Across Canada, parents are facing a decisive moment in the pandemic: whether or not to have their children vaccinated.
Ontario Premier Doug Ford has chosen to keep schools shut for the remainder of the academic year, warning Wednesday that returning kids to in-class learning before they are vaccinated could lead to “thousands” of new cases of COVID-19.
Many infectious disease specialists say an end to school closures and the path back to normalcy, even sanity, hinges on having children vaccinated. High vaccination rates will drive down the virus, protecting everyone. In Canada, the Pfizer-BioNtech mRNA shot was approved last month for children down to age 12. Canada is home to approximately 1.63 million 12- to 15-year-olds.
Some are already clamouring to get vaccinated. From Vancouver to Montreal, the early enthusiasm has been high. “As soon as appointments were opened, like, the very next day, parents started bringing their kids in,” said Dr. Laura Sauvé, a pediatric infectious diseases specialist in Vancouver. The response, said Sauvé, “has been huge.”
But she’s also hearing questions, “really valid questions,” from some uneasy parents.
Questions like, why the rush to vaccinate, if kids, overall, haven’t become seriously unwell with COVID, as researchers who analyzed child mortality in seven countries noted in The Lancet.
Children have been mostly spared the worst of COVID, at least its direct viral effects, though COVID’s social, mental and emotional toll on children has been enormous, Sauvé said. Their infection rates are lower than adults. Most infected kids have no, or mild symptoms. In Canada, as of May 28, children under 19 accounted for 11, or 0.04 per cent of deaths, 1.3 per cent of ICU admissions and 1.8 per cent of COVID-related hospitalizations since the start of the pandemic.
Other parents worry about the “warp speed” with which vaccines were developed, or whether children are really crucial to the population reaching some still elusive level of herd immunity.
A late-April polling of a sample of Canadians by the Association for Canadian Studies found that while the majority believe it’s important to vaccinate all children under 18, those with children at home were less likely (55 per cent) than those without kids at home (64 per cent) to feel that way. Thirty-two per cent of people with children at home disagreed somewhat, or strongly, with the need to vaccinate kids.
Yet more people than didn’t also felt that reaching herd immunity required vaccinating children.
It’s important not to downplay the risk of COVID to kids, said Sauvé, chair of the Canadian Paediatric Society’s infectious diseases and immunization committee. Rare doesn’t mean never. “Even though kids don’t get sick very often, there are some who get very, very sick,” she said.
In Canada, 152 children had been admitted to an ICU with COVID as of May 28. Children have also developed a rare, delayed, post COVID-19 complication known as MIS-C, or multi-system inflammatory syndrome in children. Different body parts, like the heart, lungs, kidneys or brain, can become inflamed. Children with certain underlying chronic conditions are also at increased risk for severe COVID.
The Pfizer shot was evaluated in 2,260 adolescents aged 12 to 15 (the pivotal phase 3 trials in adults involved nearly 44,000). It was 100 per cent effective against confirmed COVID-19 infection seven days after dose two.
Reactions were mostly mild to moderate — fatigue, headache, chills, muscle pain and fever. No serious adverse events or deaths were reported. The vaccine is now being tested in children as young as six months old. Studies of Moderna and Novavax vaccines in children are also underway.
Despite the vaccine’s rapid development, testing, safety and regulatory standards weren’t compromised, Sauvé said, and surveillance for rare side effects is ongoing. “Monitoring for safety doesn’t stop once the vaccines are licensed.”
An American vaccine safety committee is investigating reports that some teens 16 and older developed myocarditis, or inflammation of the heart muscle, after receiving Pfizer or Moderna. The reports are “relatively few.” The cases seemed to occur more often in males than females, more often following dose two than dose one and typically within four days after vaccination. “Most cases appear to be mild, and follow-up is ongoing,” the Centers for Disease Control group said.
Myocarditis is usually viral-triggered. Symptoms include chest pain, shortness of breath and feelings of a fast-beating, fluttering or pounding heart. Pediatricians in Canada see about 100 to 150 cases per year, pre-COVID. The cases occurring post-vaccination might be random, but they might be associated. “It’s really important we watch that possible signal closely,” Sauvé said.
Once injected, the messenger RNA that codes for the spike protein on the surface of the coronavirus, the part that allows it to enter human cells, stays mostly in the deltoid muscle.
The mRNA doesn’t replicate in the human cell, and is rapidly broken down. It doesn’t enter the nucleus of the cell; it doesn’t affect the genetic material of the “host,”the Canadian Paediatric Society said in its position statement recommending vaccination of all children aged 12 and over as soon as supplies permit.
Children “absolutely” can transmit the SARS-CoV-2 virus, though they play a smaller role than do adults, Sauvé said. “Just like ‘kids get less sick often’ doesn’t mean kids never get sick. Kids transmit less, doesn’t mean they don’t transmit.” COVID will never ultimately be quelled until children are vaccinated, she said.
Beyond safety, some parents are worried about fertility and reproduction. “There is no reason to think these vaccines impact anything about the ability to have children or harm any reproductive capabilities,” said Arthur Caplan, founding head of the division of ethics at New York University. “We just haven’t seen it and we have huge amounts of data — you’ve got hundreds of millions of people exposed (to mRNA vaccines) and we’re not seeing any reproductive impact.”
The shots will likely be available to ever-younger children, but the dosing has to be established. Physiologically, kids 12 and above resemble adults, which is why they receive the adult dose. With younger children, the body composition changes. “Those trials will take longer while they determine the best dose for those children,” said Dr. Fatima Kakkar, a pediatric HIV and infectious diseases doctor at CHU Sainte-Justine hospital. “But there’s nothing particular about this vaccine with the younger kids that I’d be worried about.”
Montreal is starting school-based vaccinations next week. But children and their parents began lining up two weekends ago at pop-up and walk-in clinics. “There was overwhelming enthusiasm in those first few days,” Kakkar said.
“The parents were dragged out of their beds because the kids really want to go back to playing sports and having their summer. It was the teens driving the push.”