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A Word from the Experts

May 17, 2021, 6:01 p.m. EDT

What this Cleveland Clinic pediatrician and vaccine expert is telling teens and their parents about getting COVID-19 shots

Jaimy Lee

Regulators have given the go-ahead for younger teens to begin getting Pfizer’s COVID-19 vaccine, which has raised questions for some parents who want to better understand how inoculation could affect their teenagers.

Pediatricians across the U.S. are fielding these questions, which range from whether the vaccine is even necessary for teens and children — they are in fact “effective transmitters” of the virus — to whether side effects will be that different from what adults experience.

“Chances are they’re going to do great with a vaccine, and they’re going to have really good protection,” says Dr. Michelle Medina, a pediatrician and a member of the Cleveland Clinic’s vaccines advisory committee, during a May 6 interview.

See also: The U.S. will begin giving COVID-19 shots to 12- to 15-year-olds as Pfizer’s vaccine gets expanded authorization

BioNTech SE (NAS:BNTX) and Pfizer Inc.’s (NYS:PFE) COVID-19 vaccine is the first one authorized for teens between the ages of 12 and 15. Teens in this age group began getting their shots on Thursday.

“The biggest concern that we hear about from parents [is that] these are young kids, with a long life ahead of them,” Medina said. “That’s always the thing that makes people hesitate. However, when you do weigh the potential risks versus the benefits, I think that scale still tips very heavily on the benefit side of things.”

MarketWatch: What may be different about using vaccines like the COVID-19 shots in younger populations? What’s different about the risk-benefit profile? 

Dr. Michelle Medina: The first question that anybody asks is, are we seeing the same type of vaccine efficacy? The nice thing is the answer is, yes, and even more so. We’re seeing 100% vaccine efficacy , even against any COVID infection. That’s one way to measure it. The other way is to check to see, are they having any response serologically? That is when you do blood testing and you measure if it looks like they have evidence of immunity. Again, the answer is yes. With the Pfizer [vaccine], it seems like it’s even more robust than what we’re seeing with the young adults, [in the] 16- to 25-year-old group. 

Right alongside that is, of course, the question that everybody will have in their mind, particularly parents: Is it safe to use? Again, the answer is yes. [It has the] same profile that we saw when they did the adult studies: local injection reactions, maybe some systemic reactions.

We do have data on some pediatric cases that were vaccinated already — more than 2 million 16- to 18-year-olds that had at least one dose of the Pfizer vaccine. But within that 2 million group, there is not a lot that we see that actually makes us worry about any signal that is concerning for safety.

The biggest concern that we hear about from parents … is, these are young kids, with a long life ahead of them. Are we doing something now that may be harmful to them in the future? Anybody who knows the answer to that is speaking through a looking glass. We don’t know. That’s always the thing that makes people hesitate. However, when you do weigh the potential risks versus the benefits, I think that scale still tips very heavily on the benefit side of things. 

We are still in the middle of a pandemic. Granted, we are fortunate in this country that we’re seeing declines [in the number of cases, hospitalizations and deaths]. But remember: Those declines happened [as people got] vaccinated, on top of everything else we’ve been asked to do over the last year. This is why we’re not seeing our 80-year-olds ending up in hospitals intubated, in the ICU and dying. They were the first people vaccinated. 

Now we’re seeing the illness strike our younger adult population because they’re still in the pipeline of getting vaccinated. In fact, we’re seeing a tremendous rise in pediatric COVID cases, as well. [Editor’s note: The American Academy of Pediatrics says that the number of pediatric COVID-19 cases climbed 4% between April 22 and May 5.] Maybe not pediatric hospitalizations, maybe not pediatric deaths. But if you’re worried about the long-term effects of a vaccine, think about the known long-term effects that we already know about COVID. It’s not just a lung disease. It’s a multi-organ disease.

We know that in children, even though they may not end up intubated, they will suffer potentially other systemic side effects that could also have long-term effects. So, again, weighing that scale, known benefits and known risks of getting COVID versus the theoretical risks, I would say the scales tip very heavily on that side as far as getting it.

MarketWatch: Pfizer has said they expect to have the first clinical data for children younger than 11 years old in September. How can parents prepare for the decision to vaccinate younger children?

Medina: Physiologically, a 12- to 16-year-old is actually different from a 16- to 18-year-old. The reason why we give childhood vaccines early and why we even give them before they even enter high school is because we know their responses to immunizations are much more robust.

If you get your HPV vaccine before the age of 15, you only need two doses, because two doses is enough to give you protection that’s fairly robust. If you get the HPV [vaccine] after the age of 16, you need a third dose. 

