The Case for Vaccinating Kids Under 5

The rapid development of approaches to combating Covid-19 has changed how the pandemic affects our lives. While there are now a number of safe and effective layers of protection for adults to reduce their risk of the worst impacts of Covid-19, young children remain relatively unshielded.

Although children have been at a lower risk of severe Covid-19 compared with older adults, the past six months have been the most perilous time of the pandemic for them — especially very young children. Children under 5 are the only age group in the United States whose caregivers haven’t had the option to help them build immunity against the virus safely via vaccination. The Omicron wave made it clear that even more than two years into the pandemic, the virus can still be devastating for people, including children, and especially those who have little or no immunity.

During the peak of the Omicron wave, hospitalization rates for children up to age 4 were five times higher than during the Delta wave, and more than 400 in that age group have died since 2020. In addition to suffering from acute illness and the risk of long Covid, children and families are experiencing other tragedies caused by the coronavirus. Over 250,000 children in the United States have lost a caregiver to Covid-19 and even more have suffered disruptions to schooling and daily life from the virus.

On Wednesday, a committee of experts advising the Food and Drug Administration evaluated the evidence and voted unanimously to recommend that Pfizer-BioNTech’s and Moderna’s Covid-19 vaccines be authorized for young children. The F.D.A. is expected to expand the emergency use authorization for both vaccines, making all children 6 months and older eligible for Covid-19 vaccination for the first time in the United States.

This is very welcome news; vaccines for children in this youngest age group are long overdue. And they could become available as early as next week, following a meeting of the Centers for Disease Control and Prevention’s Advisory Committee on Immunization Practices, which will review the evidence and make the C.D.C.’s final recommendation for how they should be used.

The most profound benefit that a vaccination could offer children is saving their lives from being cut short by disease. Vaccination could have prevented an estimated 300,000 Covid deaths in the United States between January 2021 and April 2022 if all eligible adults had gotten vaccinated. Many millions more needlessly endured a harrowing illness with physical, mental and economic consequences that can be long-term.

The benefits stand to be even greater if communities achieve high vaccination rates. Among the roughly 18 million children up to age 5 in the United States, many lives can be saved and other harms averted. Pfizer estimates that if children 6 months to 5 years receive three doses, vaccination can prevent 169,108 cases per million children vaccinated, 3,416 hospitalizations and 28 Covid-related deaths in the case of a wave similar to Omicron over six months.

The evidence is clear: The benefits of these vaccines outweigh any potential risks. Pfizer’s three-dose vaccination series for children age 6 months to 4 years and Moderna’s two-dose vaccination series for children age 6 months to 5 years generated immunity at levels similar to the immune responses seen among young adults. That these vaccines met all benchmarks is especially encouraging considering that they were evaluated among the youngest age groups (who have less developed immune systems), using a lower dose (to minimize potential side effects) and at a time when Omicron (the most infectious variant yet identified) caused the majority of disease.

The breadth of data now available includes results from the clinical trials assessing immune responses, effectiveness and efficacy; safety evaluations; and real-world observational studies that Moderna and Pfizer reported. Both companies presented their data, then the F.D.A. scrutinized and reanalyzed the results independently. The process of evaluating these vaccines has been rightfully rigorous and builds on what we have already learned from vaccinating hundreds of millions of Americans.

The data and committee conclusions are important not just for health care providers but also for families, given that in April 2022, over half of parents with children under age 5 surveyed reported they did not have enough information about the safety and effectiveness of Covid vaccines for those youngsters. Also reassuring is that these vaccines will be continuously monitored in the months ahead to ensure that they deliver the benefits indicated by the trials even as the pandemic evolves.

But we cannot expect vaccinating young children to rise to the top of caregivers’ to-do lists if the benefits are not communicated clearly or if getting vaccines is onerous. We need clear, accessible communication from pediatric providers and public health practitioners about the urgency of vaccinating children, and we need to eliminate as many impediments to vaccination as possible. Critically, we need an equity-centered approach that smooths every step of the process, from accessing information to appointment scheduling to enabling caregivers who work for pay to take time off work to get their children vaccinated.

For decades, prudent policies have successfully sustained vaccine uptake among children and aided in keeping communities safe by preventing outbreaks. For instance, nearly every state requires children to be vaccinated against at least four of eight diseases (measles, mumps, rubella, polio, varicella, diphtheria, tetanus and pertussis) to attend school, and this has helped keep rates of these routine vaccinations high across racial, ethnic and economic groups. With a supportive structure, Covid-19 vaccination can also be accessible, convenient and an expected milestone in childhood, across diverse communities — no different from any other childhood vaccine.

The summer school break is the perfect opportunity for caregivers and local, state and national leaders and the public health community to work together to ensure that children are vaccinated before the school year begins. If we have learned anything since 2020, it is that while the virus’s next move is uncertain, our decisions, our policies and our actions can save lives and avert harm.

Nicole E. Basta is an associate professor of epidemiology at McGill University and its Canada research chair in infectious disease prevention. Rachel Widome is an associate professor at the University of Minnesota’s School of Public Health

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