Updated: In the weeks following the publication of this story, Dr. Anthony Fauci walked back his comments on the vaccination of young children. Read more.
A COVID-19 vaccine for children as young as 1st grade may be approved early next school year, the country’s top infectious disease expert has told ProPublica.
Authorization of a vaccine for young children will of course hinge on whether trials show the vaccine is effective and safe for those age groups. But Dr. Anthony Fauci, the director of the National Institute of Allergy and Infectious Diseases, said he thinks it is likely that the vaccine will be authorized for elementary-aged children by September.
“I would think by the time we get to school opening, we likely will be able to get people who come into the 1st grade,” Fauci told ProPublica in an interview published Thursday.
Fauci had said in a Jan. 29 White House press briefing that some children under 16 may be able to get vaccinated as soon as late spring. Vaccinating children will be a major puzzle piece both in the country reaching herd immunity and schools being able to fully reopen for in-person instruction (and parents getting fully back to work).
Currently, teenagers as young as 16 can be inoculated under the Food and Drug Administration’s emergency authorization of the vaccine developed by U.S. drugmaker Pfizer and the German company BioNTech. The vaccine developed by U.S. biotechnology company Moderna has been approved for ages 18 and older.
Vaccine trials in children are done in de-escalating age groups, starting with older children and moving down to the youngest as trials show good results. Pfizer has fully enrolled its trial for 12- to 15-year-olds, and a spokesman said the drugmaker anticipates starting a trial for children ages 5-11 “in the first half of 2021.” Moderna is in the process of recruiting 12- to 17-year-olds for its vaccine trial for adolescents.
Public health experts say that while they think it’s safe to assume middle and high school students could be eligible for the vaccine by the start of the next school year, Fauci’s prediction of vaccinating elementary-aged children by September is optimistic.
“To me, it’s possible, but there are a lot of hurdles that have to be overcome in order for that to happen,” said Dr. Walter Orenstein, a professor of infectious diseases at Emory University School of Medicine and a former director of the immunization program at the Centers for Disease Control and Prevention. “Everything [in the trials] would have to go well.”
And Dr. Lee Savio Beers, the president of the American Academy of Pediatrics and the medical director for community health and advocacy at Children’s National Hospital, said that while she would be “delighted” to see young students vaccinated so quickly, it’s an “aggressive” timeline given the information she’s seen so far.
“We’ve not been seeing the manufacturers approach the pediatric trials with quite the same urgency as with the adult trials,” she said. “We’ve been seeing the foot come off the gas a little.”
The trials to develop the coronavirus vaccines approved in adults were sped along with public-private partnerships and billions of dollars in investments by the U.S. government. “It’s quite important that we … push with the same urgency” in the pediatric trials, Beers said.
The pediatric trials are focused on a different metric than the adult trials, as ProPublica reported. Children are less likely to have serious symptoms related to COVID-19. So whereas adult trials were focused on measuring the vaccine’s effect on the severity of illness, pediatric trials are focused on evaluating immune response by measuring antibodies.
Scientists don’t yet know the definitive level of antibodies in the blood that lead to immunity. So the trials will have to compare antibody levels in children with those found in adults, ProPublica reports. Orenstein said it remains to be seen how willing the FDA will be to approve a vaccine based on immune response instead of clinical protection.
Also, a timeline of vaccinating kids by the fall assumes that the current vaccine supply shortages will be resolved, Orenstein said, since children will be a lower priority than adults.
Fauci, however, has struck an optimistic tone about vaccine eligibility in recent days. On NBC’s “Today” show on Thursday, Fauci said, “By the time we get to April, that will be what I would call, for better wording, ‘open season’—namely, virtually everybody and anybody in any category could start to get vaccinated.”
President Joe Biden is expected to announce later today that his administration has secured 200 million more doses of the coronavirus vaccine. Currently, about 10.7 percent of the U.S. population has received one or both doses of the vaccine, according to the Washington Post. (EdWeek’s vaccine tracker shows that some or all teachers are eligible to receive the vaccine now in more than half of states.)
Preparing for hesitancy from parents
Even when a vaccine for children is approved, parents may be hesitant for their children to get the new shots. Even parents who generally trust the science behind vaccines may take a wait-and-see approach to the COVID-19 vaccine.
An online survey of 1,001 parents of K-12 public school students, conducted by the National Parents Union on Jan. 14-19, found that 22 percent said they would not get their kids vaccinated, and another 18 percent said they were unsure. A quarter of respondents said they would vaccinate their children, but not right away.
The most common reasons for parents’ reluctance or hesitation included uncertainty about the vaccine’s safety, fear that the vaccine will have been developed too quickly, and a lack of information about the shots.
While states and school systems can generally require vaccines for students to attend public school, it’s yet to be seen if they will mandate the vaccine for the coronavirus. So far, one large school system, the Los Angeles Unified school district, has indicated that it will require students to receive a COVID-19 vaccine to attend school in-person.
Orenstein said policymakers need to be prepared for high levels of vaccine hesitancy among parents and start administering surveys and conducting focus groups now to better understand the reasons.
“This is not a disease that is commonly severe in children—it’s not clear that parents perceive that their children are in that much risk,” he said. “We should be preparing now for trying to get some data on parental hesitancy or confidence in vaccination for their children and determining how best to overcome any hesitancy that is identified.”
Part of that, he said, will be crafting “the right message delivered by the right messenger in the right communication channel.”
Beers said educators, along with pediatricians, will play a big part in sharing accurate information about the vaccine and developing trust among parents. It’s also important, she said, for the vaccine trials to enroll a diverse population of children, so experts can speak with confidence to the safety and efficacy of the vaccine in all children.
And policymakers should start planning now how to equitably distribute vaccines to children when the time comes, Beers said: “Ensuring equitable distribution does not happen by accident.”
