The case for COVID-19 vaccines for children

For many of us, making decisions involves weighing up the benefits versus the risks. However, making decisions for someone else—particularly those more vulnerable—can be more complex. With the rapid rollout of COVID-19 vaccines and over 2 years of constant media coverage, misinformation and misunderstandings have flourished.

Although SARS-CoV-2 infection typically causes less severe illness and fewer deaths in children and adolescents than adults, there are still a number of benefits from vaccination¹:

Direct benefits for children:

• Helping to protect them against severe COVID-19 and postinfectious conditions, such as "long COVID" (ongoing health problems) and multisystem inflammatory syndrome in children (MIS-C)^1-4
  • MIS-C is a rare inflammatory reaction in the body that occurs about 4 weeks after infection with SARS-CoV-2, usually in children aged 8 or 9 years. The inflammation can affect the heart, blood vessels, and other organs, which can be dangerous. Fortunately, if treated quickly, most children recover fully⁵

Indirect benefits of vaccination:

• Helping to protect the community by reducing transmission of SARS-CoV-2^1-4
• By reducing viral transmission, emergence of variants may be slowed down^3,6
  • Variants could be more contagious or resistant to currently effective vaccines and therapies³
• By helping to reduce the transmission of SARS-CoV-2 in schools, disruptions to children’s education and their participation in activities are minimized¹

Normal practice for pediatric trials involves beginning them only when a vaccine has already been shown to be well tolerated and effective in adults,³ and are usually deferred until trials reach phase 3.⁷ Phase 3 trials compare the safety and efficacy of the new intervention against the current standard intervention or placebo.⁷ Pediatric trials can help researchers determine the most efficacious dose of vaccine with the least amount of side effects in children.

When planning a pediatric trial, there are a number of important considerations:

• Diversity: Like all clinical trials, it is imperative that they involve people from diverse backgrounds to ensure that trial results are as relevant as possible to all members of the population³
• Safety: As children’s immune systems have not yet been exposed to many pathogens, they tend to produce a strong immune response to vaccines.⁴ This means that children are more likely than adults to develop some side effects after vaccination, such as a fever.⁴ Therefore, a vaccine must have a good benefit-to-risk profile, triggering a strong immune response with minimal side effects⁴
• Informed consent: Parents play a key role in making decisions about the medical treatment of their children, and give informed consent prior to medical interventions.⁸ Information about the trial has to be given to children through an age-appropriate method to help them understand what is happening.⁷ The consent process should be culturally sensitive³

Before pediatric clinical trials can begin, they need to pass rigorous ethical evaluations and meet certain standards.⁷

The number of available and authorized COVID-19 vaccines for use in adults is growing, with programs slowly being extended to children.³