It’s a moment many parents have been eagerly anticipating for months: Children under 5 are now eligible for coronavirus vaccinations, among the last Americans to qualify.
Without access to vaccines, parents of young children have faced nearly impossible choices since the pandemic began. Many children have been kept away from schools, family gatherings and other activities, and deprived of normal childhood experiences. Now, all of that could change.
On Saturday, the Centers for Disease Control and Prevention recommended Moderna and Pfizer-BioNTech vaccines for children as young as 6 months old. The decision means injections will be given to these young children for the first time, possibly as early as Tuesday.
Sunny Baker, 35, a mother of two in Oxford, Mississippi, said she vaccinated her eldest daughter, Hattie Ruth, 5, at the first opportunity, and was looking forward to her 2-year-old daughter. years, Alma Pearl, to qualify.
“Yes yes yes! We would like to be on the front line,” she said.
But Ms Baker could very well be in the minority: a recent Kaiser Health poll found that only one in five parents will get their young children vaccinated immediately. Many plan to wait for now.
As the pandemic stretches into a third year and Americans weigh the risks they are willing to live with, the CDC’s decision puts parents of young children on the spot.
Vaccines have lost some of their potency against infection by new variants, although they continue to provide protection against serious illness and death. And large numbers of Americans were infected during the Omicron push, helping to give many the mistaken impression that the battle was over.
Changing advice has also contributed to a lack of enthusiasm. Daryl Richardson, 37, of Baltimore, said he has no plans to have his three children vaccinated, in part because of constant changes in the number of recommended doses.
“First it was a knock, then it was an encore, and another encore,” he said.
After navigating the perils of the pandemic with their children for so long, parents now face new questions, some so complex they have even baffled regulators and experts. Which vaccine is the best? To what extent and for how long will they work? And why bother, if the majority of young children have already been exposed to the virus?
Pfizer-BioNTech and Moderna injections are considered safe for young children and both produce blood levels of protective antibodies similar to those seen in young adults. But neither offers the miraculous protection offered by adult vaccines at the start of the pandemic.
Moderna’s vaccine appears to produce a strong immune response in young children and is fully protected within 42 days of the first dose. But the vaccine causes fevers in one in five children, and fewer providers are likely to offer it as an option compared to Pfizer’s vaccine.
The Pfizer-BioNTech vaccine is more familiar and produces fewer fevers, but children will need to receive three doses to be protected from the virus. Although it takes 90 days to achieve maximum protection, the effect may last longer than Moderna’s regimen.
“Implementing these two deployments is going to be incredibly challenging,” said Katelyn Jetelina, public health expert and author of the widely read newsletter, “Your local epidemiologist.”
“It’s going to take a lot of proactive communication about the difference between the two and the implications of taking one over the other,” she said.
A head-to-head comparison of the two vaccines could provide answers for parents, but that’s neither possible nor advisable, experts said in interviews. There are simply too many differences in how vaccines have been formulated and evaluated.
“It’s really going to be impossible to say one is better than the other,” said Dr. William Towner, who led vaccine trials for Moderna and Pfizer at Kaiser Permanente in Southern California.
The choice may depend more on parents’ willingness to take three doses rather than two, and what vaccine their providers have on hand, he said.
Many vendors are unfamiliar with Moderna, having so far only relied on the Pfizer-BioNTech vaccine. About 350 million doses of this vaccine have been administered to Americans overall, compared to 223 million doses of the Moderna vaccine and about 19 million of the Johnson & Johnson vaccine.
For young children, states have so far ordered 2.5 million doses of the Pfizer vaccine and 1.3 million of the Moderna vaccine. These figures are lower than expected, given the 18 million children in this age group.
Absorption was slow even for older children. The Pfizer-BioNTech vaccine was licensed for children ages 5 to 11 in November, but less than 30 percent in this age group received two injections.
Overall, vaccines have proven to be very safe, but many parents remain hesitant for a variety of reasons. Some are wary because the vaccines are relatively new, or because they perceive the risk of Covid-19 to be negligible to their children.
Some parents may not be interested because their children were among the 75% who would have already been infected. But vaccination provides stronger and more consistent protection even if a child has already been infected, CDC scientists noted Saturday.
Still other parents have moved on from the pandemic.
In Middletown, Ohio, some parents were more concerned with staying cool during the summer heatwave than the risks from the coronavirus. Tori Johnson, 25, is unvaccinated and said she has no plans to have her two daughters, Liliana, 7, and Rosalina, 9 months, vaccinated.
