This year’s Thanksgiving may look at lot like last year’s, with scaled-down guest lists, outdoor dinners and requests for family members to bring their masks and the mashed potatoes.
A big reason: It’s unlikely that kids under 12 will be fully vaccinated by late November. But the good news is, many could have one of the two shots needed under their belts by then.
Experts are hopeful that a two-dose COVID-19 vaccine for children ages 5 to 11 from Pfizer-BioNTech will clear regulatory hurdles by the end of October or early November, paving the way for millions more Americans to get vaccinated, at least partially, this fall. And by the December holidays — “if everything occurs as we anticipate and the [authorization] comes in late October” — many children in this age group could be fully protected against COVID, predicts Amanda Castel, M.D., a pediatrician and infectious disease epidemiologist at George Washington University’s Milken School of Public Health.
Pfizer has submitted data to the Food and Drug Administration (FDA) from its clinical trial testing a smaller-dose vaccine (one-third of the dose adults receive, with 21 days between the first and second doses) in more than 2,200 5- to 11-year-olds, and says it plans to ask the agency to authorize the product in the coming weeks. Once it does, the FDA and its panel of outside experts will review the data (this typically takes about a month) and decide whether to allow it. The trial results will also be scrutinized by the Centers for Disease Control and Prevention (CDC) and its advisory committee.
Data from Pfizer’s vaccine trial looking at kids younger than 5 are expected later this year or early next. Vaccine makers Moderna and Johnson & Johnson are also studying their products in kids and adolescents, but trail behind Pfizer’s timeline.
Vaccine can help slow surge in kids’ cases
The wait for these vaccines has been long for parents, grandparents, teachers and others anxious to keep little ones from becoming infected and spreading the virus to others. And the rise of the delta variant, coupled with schools reopening, has only amplified the urgency.
Currently, children make up more than a quarter of new COVID-19 cases in the U.S., and hospitalization rates among kids under 12 are the highest they’ve been since the start of the pandemic, national data show. That’s not because the dominant delta variant causes more severe disease in children; it’s because the strain is highly contagious, says Claire Boogaard, M.D., medical director of the COVID-19 vaccine program at Children’s National Hospital in Washington, D.C.
And even though kids tend to fare better than adults when it comes to COVID, more kids are getting infected with delta “and therefore, more kids are being hospitalized and having severe consequences,” Boogaard says.
Getting shots in arms quickly will no doubt slow the surge in illness among children. Research from the CDC shows that hospitalizations among unvaccinated adolescents who are eligible for the shots are 10 times higher compared to their fully vaccinated peers. However, the amount of time taken to test the vaccines in younger populations has been absolutely necessary, Castel says. “In the pediatric world, we always remind people that children are not young adults. They're smaller. Their immune systems are different,” she says.
And because children can have more robust immune responses to vaccines, it’s important to monitor their safety and effectiveness in adults first, says Yvonne Maldonado, M.D., an infectious disease expert and professor of pediatrics, epidemiology and population health at Stanford Medicine. “You want to be careful. You want to be paced,” she adds.
Experts will be looking closely at one response, in particular: myocarditis, or inflammation of the heart muscle — a rare complication that has popped up in some younger Pfizer and Moderna vaccine recipients and usually resolves quickly with care. Still, health officials say the benefits of the vaccine far outweigh the risks, especially considering myocarditis is more likely to result from a viral infection like COVID-19.
Vaccine rollout could add time to wait
Over 28 million children ages 5 to 11 would be eligible for the vaccine if it’s authorized this fall, and about one-third of parents say they plan to vaccinate their child as soon as it’s available, according to a new Kaiser Family Foundation report. But some patience may be needed during the initial rollout.
Many of the mass vaccination sites set up last winter and spring to inoculate adults have shuttered, and pediatricians’ offices and hospitals that can administer vaccines are overwhelmed with patients right now. And while it’s likely that pharmacies will play a role in vaccinating young children, plans so far are unclear and could vary by location.
“But I know that this is still considered a public health crisis and that all departments of health and communities are going to try to vaccinate these kids together,” Boogaard says. Her advice: Next time you are at the drugstore, ask if there’s a program in place for children’s vaccines. Also, pay attention to schools, which could offer vaccine clinics, Castel points out.
“I have full faith that our communities will get these kids vaccinated within a few weeks after the announcement comes in. So just be patient and work with your community to find the best place to get vaccinated,” Boogaard says.
How to gather safely over the holidays
In the meantime, if your child or grandchild, niece or nephew is still waiting on a shot when the holidays roll around, plan accordingly.
“Partial vaccination does not confer the full protection that we are desiring for children,” Castel says about kids who have only had one dose in the two-dose series. They could still get COVID-19 if exposed to the virus or could spread it to others, including more vulnerable individuals.
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Boogaard says “the biggest thing” people age 12 and up can do ahead of holiday celebrations is to get vaccinated. Adults 65 and older who have had the Pfizer vaccine are also eligible for a booster shot to ramp up their protection — as are people 50 to 64 with certain underlying health conditions. “Kids don't want to share their germs to people that they love and get them sick, and people who love those kids don't want to get those kids sick, themselves. And so if you're planning on spending the holidays together, it's best to protect as many people as possible,” Boogaard adds.
In addition to vaccination, moving your meals outdoors can make a holiday gathering safer, if the weather allows. If you’re inside, consider opening the windows and keeping your mask on when you aren’t eating or drinking, especially if unvaccinated children are coming over and you or someone in the group is at high risk for COVID-19. Also, keep a safe distance from others at the table to reduce droplet spread and keep up with hand hygiene, Maldonado says.
Families planning to spend several days together can adopt what Maldonado calls the “bubble” plan, where everyone tests ahead of the visit and wears a mask for the first few days while interacting with each other and limiting interactions with others. If a second negative test three to five days after the first shows nobody is infected, people can feel more comfortable mingling without masks.
“Talk with your family and just be very transparent and come up with a plan ahead of time,” Boogaard says, including the protocol if someone experiences symptoms of COVID-19.
Other factors to discuss: the number of people attending the gathering, where people are traveling from, and whether any of the guests work in a profession that puts them at higher risk for exposure.
“Just thinking through these logistics is really important,” Castel says. “And then hopefully by the December holidays, many of these kids will be fully vaccinated and some of those precautions can be loosened a little bit.”
Rachel Nania writes about health care and health policy for AARP. Previously she was a reporter and editor for WTOP Radio in Washington, D.C. A recipient of a Gracie Award and a regional Edward R. Murrow Award, she also participated in a dementia fellowship with the National Press Foundation.