Health·CBC Explains

A children's COVID-19 vaccine is now approved in Canada. What do we know about it?

CBC answers how the pediatric vaccine is different, where kids will be able to get it and other questions around COVID-19 vaccinations for younger children.

Children between 5- and 11-years old will get smaller doses than older kids and adults

Young children get their flu shots in Vancouver. On Nov. 19, Health Canada approved Pfizer-BioNTech's pediatric COVID-19 vaccine for kids five to 11 years of age. (Ben Nelms/CBC)

Now that Health Canada has approved Pfizer-BioNTech's COVID-19 vaccine for younger children, many people have questions. Here's what we know:

What do we know about Pfizer's pediatric COVID-19 vaccine? 

Pfizer-BioNTech was the first company to seek Health Canada's approval for a pediatric COVID-19 vaccine and made its submission on Oct. 18.

The brand name of Pfizer's vaccine is Comirnaty. 

The pediatric version of the vaccine is for kids age five to 11. Those 12 and older get the already approved adult formulation. 

The pediatric formulation will be given in smaller doses — 10 mcg (micrograms) instead of the 30 mcg used for people 12 years of age and older. 

The vials for the pediatric version have orange caps so health-care workers can easily tell the difference between the adult and child versions (the adult vials have purple caps).

Two teenage sisters wait for their COVID-19 shots in Toronto in this file photo. Kids age 12 and older are approved to receive the same vaccine dose as adults, but younger children will get a smaller dose. (Evan Mitsui/CBC)

At a media briefing in October, Dr. Supriya Sharma, Health Canada's chief medical adviser, said the children's version of the vaccine was "slightly different" that the adult one, but that it contained the same mRNA and works the same way. 

Like the adult version, kids will get two doses of the vaccine. 

Although the manufacturer's instructions say the two doses are to be given 21 days apart, the National Advisory Committee on Immunization (NACI) recommends a longer gap of at least eight weeks. NACI also recommended longer spacing between doses for the adult version of the vaccine. 

That's because there's evidence that a longer interval between doses generates a more robust immune response.

The longer spacing might also help to further decrease the risk of one rare side-effect — myocarditis, inflammation of the heart muscle — that has appeared occasionally in adolescents and young adults, NACI said.

WATCH | First shipment of Pfizer's COVID-19 vaccine for kids arrives in Canada

First shipment of Pfizer’s COVID-19 vaccine for kids arrives in Canada

11 months ago
Duration 2:04
Canada received its first doses of Pfizer-BioNTech’s COVID-19 vaccine for children ages five to 11 on Sunday, just two days after being approved by Health Canada. The pediatric vaccine uses a dosage that is one-third the size of those given to people 12 and older.

When can my child get the shot?

The first batches of Pfizer's vaccine for children aged five to 11 arrived in Canada on Sunday

The federal government and the pharmaceutical giant have agreed on an accelerated delivery of more than 2.9 million doses, scheduled to arrive in Canada by the end of the week. 

Public Services and Procurement Minister Filomena Tassi has said that's enough to provide a first dose to every eligible Canadian child.

The vaccines are being distributed to the provinces and territories, which are responsible for working with local public health units to get them into kids' arms. 

Where can my child get their shot?

It depends where you live, as the provinces and territories, along with local public health units, determine vaccination plans. 

On Monday, Ontario Health Minister Christine Elliott announced that the province's booking system would be up and running by 8 a.m. ET Tuesday to book appointments for kids five to 11 to get their first shots as early as Thursday. 

Kids could get their COVID-19 vaccine at doctor's offices, pharmacies, community vaccination clinics and school-based clinics. 

In Toronto, for example, "school-based clinics will be deployed throughout the city over the course of the COVID-19 vaccination campaign," according to the city's website

Manitoba opened its booking system on Monday and the province said it expected the children's vaccines to start arriving on Tuesday. 

Alberta has said that its booking system will open once doses arrive in the province. Parents can pre-register if they want to. 

In Nova Scotia, health officials said earlier this month that administration could begin in early December.

Quebec is aiming to give one dose to each child by Christmas.

What about side-effects?

