I’m a pediatrician and parent. We need to immunize kids against covid-19

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Each morning, I begin the day in my pediatric practice by logging into the electronic medical records and opening my inbox. In it sit the results of tests I’ve ordered for my patients.

These days, and for the past several weeks, too many of those results – 1 to 4 a day in a practice of about 2,000 patients – are annotated with a hot red-colored “up” arrow. Each arrow sits next to the name of a child who tested positive for the coronavirus, and signals the need for my immediate attention and action.

Each of these children will require a careful review of their medical history and then contact with their parents: Do they have a thermometer? Do they know how long to isolate? Are there any family members at risk who also need to get tested? Do the parents need a doctor’s note to excuse them from work to watch their child? Some of my young patients – particularly those with severe symptoms or a history of a serious medical condition like asthma – need to be watched especially carefully in case they need admission to the hospital. Thankfully, that has not happened to any of my patients yet, and I reassure parents that their child will likely get better over a week to 10 days. Still, the parents I call are scared and lose sleep over what could happen to their child.

And I worry, too.

The number of children getting covid-19, the disease caused by the coronavirus, in my practice is the highest in my memory. National data validates this spike: Since the pandemic began, children account for 14.6% of total cases. For the week ending Aug. 19, children were 22.4% of reported weekly coronavirus cases.

The sharp rise is not surprising as children return to school, playgrounds and extracurricular activities, all of which they sorely needed after a year of isolation and distance learning. But this is happening in a world that now has several vaccines against this terrible disease, but too many of my patients are still too young to get them.

As a pediatrician and the parent of a child still too young to get vaccinated, I’m disappointed that we are still waiting to be able to immunize kids under age 12, particularly when we consider the scientific triumph of the coronavirus vaccines. In the past, the shortest interval from conception of a vaccine to approval was four years. With unprecedented collaboration, innovation and investment across government, academia and the private sector, vaccines against covid-19 were developed and deployed true to the effort’s namesake: Operation Warp Speed.

But approval of a coronavirus vaccine for younger kids remains stuck in the much slower approaches of a pre-pandemic world. It could be late fall or even 2022 before I can vaccinate my patients. Meanwhile, pediatric coronavirus cases rise, more children are ending up in ICUs.

It has long been the norm for kids to wait longer for new medical treatments than adults. Most therapies are conceived and developed with the needs of adults in mind, and a pediatrician’s mantra is that kids are not just little adults.

So when approval for a treatment is given for adults, there are usually two ways forward in pediatrics. The first is to prescribe that drug “off label” to children after weighing the need, experience and opinion of experts. This is quite common for drugs but not with vaccines. The second is to conduct “bridging” studies with a smaller number of kids to see if we can extrapolate the findings from adults to their age groups.

This is the approach investigators have taken with the coronavirus vaccine. There have been ample number of parents who were willing to enroll their kids in these trials. But the studies began only in March, nearly four months after the first vaccine was approved under emergency use authorization for those 16 and older – and a year after Operation Warp Speed began.

Under normal circumstances, such a delay wouldn’t be a major concern. But given the nature of the pandemic, and the resources invested to bring this deadly virus under control, I’ve often wondered why we didn’t break tradition and perform these bridging studies alongside of, instead of after, those in adults.

Still, with the pediatric trials full and proceeding even on a traditional timeline, it seemed enough to wait and hope that the vaccine would be approved for at least another tier of kids, ages 5 to 11, roughly by the start of the school year. That was not to be – in late July, the Food and Drug Administration threw a curveball at the scientists: It directed both Pfizer and Moderna to double the number of participants in their studies, thus cementing further delay.

The FDA was acting with good intent: Reports have emerged that there may be a very small risk of myocarditis – inflammation of the muscle of the heart – as a side effect of the mRNA coronavirus vaccine in adolescents. Recent numbers point to the rarity of this side effect – 67 teens per 1 million doses administered, and there have been no deaths reported due to it.

Again, in a pre-pandemic world, or one where there was no chance of new viral variants emerging, waiting longer would be the right thing to do. But that’s not the world we live in. In a letter to FDA Acting Commissioner Janet Woodcock, the leader of the American Academy of Pediatrics (of which I am a member) urged a different, more sensible approach – and not at all extreme.

“The FDA should strongly consider authorizing these vaccines for children ages 5-11 years based on data from the initial enrolled cohort, which are already available, while continuing to follow safety data from the expanded cohort in a post-market setting. This approach would not slow down the time to authorization of these critically needed vaccines in the 5-11 year age group,” writes Lee Savio Beers, president of the AAP.

So far, the FDA has not taken this suggestion and adjusted to the reality of kids under 12 – who make up about 14.4% of the total U.S. population – going back to school unvaccinated in the face of the delta variant.

As a parent, I’m queasy about what this fall and beyond will bring.

My wife and I have an 11-year-old who will start middle school shortly. We recently celebrated the start of soccer season, her first since covid-19 began. On a Saturday morning, watching her play defense for the same coach she has had since kindergarten marked a milestone for us – I think every child, coach and parent on that grassy field had similar feelings. Still, I couldn’t help nervously wonder if and when the first sniffle or sneeze in a still-too-young-to-be-immunized player would lead to a decision to cancel a practice, game or the whole season.

We also have a 13-year-old who got immunized the first day the vaccine was available for her age group. Yet, with an unvaccinated sister, and two physician-parents, we feel compelled to hold her back from sleepovers and other social activities in close quarters that would risk the health at home. These constraints spill over into anger on my teen’s part and guilt on ours.

Then there’s the coming winter, the first since the pandemic began when kids will be in school during flu season. Flu shots, masks, regular testing and other measures will help. Therapies for children with severe or life-threatening covid-19 include the use of steroids, the antiviral remdesivir for hospitalized kids who are over 12, and the possible off-label use of monoclonal antibodies in kids over 16 if a pediatric infectious-disease specialist concurs. But not one of these therapies brings the same level of protection and confidence as a vaccine.

At this point, we can take solace in what I tell the parents of my patients under 12 – sometime, I hope this winter, a vaccine for children ages 5 to 11 will come. Children younger than that will have to wait longer. Whenever the vaccine arrives, I hope you’ll get your kids in line for it – whether they are age 11, 5, 2 or 6 months. Immunizing children is absolutely the next critical phase of overcoming covid-19.

I know some parents are nervous – about this vaccine or vaccines in general. But the risk of getting covid-19 far outstrips the risk of the vaccine or even of the therapies should a child get critically ill.

And so I hope for a time, not far away, when most of us, including my patients, are vaccinated.

That’ll mean a lot fewer red-hot colored arrows in my doctor inbox, more weekends with kids out on the soccer field and more parents like me saying ‘yes’ to sleepovers.