Parents drove hours to get their kids into a Covid-19 vaccine clinical trial in Houston. One call even came from New York City.
“My name somehow came up, and she wanted to bring her child,” pediatric infectious disease specialist Flor M. Munoz recounted. She directed that parent to a closer site but said requests to participate in her study have come in from Austin and other Texas towns hours away.
Munoz, who has been running clinical trials for 25 years, knows firsthand how difficult it can be to accrue enough participants to run vaccine studies. The pandemic changed that. Parents volunteered their kids for a Moderna study that requires multiple visits—each one taking up half a day—over several months and possibly years to complete data collection.
“I am most grateful for parents who are willing to do this, and for their children who are willing to join as well,” said Munoz, who holds posts at both at Baylor College of Medicine and Texas Children’s Hospital. “This community engagement is what we need to be able to make progress with controlling this pandemic.”
Munoz’s experience suggests that lots of parents are eager to get their kids vaccinated, despite concerns among public health officials that parents are more hesitant with their own children than they are for themselves.
A recent Kaiser Family Foundation survey found 30% of parents said they would vaccinate their children as soon as possible, while about a quarter say they definitely wouldn’t. Another 18% said they’ll wait for a school requirement. The Kaiser survey found parents’ views on inoculating their children lined up with whether they planned to get vaccinated themselves.
More than 15,000 local pharmacies will be ready to vaccinate 12- to 15-year-olds once the Food and Drug Administration greenlights the Pfizer shot for those teens, Jeff Zients, the White House coronavirus response coordinator, said May 7 during a Covid-19 press briefing. The government is also working to get more pediatricians and family doctors to offer shots in their offices to “make it as easy and convenient for adolescents to get vaccinated.”
“We already have in place the operational public education plan to immediately hit the ground running,” Zients said.
A key consideration for parents will be “co-administration,” or when children need to get different vaccines and at what times. Patients are supposed to wait two weeks before and after their Covid-19 vaccines before they get other shots.
“That may become a big issue,” Yvonne Maldonado, senior associate dean at Stanford University and an infectious disease pediatrician at Lucile Packard Children’s Hospital in Palo Alto, Calif., said. “We, as pediatric providers, want to make sure that there are no barriers to children getting either the Covid vaccine or their general immunizations.”
For adolescents, that could include the HPV vaccine or the DTaP to protect against diphtheria, tetanus, and pertussis, Kathryn Edwards, professor of pediatrics in the division of infectious diseases at Vanderbilt University School of Medicine, said. These aren’t shots that must be administered every year, but the pandemic has delayed a lot of routine care, including childhood vaccinations.
The American Academy of Pediatrics is developing guidelines to help doctors navigate potential co-administration of their Covid-19 vaccinations with other vaccines on their regular schedule, Maldonado said. The society wants to move quickly after federal recommendations come out.
“This is a really important issue. We’re all aware. And we’ll be working to make sure that that children get all the vaccines that they need to get in an efficient and safe manner,” Maldonado said.
CDC Director Rochelle Walensky said during an Instagram live event May 7 that experts are looking at that two-week recommendation. The primary concern isn’t safety, but rather whether putting these vaccines too close together could compromise the immune response, she said.
Parents will be asked about other vaccines to make sure that the proper interval is respected between those and the Covid jab, Munoz said.
Vaccines are a key part of childhood health care, and pediatricians are used to rapidly incorporating new shots into regular child care. They’re practiced at communicating with their families about the importance of vaccinations and how to manage the logistics.
Children and teens are less likely than adults to get severe cases of Covid-19, but they make up about 22% of the population, so expanded vaccinations will be an important step in bringing the pandemic to an end. The 12 to 17 age group makes up about 24.6 million teenagers living in the U.S., according to the federal website ChildStats.gov.
Among children, the vaccine will likely have the greatest impact on adolescents, Edwards said. A higher proportion of adolescents with Covid have been hospitalized and put on ventilators than younger children. The older adolescents were a little bit more like adults than they are like younger children, Edwards said. “The benefit will be great in that group.”
Vaccinating younger people also helps stop Covid-19’s spread in communities. “We want children to be safe, and we want them to prevent transmission from occurring within their communities as well,” Maldonado said.
“If kids are going back in person to school in the fall, it will be better if more in the community are vaccinated. It can help school run more smoothly without concerns about the need to quarantine and mitigate positive cases,” Angela K. Shen, a visiting research scientist at the Vaccine Education Center at Children’s Hospital of Philadelphia, said.
Lots of Options
Some communities are considering using schools as a vaccination sites, said Shen, who spent more than two decades in federal health agencies ranging from the FDA to the Centers for Disease Control and Prevention and the National Vaccine Program Office. “I think that is a good idea. We can rely on both—mass vaccination and pediatric offices.”
Adolescents should be able to get vaccinated in pediatric institutions, hospitals, clinics, and pharmacies just like 16- to 17-year-olds can get Pfizer shots now, Munoz said. “There’s no difference in terms of the process.”
As vaccines open up to younger children, particularly infants and children under 5, Munoz said, it will be important for them to go to their pediatrician. “It’s best for them to go see their pediatrician, and to get vaccinated there as that that’s their medical home.”
Pediatric vaccine studies typically work in what’s called de-escalation, in which testing begins in younger age groups, once it’s been proved safe and effective in older kids. Pfizer started a study in March for children 11 years to six months. Likewise Moderna also announced in March it began studying the vaccine from children 12 years to six months old. J&J announced in April it’s testing its vaccine in 12- to 17-year-olds.