Ask the Pharmacist

Q) I heard the United States has just approved vaccines for younger kids. What can you tell me about this?

A) After months of speculation and by now years of research, the FDA (the bureaucracy that monitors the approval of new drugs and vaccines within the U.S.) has recently approved the use of both Moderna’s & Pfizer’s vaccines for children from the ages of 6 months to 6 and 5 respectively (this reflects the fact that Pfizer was previously approved for kids down to the age of 5, whereas Moderna bottomed out at the age of 6).

This decision was based upon the recommendation of the U.S. Center for Disease Control and Prevention (perhaps better known as the CDC) which scrutinized the available data and found both vaccines to be safe and effective within this age group. This opens up the publicly funded vaccine programs for their 18 million preschoolers although the looming question is just how many parents will take advantage of this.

At this point, only about 29% of children aged 5 to 11 have been vaccinated since last October (which is when it was first authorized) and the numbers here in Canada are not much better. In the 5 to 11 years age group 56% have received one dose and only 42% are fully vaccinated here north of the border. A recent survey suggests that only one in five parents of young children plan to get their kids vaccinated as soon as is possible.

Using U.S. data (they do a much better job of tracking these things than Canada does), which should correlate with ours, only about 3% of COVID-19 cases occur within the pre-school age group. Hence, the risk of infection appears to be low which makes sense given how little infants are exposed to the coughs and sniffles of the general population relative to the rest of us. It also is, generally, a milder infection in children than it is in adults.

However, the hospitalization and death rates in this group are much higher than those for older children which is the main reason that experts feel that extending vaccine protection to this group is so important.

To date, more than 30,000 U.S. children under the age of 5 have been hospitalized with COVID-19 and close to 500 deaths have been ascribed to it. This makes COVID the fifth leading cause of deaths in children aged 1-4 and the fourth leading cause of death in children under the age of one. Those are sobering numbers.

The Pfizer vaccine is delivered as a three-dose series and it appears to be about 80% effective in preventing symptomatic disease, although this figure could change as the vaccine is administered to more and more infants. The Moderna vaccine is a two-shot series and the data seems to indicate that it is only about 40-50% effective at preventing infections.

This does not necessarily mean the Pfizer version is significantly better as they were tested at different times and hence may have dealt with different variants when the studies were run. As we know, not all COVID variants are created equal when it comes to both infectiousness and severity.

Moderna has now begun testing a booster shot (i.e. a third shot in the series) to see if this will improve their “numbers”. The Pfizer vaccine series works as two initial doses spaced three weeks apart starting at the age of 6 months. The third dose will be administered at least two months later. Each dose is one-tenth the dose that is currently given to healthy adults. For Moderna, the dose is one-quarter of its adult dose, and they are separated by about four weeks.

One concern many parents might, and should, have is regarding the possibility of side effects from the vaccine. The good news is that it appears these adverse events are relatively short-lived, uncommon and minimal in small children, especially when compared to older children and teens. The most frequently seen ones are the usual suspects:

· pain at the site of injection
· fever
· fatigue
· fussiness

In the trials, neither vaccine has caused any of the forms of myocarditis (an inflammation of the heart) that has plagued some young adults. Some parents might reasonably point out that because the vaccine is new, we may not yet know the full story when it comes to side effects. The rebuff to this is that countries such as China (which rolled it out to kids 3 and up before the Omicron surge) has now fully immunized 84 million children, Chile, Argentina, Cuba and Venezuela have been vaccinating kids as young as 2 for months now.

We, in Canada, have traditionally been slow to approve many new treatments. This is not always a bad thing. As such, it appears we are still at least weeks away before Health Canada will make any decisions about approving the same vaccines in our kids. That said, the writing is on the wall and it would be a major surprise if our preschoolers are not being presented with the option to be vaccinated before the end of the summer. For more information about this or any other health related questions, contact your pharmacist.