pediatricians, pharmacies, and other providers to prepare for this moment.
“Together, we are completing the operational planning to ensure vaccination for kids, ages 5 through 11 are available, easy, and convenient,” he said.
But the first few weeks of the rollout likely will be rocky, said Jen Kates, senior vice president and director of Global Health and HIV Policy at the Kaiser Family Foundation. Kates has been tracking COVID vaccine rollout and public opinion throughout the pandemic.
“For the 5- to 11-year-olds, it’s a different regimen. Pfizer is having to repackage and send out different colored-coded vials to distribution points,” Kates said.
The two-dose regimen will be a third of the amount given adults.
“Eventually things will smooth out and parents who are anxious will figure it out, and then it will move to the harder phase” of convincing reluctant parents, Kates said.
The Massachusetts health department, along with the Massachusetts Chapter of the American Academy of Pediatrics, on Monday told pediatric health providers that the first shipment of vaccines will require sites to accept a minimum of 300 doses and all must be used within one month.
Massachusetts officials are not planning mass vaccination sites for children. Instead, parents will make appointments through their doctors or other health care providers, though details about when and how to make appointments have not been released.
“We strongly recommend the scheduling of dedicated vaccination clinics starting in early November as there will likely be a very strong demand for vaccinations as soon as the recommendations are announced,” the advisory said.
Polling data suggest that, while many parents are eager to immunize their children, many others are more reticent. A Kaiser Foundation poll in September of parents of this young age group found that roughly one-third said they will vaccinate their children as soon as the shots are available. Another third said they would wait a while and see how children are faring before deciding. But nearly a quarter of those polled said they definitely would not give their youngsters the shots.
“There is going to be greater reluctance by a greater share of parents than before,” Kates said. “This will require greater education and time.”
More than 6 million cases of COVID-19 have been reported in children since the start of the pandemic, with 23,582 hospitalizations and 558 deaths, according to the American Academy of Pediatrics. And with the contagious Delta variant still dominant, children now account for more than 25 percent of the reported weekly cases, the academy data show.
Dr. Rick Malley, a pediatric infectious disease physician at Boston Children’s Hospital, said pediatricians find themselves in a challenging position speaking with parents about the COVID vaccine.
“We are constantly balancing the question of what to do for the individual child versus the public good,” he said. That is, balancing the risk of not vaccinating a child who is unlikely to suffer serious side effects from COVID with the very real risk that an unvaccinated youngster can still spread the disease to others who may get seriously ill.
And then there is the risk that a very small number of vaccinated children may suffer heart inflammation from the Pfizer shots, the only vaccine yet authorized for children.
“The good news is that most of the kids with heart inflammation have recovered, but we don’t know if they will have long-term problems,” Malley said.
A number of countries, including Norway and the United Kingdom, have recommended just one dose of the Pfizer vaccine to children 12 and over because many of the myocarditis cases were reported after a second shot, and more typically in young males.
Dr. Shari Nethersole, a pediatrician and executive director of Boston Children’s Hospital Office of Community Health, said parental thoughts on shots for youngsters run the gamut from those who are eager for their children to be vaccinated to those who are generally mistrustful of the medical community and want to wait.
Historically, Massachusetts has one of the highest rates in the country for established childhood vaccines from polio to pertussis, but the COVID shots are new and the scientific understanding of how they work is developing in real time. Plus, COVID is less of a threat to children than many of the diseases they’re already vaccinated against.
“Part of it is getting people to step back and look at the big picture,” Nethersole said. “Yes, there may not be a lot of benefit to a child himself [getting the COVID shot], but it can be a huge benefit for the family and the community. ... What is our responsibility to each other?”