COVID-19 vaccination research turns toward young children: Clinical trials involving kids underway
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* Aaron Warnick

![Figure1](http://www.thenationshealth.org/http://www.thenationshealth.org/content/nathealth/51/4/1.1/F1.medium.gif)

[Figure1](http://www.thenationshealth.org/content/51/4/1.1/F1)

A teenage “student ambassador” receives a dose of COVID-19 vaccine in Detroit in April during an event to promote and encourage Michigan residents get their vaccines. Researchers are testing vaccines for use on younger U.S. children.

Photo by Matthew Hatcher, courtesy Getty Images

As vaccine supplies increase and more U.S. adults are inoculated against COVID-19, scientists are researching use of the vaccines in children. Yvonne Maldonado, MD, chair of the American Academy of Pediatrics’ Committee on Infectious Diseases, a professor of global health and infectious diseases at Stanford University, and an APHA member, shares insights in this Q&A with *The Nation’s Health.*

## Do we know yet how well COVID-19 vaccines will work on children?

We have vaccinated millions of people, including children ages 16 to 17, with the Pfizer vaccine. It’s not like we’re starting from zero, we’ve had lots of experience with the vaccines already. I think we can anticipate what kinds of side effects there could be from having seen what’s going on with the adults. That’s a huge benefit in trying to understand what’s going to happen with children.

We already know that for 12- to 15-year-olds, data are already fairly well developed and there are a number of studies already done in 5- to 12-year-olds. We haven’t heard anything negative so far — that doesn’t mean there aren’t side effects to be worried about — but I think we would have heard if there were really major concerns.

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[Figure2](http://www.thenationshealth.org/content/51/4/1.1/F2)

Cynthia Leonard helps her son Messi McDaniel, 6, take a COVID-19 test in Los Angeles in July. While children are not at high risk for severe illness from the disease, they are not immune. Researchers are testing vaccines for use on children.

Photo by Al Seib, courtesy The Los Angeles Times/Getty Images

## What determines safety of a vaccine for a child versus an adult?

I think you’re right to emphasize safety because that’s the first thing that pediatricians will look for. Looking at the adult studies, we know that adults get a sore arm, they get a red arm, they can get a swollen arm, they can have flu-like symptoms. So those are things that we will be looking for in children. But some things are different for children.

Little kids are more likely to develop higher fevers with their infections than adults and older children. It’s not uncommon for a young child to have a viral infection and have a fever of 104. We will be looking for fever and what we call constitutional symptoms: Is a child lethargic, are they not eating, are they not interacting normally?

The other thing that we have to think about is children can’t always tell us how they feel. That’s why doing these trials with providers who are used to dealing with children, preferably pediatricians, is a really good idea because we know how to deal with children. We know how to monitor symptoms when children are not able to articulate them.

## Is there a pathway out of the pandemic that does not involve vaccinating children against COVID-19?

There are 85 million children under the age of 18. They make up a pretty large portion of the U.S. population, and why we would want to purposely ignore a major portion of the population doesn’t make sense from the standpoint of protecting those individuals, as well as from a population immunity standpoint. Making sure that children are included is important for their health as well as for the general population.

We know that children are less likely to get severe illness, but they make up about 13% of all the infections in the U.S. Maybe we’re missing some infections (from asymptomatic cases) and even when you try to adjust for that, it’s true that children probably make up less of the population. But they do get sick, they can transmit to others and they can be hospitalized. We’ve seen almost 300 deaths in children.

If you look at other diseases in pediatric populations, such as influenza, hepatitis and other viral and bacterial diseases, and you compare those diseases for which we already have vaccines for kids, and you look at the hospitalization and death rate from COVID-19 and children, they’re comparable or higher.

You could make an argument that this vaccine is needed to protect children against a disease that can actually cause severe outcomes in them.

Although it’s rarer than in an adult, it’s not zero. We want to protect all of our population.

![Figure3](http://www.thenationshealth.org/http://www.thenationshealth.org/content/nathealth/51/4/1.1/F3.medium.gif)

[Figure3](http://www.thenationshealth.org/content/51/4/1.1/F3)

COVID-19 vaccination for kids may become a priority as students spend more time in school.

Photo courtesy Ridofranz, iStockphoto

*For more information on pediatric health and research to vaccinate children against COVID-19, visit [www.aap.org](http://www.aap.org).*

***Editor’s note:*** *This article was updated post-publication*.

*   Copyright The Nation’s Health, American Public Health Association