With child vaccines, we enter a new phase of COVID-19 pandemic

This week marks the beginning of a new phase of COVID-19 pandemic: Now over 90 percent of the population in the United States are eligible for vaccination. Pfizer/BioNTech has received an emergency use authorization (EUA) for the use of their vaccine in 5- to 11-year-olds.

The vaccine rollout in this age group appears to finally correct one specific thing that was sorely missing in the vaccine rollout for those above the age of 12 — primary care physicians are included.

In the early days of COVID-19 vaccination, vaccines were mostly administered at clinics in hospitals, pharmacies, mass vaccinations sites and community centers. This is an incredibly efficient way to vaccinate large swaths of the population, but it is not conducive to a one-on-one discussion with patients who may have legitimate questions on the vaccines that deserve an answer.

For many people, primary care physicians can help field such questions as they hopefully have a trusting and long-standing relationship with their patients and answer questions about medications and other vaccines daily. Trusted messengers, in familiar settings, are key to moving the needle on vaccination rates. For those without primary care physicians, it is more challenging to voice questions but fortunately, there are many resources available.

In fact, as a doctor myself, I do much better at answering questions one-on-one with vaccine-hesitant people than trying to reach vaccine-hesitant people through sharing important messages with the media. For the pediatric population, and their parents, this is even more important. Enlisting pediatricians and family medicine physicians will likely be very fruitful, and we still have time to replicate this model with adult primary providers. 

Although a low rate of serious illness occurs in most children it should not be taken as reason not to vaccinate children. The Pfizer/BioNTech vaccine is safe and highly effective. It not only decreases rates of serious illness, but overall symptomatic illness. It has been given to hundreds of millions of people around the world and its positive impact is plain to see, cases are now slowing, deaths are slowing, hospital systems are no longer overwhelmed in most places.

COVID-19 in children is not zero risk but one comparable with other respiratory viruses children face perennially, especially in those below 12.  Because of this fact people legitimately ask about the benefits the vaccine offers to the individual healthy child if they are not at risk for serious disease. However, as legitimate this line of questioning is, it ignores some crucial facts. 

COVID-19 is not something one should want to experience, even if it is a mild case. The disruption, isolation, quarantine, testing and contact tracing can largely be avoided because we now have safe and effective vaccines available. No one should want to be sick or to have a child sick with a vaccine-preventable illness.  Even though infections like chickenpox and rotavirus seldom killed children in the United States, these vaccines are widely embraced to rid childhood of these infections. Indeed, if there was a safe vaccine for any of the viruses that cause the common cold it would be a valuable if it prevented just one or two colds per year per person. However, with this vaccine there seems to be an implicit assumption that the vaccines should be avoided if it is only mild disease that they are preventing. This sentiment reveals some bias against a human technological solution to a problem.

Some people may cite safety concerns, but no concerning safety signals that alter the risk/benefit ratio of the vaccine have emerged. Cardiac complications of the mRNA vaccines, which are often mentioned, are not common in young children and are a manageable risk in older teenage and young adult males  No cases occurred in the Pfizer clinical trial in 5- to 11-year-olds.

In the U.S. as we continue to vaccinate more individuals above the age of 5, immunity will build in the population and it will be harder for the virus to find people to infect, and there will be less opportunities for the virus to spread or mutate. The higher population immunity is, the better each of us are individually; risks of exposure daily will get lower. Children now have a very safe vaccine available to them and will be able to return to normal social interactions largely free from the threat of COVID-related disruptions and illness. While there is currently a heightened attention to vaccination of children, a priority still exists to vaccinate those adults who are at highest risk of hospitalizations who remain non-immune.

COVID-19 vaccines are one of humankind’s great success stories in battling nature. If only more of the population would embrace it.

Amesh Adalja, M.D., is an infectious disease physician and a senior scholar at the Johns Hopkins Center for Health Security. Follow him on Twitter: @AmeshAA