Life had already returned to normal, she said.
Simone Williams, 32, said she was hesitant to vaccinate her 1-year-old twins, Caidon and Arissa, and 4-year-old Bryan. “I would get them for them if it was necessary, but otherwise I’m in no rush,” Ms Williams said.
Some pediatricians were preparing to explain to parents the interest of getting vaccinated. Even routine vaccinations are a touchy subject in many parts of the country.
Pediatricians “have struggled with this for many, many years with the flu vaccine and the standard dosage for measles, mumps, rubella and chickenpox,” said Dr. Lindsey Douglas, pediatrician and medical quality director. and security at Mount Sinai. Kravis Children’s Hospital in Manhattan.
“Over the past two and a half years, there is certainly a lot more information available,” Dr. Douglas added. “But there is also a lot more misinformation.”
In some ways, the odds were against the use of vaccines in younger children.
Both the Moderna and Pfizer-BioNTech vaccines have offered dramatic estimates of efficacy in adults, well beyond expectations, and raised hopes for a virus-free future.
But as vaccines were gradually tested in young children, the virus rapidly transformed, with each new form more elusive and more difficult than the previous ones.
The latest versions of the Omicron variant have evolved to partially dodge not only two-year-old vaccines, but even immunity produced by infection in the form of Omicron that circulated just months ago.
The original estimates of efficacy in adults were around 95%. That figure has now given way to 51% for two doses of Moderna’s vaccine in children 6 to 23 months old, and just 37% for children 2 to 5 years old.
As low as that sounds, two doses of Pfizer’s vaccine didn’t even meet the Food and Drug Administration’s bar for an immune response, justifying the agency’s decision in February to delay evaluating the vaccine until later. until the company tested three doses.
“As a mother, I think it’s unacceptable that it’s taken so long to get our little ones vaccinated,” Dr Jetelina said. But “as an epidemiologist, I also know the value of doing rigorous clinical trials and finding the right dosage”.
Based on the data, the FDA this week authorized two doses of the Moderna vaccine and three doses of Pfizer-BioNTech as the “primary series” for young children.
If authorities determine that even the youngest children need boosters against future variants, children will need to receive a third dose of Moderna and a fourth of Pfizer.
In press releases and in data reported to federal regulators, Pfizer has estimated an 80% efficacy for three doses of its vaccine. But that calculation was based on just three children in the vaccinated group and seven who received a placebo, making it an unreliable measure, CDC advisers noted at a meeting Friday.
“We should just assume that we don’t have efficacy data,” said Dr. Sarah Long, an infectious disease expert at Drexel University College of Medicine. But Dr Long said she was “quite comfortable” with other data supporting the potency of the vaccine.
Parents of younger children may be more willing to opt for a Covid vaccine if it can be offered alongside other routine vaccinations. Dr Towner said either vaccine would be better than none, but he predicted more parents might opt for Moderna.
“I’ll be honest, it might be a bit difficult for some parents to do three doses instead of two,” he added. “If they have the choice, and if both are available, that may entice some parents to adopt the Moderna.”
Some parents won’t need convincing. In Alexandria, Virginia, Erin Schmidt, 37, said the news was “life changing” because her family was living in a “kind of alternate isolated reality.” After vaccinating her 2-year-old daughter, Sophia, she plans to crack open a bottle of champagne, take Sophia to a museum, and “show her the world.”
Brendan Kennealy, 38, of Richfield, Minnesota, said after vaccinating his daughters, Hazel, 4, and Ivy, 1, he and his wife Jocelyn, 35, would drive them to the lakeside town of Duluth , where they plan to try new restaurants and catch an outdoor concert by a local folk group called Trampled by Turtles.
The family had to avoid spending time indoors with their mother, who has lupus and is vulnerable to severe Covid. Her children missed the national fair, dropped out of swimming lessons, and dropped out of gymnastics.
“I’ve been very, very happy a few times in the past, and then they pulled the rug out,” Kennealy said of the FDA halting progress on childhood vaccines.
“Those bursts of hope were so needlessly defeated,” he added. “Until we’re at the Walgreens or wherever we take them for their pokes and band-aids, I try to keep that at bay.”
Adam Bednar contributed reporting from Baltimore, Christina Capechi of Richfield, Minnesota, Ellen B. Meacham of Oxford, Miss., and Kevin Williams of Middletown, Ohio.