White Coat, Black Art·The Dose

What we know about kids and COVID-19 vaccines

With the possibility of COVID-19 vaccination getting closer for children ages five to 11, pediatricians say they're getting questions from parents about how safe and necessary they are, and are ready to discuss any concerns with compassion.

If parents feel heard and understood, they're in a much better position to make decisions, say pediatricians

Kate Misener, 6, puts on her mask before heading in for her first day of Grade 1 at Spring Valley Elementary School, in Ancaster, Ont., on Sept. 8. Wearing masks and vaccinating adults remain key ways to protect the youngest Canadians from COVID-19. (Evan Mitsui/CBC)
COVID vaccines are already approved in Canada for people aged 12 and older. Now, PfizerBioNTech says it plans to apply to Health Canada to authorize its vaccine in children aged five to eleven, as early as this week. So what do we know about kids and COVID vaccines? 21:28

It's normal for parents of school-aged kids to have questions about the prospect of COVID-19 vaccines becoming available to protect younger Canadians, according to pediatricians who say showing compassion with vaccine hesitancy could go a long way.

Health Canada said it expects to receive Pfizer-BioNtech's formal filing for authorization of its vaccine for children aged five to 11 as early as this week

Daniel Flanders, a pediatrician in Toronto, is already fielding calls from parents who want their children to be first in line for the immunizations, as well as parents who are more cautious.

"There's a spirit nowadays in the media and in doctors' offices where, you know, parents feel like if they even for a moment feel skeptical they're going to be shunned," Flanders told Dr. Brian Goldman on The Dose podcast. "I agree we need to push to get everyone vaccinated, but I think we need to be a little bit more compassionate and understanding." 

When COVID-19 vaccines rolled out to adults and teens worldwide, people generally became more comfortable as the safety data accumulated, Flanders said. He suspects the same will happen if Health Canada approves the vaccines to protect younger kids. 

Enzo Russo, 14, receives the Pfizer-BioNTech vaccine to protect against COVID-19 during a vaccination day in Rio de Janeiro, Brazil, on Sept. 17. Health Canada is currently assessing whether to approve the vaccine for children aged five to 11. (Ricardo Moraes/Reuters)

Flanders said he has "all the time in the world" to talk to parents and patients who are eager to learn more to make an informed decision about COVID-19 vaccinations.

The Pfizer vaccine, which is already authorized in those 12 and up, has been shown to lead to a strong immune response in school-aged kids, based on a clinical trial of more than 2,200 participants, the companies said last month in a press release

Regulators like Health Canada and the U.S. Food and Drug Administration are currently independently scrutinizing the company's results as they decide whether to give the green light to vaccinate school-aged kids. 

Canada has more than four million people aged 5 to 14. 

Dosing vaccines in kids

Flanders said vaccine makers do research on what dose hits the "sweet spot" to gain the desired degree of immunity without increasing the risk of adverse events or side effects.

In the clinical trial, children aged five to 11 received a third of an adult's dose, or 10 micrograms instead of 30 micrograms. Flanders said some pediatric vaccines use the same, half or a third of the dose of adults, which he called reasonable.

"The idea being that not only are children smaller than adults, but their immune systems are probably on average a little stronger, a little more potent in their reaction," Flanders said. "So they need a smaller dose to create an equivalent level of immunity."

WATCH | COVID-19 vaccine questions answered:

Answering your questions about vaccine safety and COVID-19

2 months ago
13:01
Dr. Cora Constantinescu, a pediatric infectious diseases specialist and head of the vaccine hesitancy clinic at Alberta Children's Hospital, answers your questions about COVID-19 vaccines, their side-effects, and vaccinating children and those who are pregnant. 13:01

The dose for kids is based on what's discovered during the clinical trials.

Flanders is gearing up to immunize school-aged kids against serious illness, hospitalization and death from COVID-19. To that end, he's practising his empathy skills.

"I think that if parents feel heard and parents feel understood, they're in a much better position to understand that even though this is a new vaccine, we're balancing risk here," he said.  "I'm there to answer questions. I'm there to help navigate difficult decision making."

