by Gillian Rutherford, University of Alberta

Credit: Pixabay/CC0 Public Domain

Ever since Canada approved the child-sized Pfizer-BioNTech vaccine against COVID-19 and started to distribute nearly three million doses, some parents have jumped at the chance to get their kids vaccinated, while others still have questions.

"Even before it was approved, about 50 percent of parents were already very eager to immunize their children as soon as possible," said Robyn Harrison, clinical professor of infectious disease in the Faculty of Medicine & Dentistry and vice-chair of Canada's National Advisory Committee on Immunization.

"There have been something like four billion people vaccinated with at least one dose of COVID vaccine around the world, and they've given millions of doses of the vaccine that we are using to children five to 11 years old in the U.S. with no unexpected safety concerns. So I think it's incredibly safe, but one cannot argue with parents who want to be cautious," said Joan Robinson, professor of pediatric infectious diseases, chair of the Alberta Advisory Committee on Immunizations, and editor-in-chief of the Canadian Paediatric Society's journal, Paediatrics & Child Health.

"I think it is important to be patient with those who may feel hesitant and help them to learn the information about the vaccine and the pathogen," said Harrison. "We have seen with the adult version of the vaccine how quickly the evidence base on its safety accumulates.

"It's important to ensure all families have access to trustworthy and accurate COVID-19 vaccine and pandemic information, so they can make decisions with confidence."

Folio invited Robinson and Harrison to answer some of the most frequently asked questions from parents about the COVID-19 vaccine for children aged five to 11.

How is the children's vaccine different from the adult vaccine?

The dose is smaller. Kids get 10 micrograms; people 12 and older are given 30 micrograms. There's also a different solution used to "buffer" or stabilize the active ingredients: it's phosphate buffered saline (PBS) in Pfizer-BioNTech's adult vaccine and tromethamine (TRIS) in the children's version. TRIS is used as a buffer in other vaccines and medications, and no safety concerns have been identified.

What are the arguments in favor of vaccination for children?

"I think it's important to recognize how much children have suffered due to this pandemic—whether their parents are having economic problems or they are being forced to miss in-person school," said Robinson.

Thanks to the ever-increasing vaccination rate among adult Canadians, under-12s currently account for the highest number of new COVID-19 infections. And while kids appear to be less likely to spread the disease, infections in the young have played a significant role in the fourth wave, Robinson noted.

"The more people that are immunized, the more likely we are to avoid a fifth wave," she said. "The sooner we can get a higher percentage of the population immunized the sooner the pandemic will actually be either over or less of a problem—and that will benefit children."

Pfizer-BioNTech has reported that its vaccine for children was 90.7 percent effective at preventing infection seven days after the second dose during their clinical trial.

While it's true that children seem to be less susceptible to severe COVID-19 infection, that doesn't mean they can't end up in hospital or even intensive care with the virus. Eighty-five cases of children admitted with a severe complication known as Multisystem Inflammatory Syndrome have been reported in Alberta, and the five-to-11 age group is most likely to be affected, Robinson noted. She also said it's still too early to know how long COVID might affect children.

"When you consider an intensive care unit stay for a child, or a death, it becomes clear why it is desirable to have vaccines for prevention," Harrison said. "We don't want to risk serious illness from a virus in a child if it can be prevented."

Robinson underscored that without vaccination, it is not a matter of if your child will develop COVID-19, but when.

"Some people might say, "I'll just make sure my child never gets COVID," but the way things are evolving, over the next few years almost every person on the planet will either be vaccinated or will get COVID," she said. "Just staying home and never interacting with other people is not healthy for children either."

Will it help against the new omicron variant?

Harrison and Robinson agreed it's really too early to tell how effective existing vaccines may be against the newly identified variant, which is why other public health measures such as masking, social distancing and handwashing will remain important.

What are the risks of vaccination for children?

The most common side-effects for anyone getting a vaccine are a sore arm, fatigue, headache, muscle pain or chills for a day or two, and that applies to kids too.

Parents may have heard of a rare but significant pair of side-effects—myocarditis (inflammation of the heart muscle) and pericarditis (inflammation of the lining outside the heart)—which seemed to be more common in teenagers than older people, but they have not been reported in younger children so far. When they do happen, they are usually mild and resolve within a few weeks. It's important to point out, Robinson said, that the risk of developing myocarditis from COVID-19 is higher than it is from the vaccine.

One thing that should give parents confidence in the safety of the vaccine is the surveillance and reporting systems used by regulators and health agencies in countries around the world. These systems flagged the rare link between the vaccine and myocarditis/pericarditis, for example.

"These international groups are communicating so any potential side-effects from the new vaccine are detected and the information is acted upon and communicated to the public quickly," said Harrison.

Are there some children who shouldn't get the vaccine?

Again, it's very rare, but if your child has an allergy to one of the vaccine components, it may be contraindicated. Children with other allergies or asthma are very unlikely to have a reaction.

Don't take your child for vaccination if they have a fever or any other symptoms that might potentially be COVID-related. Make a new appointment for about 10 days later, when your child is sure to be no longer infectious.

Got any tips for helping my child cope with vaccination anxiety?

If you have needle anxiety yourself—it is common—try not to pass it on to your children.

You know your child best, so decide whether to give them lots of warning that they'll be getting the vaccine or wait until it's almost time. Either way, give them the chance to make a plan about what might help them through the experience.

"Do they want to take along a stuffed animal that they love? Do they want to bring the iPad? Because this is a situation where a screen to distract them might be a good idea," Robinson said. "Even blowing bubbles can work for some younger children. And a small treat to look forward to when they get back home can help too."

The nurses who deliver the vaccine may also have suggestions on how to hold your child so they feel secure and are also still for the shot. "We're fortunate in Alberta because we've had very strong public health programs and years and years of experience immunizing children," Harrison said.

Harrison also recommends making sure kids know that having access to vaccines is one more positive step towards moving beyond the pandemic, and it's something to celebrate.

"When a child is at the vaccine clinic, help them feel that positivity," she said. "They can feel excited that they are contributing too, in a really important way."

Provided by University of Alberta