The objective of protecting children against any potential side-effects is a big reason they're last to be enrolled in clinical trials and given the vaccine, said Dr. Caroline Quach-Thanh, a pediatric infectious diseases specialist and medical microbiologist at Chu Ste. Justine in Montreal.  Quach-Thanh is also the former chair of NACI.

"When we see that it's safe in older people then we are more at ease giving it to younger children," she said. "So that absolutely is reassuring."

WATCH | Specialist addresses concerns about the vaccine:

Specialist focuses on key concerns for pediatric use of COVID-19 vaccine

11 months ago
Duration 2:05
Pediatric infectious diseases specialist Dr. Anna Banerji answers questions about the dosage of the COVID-19 vaccine for kids and the risk versus benefits. (Pfizer)

Both Health Canada and NACI extensively examined safety and efficacy data before approving the children's vaccine and making recommendations on its use. 

According to NACI's guidance, issued on Friday, that included the "manufacturer's clinical data in the regulatory submission to Health Canada, modeling projections on the impact of a pediatric vaccine program, and post-market safety data for the 30 mcg dose in older age groups."

The most concerning side-effects that emerged after millions of teens and adults were immunized were very rare cases of myocarditis or pericarditis (inflammation in or around the heart). 

But even in the rare instances that occurred, most cases were mild and resolved themselves without hospitalization, Quach-Thanh said. 

Plus, people are much more likely to get heart-related illness if they become infected with COVID-19, experts agree. 

Pfizer's clinical trial data included 2,268 children aged five to 11, according to a company news release

What are the benefits to vaccinating my child against COVID-19?

Because children are less likely than adults to get seriously ill from COVID-19, some parents question why their kids need the vaccine.

But some do suffer serious illness, said Dr. Eileen de Villa, Toronto's medical officer of health said at a media briefing in October — and the virus that causes COVID-19 finds people who aren't vaccinated. 

"If you are not protected, the virus will seize that opportunity to infect, whether you are younger or older," de Villa said.

Even if they don't get sick themselves, children can transmit the virus to people who are more vulnerable to life-threatening illness,  she said. 

Vaccinating your child means "you are protecting them, you are protecting your family and yourself and you are protecting grandparents and elders who could become sick and be at risk as a result," de Villa said. 

Parents also need to consider the benefits of getting their children back to a more normal life, Quach-Thanh said. 

"You can go back to school and you can stop, you know, going to your testing centre every other week because you have a sniffle once you're vaccinated," she said. 

"I think life as we knew it is going to be much easier to get back to [with vaccination]."

Is Pfizer the only COVID-19 vaccine available for kids under 12 in Canada?

Yes. It's the only pediatric COVID vaccine for kids under 12 that's been approved here. 

Moderna has also developed a children's vaccine and applied for approval earlier in November. Its vaccine is for kids between ages six and 11 years of age. 

The brand name of Moderna's COVID-19 vaccine is Spikevax.

Health Canada is reviewing its application. 

If approved, Moderna's kid-sized dose would be half the amount given to children 12 and older and adults (50 mcg instead of 100 mcg). 

Should I space out my child's COVID-19 vaccine and their flu shot?

Yes, at least for now. 

NACI recommends that children get the COVID-19 vaccine at least 14 days before or after receiving another vaccine, including the flu shot.

The separation time is a precautionary measure because the COVID-19 vaccine for kids aged five to 11 is being introduced in the general population for the first time. 

Health officials are watching closely in case of a "very, very rare scenario that there may be an adverse event," said Dr. Isaac Bogoch, an infectious diseases specialist at University Health Network in Toronto. 

If that were to happen, "you'll at least be able to point to which vaccine was the culprit," Bogoch said. 

Adults do not need to separate the flu shot and the COVID-19 shot and it's safe for adults to get both at the same time, NACI says. 

ABOUT THE AUTHOR

Nicole Ireland is a CBC News journalist with a special interest in health and social justice stories. Based in Toronto, she has lived and worked in Thunder Bay, Ont.; Iqaluit, Nunavut; and Beirut, Lebanon.

With files from Christian Paas-Lang, Marielle Torrefranca, Bruce Hoye and Amina Zafar

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