The risk of "something really rotten" happening to a child from the vaccine is "so incredibly low" compared with "fairly significant" risk from COVID-19 itself to adults in the kid's life, such as a grandparent, uncle or teacher, he said.

Dr. Dan Flanders takes the time to speak with parents with questions about having their young ones vaccinated to protect against COVID-19.

If young kids are nervous about getting a shot, Flanders suggested that parents can help prepare them by reading books about getting a needle beforehand and by projecting confidence themselves. 

Flanders said children look up to their parents during vaccinations. If they see a confident, positive gesture from mom or dad, it gives the child strength. 

Protection for my child

Dr. Cora Constantinescu, a pediatrician and infectious diseases specialist at Alberta Children's Hospital in Calgary, runs a clinic that provides pediatricians in the community with tools to help address parents' questions about COVID-19 vaccines.

 "Right now, the main issues in vaccine hesitancy for children are confidence, so safety issues, and complacency, so does my child need this vaccine?" Constantinescu said.

Since parents are already going to grapple with those two issues, Constantinescu said, making kids' vaccinations as convenient as possible is paramount to success.

Like Flanders, at Constantinescu's clinic they make it clear they're "not trying to get into a philosophical debate," but to help parents protect their children with a personalized approach for each individual child's needs, including medical conditions.

Throughout the pandemic, Constantinescu said surveys suggested parents wanted their child's health to be prioritized, including mental health and socialization. 

"What a vaccine to children is going to mean to parents is that they're finally seeing personal protection within grasp for their child," Constantinescu said.

Now during Alberta's fourth wave, 30 per cent of COVID cases are among those aged 19 and younger, who are being more severely affected than in previous waves, she said. 

WATCH | The road to getting youngest Canadians vaccinated:

The importance and hurdles of getting COVID-19 vaccines for kids

9 months ago
7:06
Providing COVID-19 vaccines to children will be an important step in reaching herd immunity, experts say. But it’s unclear when children will be eligible and some parents aren’t sure if they want their kids to get the shot. 7:06

The pandemic continues to play out differently across the country, Constantinescu said, with a constant being how schools reflect the COVID-19 burden in the larger community. 

Surveillance beefed up for safety concerns

Dr. Karina Top, an associate professor of pediatrics at Dalhousie University and a pediatric infectious diseases physician at the IWK Health Centre in Halifax, said during Pfizer-BioNtech's clinical trials, the companies didn't report any serious safety concerns. 

The clinical trials in teens and adults were done in thousands of people. Since the vaccines have now been rolled out to millions of people, adverse events such as myocarditis have been reported after immunizations. 

Myocarditis, or inflammation of the heart, occurs more often from COVID-19 itself than from the vaccinations

Myocarditis also occurs more often in males than in females. Physicians say the symptoms are usually mild and are easily treated.

"We already have a rigorous system of vaccine safety monitoring in place in Canada and with COVID vaccines, that system was augmented and enhanced further," Top said.

In Canada, the surveillance systems cast a really wide net — including reports that are likely just a coincidence and not linked to vaccines — to make sure the vaccines are as safe as possible. 

Parents of children who are vaccinated may also sign up for surveys from the Canadian National Vaccine Safety Network or CANVAS, which captures unexpected health events in the week after vaccination, she added.

Flanders and Top said if approved, provincial and territorial officials could decide to roll out the vaccines to kids in all of these places:

  • Mass immunization clinics such as those already used for adults and teens.

  • At primary care clinics staffed by physicians, nurses, nurse practitioners and others familiar with giving vaccines to young children.

  • Schools, particularly for those aged nine and up. 

  • Mobile vaccine clinics. 

  • Pharmacies. 

Since those aged five to 11 attend school and have more social contacts than younger children, achieving high rates of vaccine coverage would help prevent the spread of contagious variants, Top said, a step toward returning to what life was like before the pandemic. 

Other COVID-19 vaccine makers such as Moderna and Janssen/Johnson & Johnson haven't yet released data from their trials for children under 12.

Written by CBC's Amina Zafar

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