It’s also potentially the reason why you see younger adults have much more robust local reactions to the vaccine compared with older adults. That data was also in the Pfizer trials, that even those particular local reactions were more evident in younger adults. So, again, it tips heavily in their favor.

Chances are they’re going to do great with a vaccine, and they’re going to have really good protection, even in the short term, but hopefully in the long term, as well.

The biggest question that people have when you start going down in age is that they respond to different types of vaccines differently than a teen and maybe even differently than an adult. No vaccine is exactly the same. If you think about the childhood series of immunizations, they’re all a little bit different from each other. Some of them are polysaccharide-based or sugar-based. Some of them are protein-based. And kids respond to different types of vaccines differently. They respond more robustly to protein-based ones. 

MarketWatch: Some parents are talking about being more comfortable with the Johnson & Johnson (NYS:JNJ) vaccine, for example, than the mRNA vaccines because it’s a more familiar type of vaccine, even though Pfizer’s vaccine is the only one authorized for teens at this time. Is this something you are hearing from parents?

Medina: People are making those calculations right now. You know what? I’d rather that they think about it that way than to simply say they’re not going to go for it. Those are fair questions to ask.

With the J&J vaccine, even though the technology as far as having a virus carry the material that produces an immune response, is not new, this particular technology is still new. It has been used only in Ebola. [Editor’s note: J&J’s Ebola disease vaccine was approved by the Food and Drug Administration in 2019.]

If you talk about something that’s a traditional vaccine, similar to what we’ve always given for decades, similar to what we’ve always given for decades, it’s Novavax. [Editor’s note: Novavax Inc.’s (NAS:NVAX) investigational COVID-19 vaccine is still being tested in a Phase 3 clinical trial in the U.S.]

The concern, obviously, is [worrying] about what does it do to their makeup. It’s really hard to imagine that that would be anything to worry about. And if people say, I’d really rather have the traditional one, one that I’ve known for decades, that’s probably closer to the Novavax [shot]. I wouldn’t necessarily wait for that.

The other question is a more practical one. Yes, they’re going to get side effects. That first day is going to be rather painful as far as local injection [site], and some people may have a fever, and some of the fevers may be more robust. Because these are kids, potentially it could be much more robust. The trial showed us that it’s about the same number of [teens] as adults who get those systemic reactions, but it doesn’t really quite tell us how robust that is — like, how bad is that fever?

It’s fair to be prepared on a practical basis. Does that mean take them off school the next day, take them off sports the next day, or avoid seeing other people the next day? Those are very fair questions to think about. That being said, the logistics of this is going to play into that. If they have the ability to get the dose on a Monday, get the dose on a Monday.

MarketWatch: Is there anything else that comes to mind around this topic?

Medina: We hear from parents that [children who contract SARS-CoV-2 don’t get] that sick, so why bother? There’s many levels to that question. Some people respond to the notion that the benefits really outweigh the risks. Some people respond to, if you don’t vaccinate the kids, nobody is going to get away from this, and we’re all going to have to do this for a long time, because [children are] effective transmitters. Some of it may be personal. If you have family members who are at risk, your kids may not have a good way to interact with them unless they’re vaccinated, too.

The other thing is, we have to also ask the teens. I have a 15-year-old, and, I’ll be honest with you, vaccine envy is real. She’s with classmates who are 16. She’s like, what? I can’t get the vaccine?

It’s true when we look at HPV. Remember the whole thing that happened with the HPV [vaccine] rollout. [Editor’s note: The FDA in 2006 approved Gardasil, the first human papillomavirus vaccine, which was developed by Merck & Co. Inc. (NYS:MRK) . However, the vaccine faced controversy over mandates in some states for teens to get vaccinated against the sexually transmitted infection.]

When you ask the kids, it’s a different equation that they play out in their heads. “Well, of course, I want to get that.” “Of course I don’t want to get cancer.” We also have to ask that question, how are the teens and the young kids actually thinking about this. In my practice, I do that. I ask the parents, and they ask the kids how they feel about [being vaccinated against COVID-19]. Some kids are, like, fine, but some of them are very adamant about it: “I don’t want to wear the mask anymore!”

This Q&A has been edited for clarity and length.

Read more A Word from the Experts interviews:

•  How 6 feet became 3: Meet an ER doctor behind the research showing kids are still safe in school with new social-distancing standard

•  It’s a ‘question of time’ before another virus jumps from animal to human, says co-inventor of flu treatment Tamiflu. Preventative therapies are needed.

•  The new B.1.1.7 is a ‘superspreader’ strain. Here’s how the U.S. can control it, says Dr. Eric Topol

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