Ottawa doctors answer your questions on the COVID-19 vaccine for kids

With Health Canada expected to approve a COVID-19 vaccine for kids in the coming weeks, two Ottawa doctors answer your questions on the vaccine for 5 to 11 year olds. 

Dr. Vera Etches is Ottawa's medical officer of health and Dr. Nisha Thampi is a pediatric infectious disease physician and the medical director of infection prevention and control at CHEO, eastern Ontario's children's hospital. 

The United States approved the Pfizer-BioNTech vaccine for children earlier this week. In response to the upcoming approvals, Ottawa Public Health (OPH) says it will be able to vaccinate all children in that age group within four weeks of being given the green light.

• Ottawa Public Health outlines plan to vaccinate kids as young as 5

This discussion has been edited for length and clarity.

Q: I have an 11-year-old child. Should we wait until they can get the full adult dose in a few months or get the child-sized dose now?

Thampi: The pediatric vaccine is a 10 microgram dose, whereas the dose for those 12 and older is 30 micrograms. However, Pfizer has shown that the immune response following the lower dose in nine to 11 year olds was very similar to the immune response in 16 to 25 year olds. 

What we were hearing from the American advisory committees was a recommendation to get the shot as soon as it's available to you and stick to the age-based recommendation. 

Q: My child is large for their age, should they be getting an adult-sized dose?

Etches: The way the studies were done was based on age, not weight. There is obviously weight variation between five and 11 year olds, so I think that will be part of what Health Canada is examining. 

At Ottawa Public Health clinics, we'll be following the product monograph so we wouldn't be offering the adult dose to younger children. We call that "off label use", but it is something parents could talk to their own physician about to decide what is best for their child. 

Q: My understanding is children aren't spreading COVID-19 or suffering from severe consequences from the infection. What's the risk in waiting a little longer to gather more information on the vaccine? 

Etches: The goal is really to prevent COVID infection in children because we know there can be long-term effects from COVID infection. Most children will not have serious illness, but some are going to need this vaccine for protection against serious illness.

Vaccination helps decrease the transmission of COVID and it makes it safer for them to do the things they need in their lives, like being in school, visiting grandparents, participating in sports more safely. So there are direct benefits to all children. 

Thampi: The priority whenever we have a pediatric vaccine coming out is around the safety of that vaccine, the efficacy is the secondary goal. From the data presented it would seem that goal has been achieved. We have a safe vaccine, that also seems to be effective in terms of an immune response in kids who are five to 11 years old, which is the age group that we're currently seeing a substantial burden of COVID-19 illness.

Q: My child is immunocompromised, should they be getting the vaccine?

 Thampi: What I have seen so far is the benefits of the vaccine outweigh the risk, particularly in those who may not be able to mount a strong immune response naturally to a COVID-19 infection, but I would encourage you to speak with your child's health care provider.

Q: How can I prepare my child for the vaccine, especially if they're afraid of needles?

Thampi:  Let them prepare ahead of the appointment with strategies that can help them feel in control. We have experienced nurses, pharmacists and medical staff who can also diffuse the pain when they give the needles, and we can use numbing spray and distractions to help reduce the fear and the pain. 

Q: What are the potential long-term consequences of getting the vaccine?

Etches:  The contents of the vaccine, it's broken down, it goes away, what remains is your immune system is prepared. When we think about other vaccines, if something happens we see it right away, like an allergic reaction or in rare circumstances, we've seen with some adults, the heart gets a little bit of irritation for a while. That needs to be looked at at the time, but we don't see long-term impacts. 

Q: My child has already had COVID-19, do they still need the vaccine?

Thampi: Kids who had previous infection didn't have high antibody levels like we would expect to see and certainly not at the level of kids who had received the vaccine.