Wondering about vaccinating younger kids against COVID-19? Alberta experts weigh in
Health Canada is reviewing Pfizer's submission for 5 to 11 year olds
Many Alberta parents have questions about the COVID-19 vaccine for kids under 12, as regulators in Canada and the United States get closer to making a decision about whether to approve it.
Health Canada is currently reviewing Pfizer-BioNTech's request to approve its vaccine for 5 to 11 year olds and, on Tuesday, a U.S. Food and Drug Administration advisory panel voted in favour of giving it the greenlight.
Pfizer's formulation for kids contains one third the dose used for those 12 and up, as well two doses are supposed to be given three weeks apart.
Data shows the vaccine is 90.7 per cent effective in preventing symptomatic COVID-19 in children between the ages of five and 11.
"I think it's really hopeful," said Dr. Cora Constantinescu, a pediatric infectious disease specialist at Alberta Children's Hospital who also works in a vaccine hesitancy clinic there.
"We get a plethora of questions.… But if you ask me what the biggest concern is, it's always safety."
Immunizing children is front of mind for many parents right now and a particularly pressing issue in Alberta, according to Constantinescu.
"This pandemic has shown us over and over again that the kids' COVID threat depends on how many infections we have in our society. And in this fourth wave we've had more infections in kids than ever before," she said.
"Based on what's happening in the real world data plus these clinical trials the safety profile [of Pfizer's vaccine for kids] looks very reassuring."
Myocarditis concerns
A key concern for parents is the rare risk of myocarditis, inflammation of the heart muscle, which has been documented in mostly male teens and young adults.
Depending on the study you look at, the incidence rate ranges from one in 10,000 to one in 50,000, according to Dr. Jim Kellner, infectious disease specialist at Alberta Children's Hospital and member of the federal COVID-19 Immunity Taskforce
The Pfizer trial is too small to pick this up.
"While that risk is very rare, it's still common enough for people to be thinking about it and worried about it," he said.
The FDA's risk-benefit analysis looked at various U. S. scenarios predicting hospitalizations, ICU admissions and deaths related to both COVID-19 and myocarditis.
It found in almost every scenario the benefits of the vaccine outweighed the risks.
Kellner said the FDA erred on the side of overestimating the potential for the vaccine to cause myocarditis and under-estimating the potential impact of COVID-19.
"From my perspective the risk benefit analysis is showing there's a definite benefit to providing the vaccine to prevent infection and prevent serious outcomes of COVID-19."
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Myocarditis can also be a complication of a COVID-19 infection and, according to Kellner, these cases tend to be more severe and longer lasting than those occurring after immunization.
"I'm not downplaying it in the least. But fortunately what seems to happen is these [post-vaccination] episodes are mild and short-lived with complete resolution over a relatively short period of time is what's being seen in the vast majority of cases."
According to Kellner, there's also reason to believe the rate of myocarditis in younger children could be lower because data out of the U. S. and Israel show 16 to 20 year olds are more likely to develop myocarditis after immunization than 12 to 15 year olds.
He said the lower dose in the kids formulation could also lower the risk of myocarditis.
Considering other factors
There are other factors for parents to consider, Kellner said.
While kids are much less likely than adults to end up with severe outcomes from a COVID-19 infection, there is still a risk. Up to one quarter of children who are hospitalized for the COVID end up in intensive care, according to Kellner.
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Long COVID and MIS-C — a serious inflammatory condition triggered by the coronavirus— are risks that shouldn't be ignored, he said.
And then there's the impact on the overall pandemic, since vaccinating children is expected to lower overall transmission rates.
But in addition to protection against disease, Constantinescu argued vaccination will protect kids against the ongoing mental health toll brought on by isolation and disruption of activities as well as time lost in school.
"There's so much that kids have given up and such a huge cost that kids have paid in this pandemic. It's so much more than looking at how many kids die from COVID," she said.
"At the end of the day what I want parents to think through is not what this will mean to the pandemic, but what this will mean to their kids and their life and their chance to returning to normal."
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