The Shot Clock

As the COVID-19 vaccines continue to roll out, doctors answer your questions on safety and when your children will be able to get a shot.  

When I heard a COVID-19 vaccine was approved, I had a .3-second fantasy of traipsing to the pharmacy with my family to get the Shot That Will Make Everything Better. Then I remembered about supply chains. But even once the immunization becomes available to the general population, children will need to keep waiting. As of press time, the two vaccines approved in the U.S. by Emergency Use Authorization (EUA) are the Moderna vaccine (18 and above), and the Pfizer/BioNtech vaccine (16 and above).

When will there be a COVID-19 vaccine for kids?

Pfizer/BioNtech started tests for those aged 12 and up in October 2020, and Moderna started in December. Trials seem to be taking about four to six months. Once one age group has been cleared as safe, the tests will drop to a lower age. Malaika Little, M.D., MPH, pediatric infectious disease specialist and director of Randall Children’s Hospitalist Team, is hopeful kid-approved vaccines will be available in Oregon sometime in 2021. (See What We Know About Timelines below for more details.) 

Jay Rosenbloom, M.D., Ph.D., F.A.A.P., a pediatrician with Pediatric Associates of the Northwest, says the exact timing for kid vaccine tests is hard to predict. “Children” make up many groups, all of which need to be tested separately. Testing has to determine safety and effectiveness as well as dosage and protocol. Some vaccines, like HPV, require two shots for those under 15, and three for those over. Other vaccines, like the diphtheria/tetanus/pertussis bundle, require a higher dosage for effectiveness in infants than for adults. Studies need to determine the dosage, number of doses, and how far to space them apart.

Will it be safe to vaccinate my child?

“It is no small matter to inject something into well children,” Rosenbloom says. “If there are risks and side effects, we need to know what those are.” What gives doctors confidence that testing is adequate in spite of the fast-tracking of these vaccines? “This timeline has been so much faster than we’ve seen with other vaccines, partly because we have so much disease out there,” Little says. Meaning COVID-19 is so rampant that the needed level of exposure for testing can be achieved in months rather than years.

The approved vaccines are mRNA vaccines. While they have never been used before, Little notes that “this is technology people have been working on for easily 10 to 15 years.”  

Will enough people in Oregon get vaccinated to achieve herd immunity?

Most doctors are optimistic about people’s general willingness to trust the vaccine. They are convinced it is safe, and hopeful that people in Oregon can be convinced, too.

Dr. Anthony Fauci, chief medical advisor to the president, estimates that the proportion of Americans who need immunity in order to stop the spread of the virus is somewhere between 70% and 90%. This doesn’t leave room for a lot of people to refuse the vaccine. And as Ryan Hassan, M.D., a pediatrician with Clackamas & Oregon Pediatrics, points out, the COVID-19 vaccines are the first immunizations that have ever had an anti-vaccination movement in place before they even existed. He thinks the solution is for public health professionals to disseminate “accurate, understandable information so people can easily understand this vaccine is safe, and feel comfortable getting it.”

“I feel really lucky that I’ve spent my whole career with the people who are working on this and they are tireless, and this is happening all over the world — vaccinations are coming out of first, primary good intent,” Little says. “There’s no drug company scam, no ulterior motive.”

What can we do while we’re waiting?

One of the best things you can do to keep your children safe is to make sure all their other vaccinations are up to date. It’s true that children tend to have less-severe cases of COVID-19 than adults, Little says. “But I can tell you there are still kids getting really sick. Core childhood vaccines are probably more important now than ever before, because dual diagnoses and comorbidities are a huge risk,” she adds. 

Dr. Little encourages us to think about this from a general public health perspective. “Keep washing your hands; keep wearing your mask,” she says. “We’ve seen other countries make a big difference in flattening their curves through public health measures. Behavior is No. 1 for infection prevention. And the vaccine is an amazing tool we can use in the long term.” Explain this to your kids and empower them to be part of the solution.

It has never changed my 4-year-old’s (or my 1-year-old’s) position on shots to tell her that the disease is worse than the shot. What has helped a little, though (with the 4-year-old), is the book The Brave Monkey Pirate. In it, young Modi is given a magic stone which, when squeezed very hard to the count of three, transports him into the future, when the shot is finished. Go out and find your kid a magic stone, and keep it in a safe place while you wait. 

What We Know About Timelines

The Oregon Health Authority did not respond to repeated requests for information on the rollout of the vaccine for kids (and we get it). According to the American Academy of Pediatrics at press time, Pfizer/BioNtech’s trial for 12- to 15-year-olds is fully enrolled, and Pfizer may be able to seek authorization for that age group before the end of June. Moderna, Janssen and AstraZeneca are months or more behind Pfizer.

According to an OHSU chart updated January 25: After Oregon opens the vaccine to those 65 and older, several high-risk groups will still need to be vaccinated before vaccines are made available to the general public. If Pfizer gets its vaccine authorized for 12- to 15-year-olds by late June and high-risk kids in that age group receive the vaccine in July, it seems optimistically possible that low-risk kids in that age group might start getting it around schooltime. The next-younger group will follow (if all goes well) about four to six months later.

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Stephanie Gehring spends her days trying to guess how her 4-year-old will next attempt to smuggle water out of the bathroom, being astonished by the range of tongue-clicking noises her 1-year-old can imitate, and arguing with her husband over what to plant in their tiny, full-shade vegetable garden. You can see her visual art, old samples of her writing, and an infrequently updated blog at stephaniegehring.com.