Children ages 5 to 11 now can receive a COVID-19 vaccine from Pfizer-BioNTech under emergency use authorization from the Food and Drug Administration and recommendation from the Centers for Disease Control and Prevention. Rebecca Lee Smith (IGOH), an epidemiologist and also professor with the Carle Illinois College of Medicine and the College of Veterinary Medicine, works with school districts on COVID-19 safety protocols and tracking viral spread among children. Smith talked with News Bureau Biomedical Sciences Editor Liz Ahlberg Touchstone about the vaccine approval for school-aged children.

Why should kids be vaccinated against COVID-19? How common is infection and serious illness among kids?

When kids returned to in-person school, the hospitalization rate in school-aged children increased by a factor of five, according to a CDC report. As of last week, 6.4 million children have tested positive, and in states that report the data, between 0.1% and 2% of children testing positive end up in the hospital and up to 0.03% die. That may sound like a very small risk, but even small percentages of large numbers add up, and it has resulted in more than 8,300 hospitalizations among 5- to 11-year-olds and COVID-19 being among the top 10 causes of death for U.S. kids this year.

On top of all that, we know that infections in school-aged children have driven community infection. Vaccination decreases the risk of both infection and transmission, and therefore protects the public – including younger siblings, who aren’t eligible yet.  

What kinds of COVID-19-related challenges have schools and families with school-aged children faced since reopening? How can widespread vaccination address those challenges?

COVID-19 has been such a challenge for schools and for families with school-aged children! We parents know that schools are a great place for kids to exchange germs, and this virus is no exception. There have been major outbreaks in schools all around the country, forcing schools to switch to remote learning and sending parents scrambling to safely care for their kids while also maintaining their own work. Widespread vaccination would reduce both the risk of infection in the school environment and decrease the need for extensive quarantines.

We are lucky in Illinois to have widespread surveillance testing available in our schools, as well as a school mask mandate and vaccine mandate for teachers, limiting school-based outbreaks. We also have, in some areas, test-to-stay, meaning that close contact with a case doesn’t automatically result in two weeks of quarantine. Even so, we have seen outbreaks within Illinois schools.

Widespread vaccination works synergistically with all the other mitigations we have in place, resulting in a COVID-19 control program that is stronger than the sum of its parts. My hope is that once we see widespread vaccine uptake, we can start to approach what’s being called the “off ramp” for schools, relaxing mask mandates and returning some activities that have been limited. 

If a child is healthy with no underlying conditions, why be concerned? Wouldn’t contracting COVID-19 be mild for them and give them natural immunity?

It should be noted that children have had severe infections and died without having known underlying conditions. Vaccines actually offer more protection than natural immunity, and are very effective at preventing serious disease, including long COVID-19 or multisystem inflammatory syndrome. In addition, the few serious adverse events that have been associated with vaccination in teens – such as myocarditis, an inflammation of the heart that’s been documented in a small percentage of adolescent males – are more common after infection than they are after vaccination.

Why is the vaccine dose for kids 5-11 so much smaller than for those 12 and up? Should a parent of an 11-year-old wait until they turn 12 to get them the higher dose?

The vaccine dose for kids is based on immune response, and the smaller dose is known to be effective in 11-year-olds. It is better to get the shot now! In addition, kids on the cusp will likely be eligible for a booster after they turn 12.

What advice do you have for parents regarding vaccination? For school systems?

I recommend that parents get their kids vaccinated as soon as they are eligible. That’s what I will be doing. And remember that 5- to 11-year-olds, if given the first dose right away, will not be fully vaccinated by Thanksgiving – so remain cautious about exposures over the holiday.

School systems need to start thinking about changes to their testing programs for vaccinated kids. Given the timing, I’m not recommending any other changes this semester, but come spring we can start to think about scaling back other control measures if vaccine uptake is high enough.