Covid-19 Vaccines for the Youngins
As of this weekend, the CDC has officially recommended the Covid-19 vaccine for all ages greater than six months. Furthermore, there are now options available as to which of the mRNA vaccines may be offered to all ages, as both the Pfizer and Moderna vaccines were approved for such use.
Are they safe?
It depends on what degree of safety you expect from the vaccine. The issue with both the Pfizer and Moderna trials is similar to that of the trials that preceded them for older children. Specifically, they did not test the vaccine in a large numbers of them. In the Moderna trial, approximately 4,700 children under the age of 5 years were administered the vaccine with fairly typical vaccine related side effects noted. These included local reactions (redness/swelling/pain), fevers, swollen lymph nodes, fatigue, headache, muscle aches, and nausea/vomiting. The Pfizer trial, 2,970 children under the age of 5 years were administered the vaccine, again with the same typical vaccine side effects noted.
Trials of the magnitude conducted are adequate for common side effects. They are not designed to detect the 1:2,500 variety or rarer. Is it likely that something catastrophic is going to manifest from the vaccine in 1:3,000 infant vaccine recipients? No. Is there actual data to support that statement? No.
Do they work?
It depends on what degree of protection you expect from the vaccine. Are you seeking protection from any infection? Getting hospitalized? Death?
Both clinical trials were approved based on their data demonstrating antibody responses similar to older individuals who had received the vaccine in prior trials. This is a proxy for protection. The Pfizer trial was too small to assess whether there was any protection from contracting Covid-19 despite vaccination or any specific outcomes if contracted. The Moderna trial results for the 6 month to 2 year age group demonstrated 50.6% effectiveness at preventing infection with Covid-19. The vaccine was effective in preventing Covid-19 in 36.8% between the ages of 2 and 5 years. Again, the trial was too small to ascertain protection from the more serious endpoints (hospitalization/death). It was worth noting that the Moderna trial was too small to assess protection in the 6 to 11 year old range. It was 93.3% effective in the 12 to 17 year age range.
While addressed in more detail in a prior blog, it is very difficult to conduct a study in children to demonstrate protection from more serious Covid-19 infections. The reason is that they are very uncommon in children. As of June 2, 2022, the CDC had reported 1,086 deaths in children since January 2020 from Covid-19. Yes, you read that correctly, in 2 1/2 years there have been 1,086 fatal outcomes. Compare that with the 1,004,150 deaths in folks older than 17 years during the same time period. Just as an added kicker….299 of the 1,086 fatal outcomes were in infants under 1 year of age. It does not break their age down by month, but it is safe to assume that nearly 1/5 of the fatal outcomes are in infants that cannot even be vaccinated.
So, what should I do Doc?
What should you do? I cannot give you a strong argument to run out and vaccinate every youngin. Do they have some risk if they get Covid-19? Yes. They also have risk on a daily basis from a very long list of Darwinian challenges they undertake. In 2020 alone, 4,300 kids were shot dead. As in the bullet variety of shot, not vaccine*. Also in 2020, 3,900 died in car crashes, and another 1000 by overdose. Just keeping it real.
Do I genuinely think you will harm them if you vaccinate them? No, I don’t. But again, the safety data is limited at this time. Some solace can be taken from the fact that it has been safe in other ages. Alas, little kids are not the same as adults. You can see that quickly in the limited effectiveness data published.
So ultimately you will need to take a good look at your personal risks, tolerance for taking on risks, and expectations for benefits in deciding. Do you live with great-grandparents? Does Dad have diabetes and early heart disease? Does Mom have lupus and on immune suppressants? Is there a sibling with cancer on chemotherapy? There are reasons folks take on risk. This is why I am appreciative that the vaccine is available if you want it. In a couple of months, more data will be available to further refine your decision making.
* also not the Bulleit variety of shot, which is quite tasty