SHERIDAN — COVID-19 vaccinations have started for people aged 16 and older in Wyoming, and while the vaccine has not yet been approved for children, pediatricians should prepare for that milestone, according to the American Academy of Pediatrics.
Three immediate actions pediatricians can take, the AAP said, are learning about the vaccine, preparing themselves and staff to be immunized and sharing vaccine communications expertise.
“I will absolutely receive the vaccine the first chance that I have to receive it,” said Dr. Michael Sanderson, who is a fellow of the American Academy of Pediatrics and physician at Northeast Wyoming Pediatric Associates.
According to the AAP, more vaccine trials in children are needed to ensure there are no pediatric-specific side effects, and another area being studied involves transmissibility of the virus by those who are fully immunized. As of early December, Sanderson said once widely available, he would “absolutely recommend” the vaccine for patients who are 18 years of age or older.
"AAP has stated and I agree that it is critical that the pediatric population be included in ongoing and future trials, so that we can ensure these vaccines are safe and effective in younger children and that younger children have access to these vaccines," Wyoming Public Health Officer Dr. Alexia Harrist said.
The studies that have been done on adults are large — Pfizer, with greater than 43,000 participants, and Moderna with 30,000 — and the science has been “conducted rigorously.”
“A lot of folks feel like these vaccine emergency use authorizations are moving forward too quickly to be done safely, but the reality is that all of the same steps that are usually taken to ensure vaccine safety and effectiveness in these processes are still being taken,” Sanderson explained.
However, he would not recommend the vaccine for anyone younger than 18 years of age — even though Pfizer included individuals who were 16 and 17 years of age in their study — because the sample size was small. Furthermore, the American Academy of Pediatrics has not recommended either COVID-19 vaccines for children of any age, he said.
"The ACIP does recommend the use of the Pfizer vaccine in individuals aged 16 years and older. There are pediatrics experts who serve as voting members of the ACIP, and also representatives from the AAP serve as liaisons to the ACIP. Based on this recommendation from the ACIP I do have confidence that individuals ages 16 and 17 can be vaccinated with the Pfizer vaccine safely," Harrist said. "For adolescents aged 16-17 and for other groups for whom data are limited, the decision to vaccinate is between the patient and their provider based on many factors, including the patient's risk of getting COVID-19 and potential consequences of getting COVID-19."
Kim Deti, spokesperson for the Wyoming Department of Health, called vaccination development “a process with many steps.”
“We are very excited about the development of these vaccines,” she said. “At this time, neither of the authorized vaccines are okayed to be used for children, but that doesn’t mean that they won’t be, or that another vaccine won’t be in the coming months. This is just for right now.”
According to a Dec. 17 report from the Associated Press, makers of the Pfizer vaccine began testing the vaccine in children as young as 12 in October, which is expected to take several more months. The Food and Drug Administration will have to decide when there’s enough data to allow emergency use in this age group. Depending on the results, younger children may be enrolled for study as well. The Moderna vaccine began enrolling study participants ages 12 to 17 this month and will track them for a year. Testing in children younger than 12 is expected to start in early 2021.
At this moment in time, it is impossible to say when the vaccines will be available to children, Sanderson said. Patient populations for children in vaccine studies will need to be large and diverse to demonstrate that COVID-19 vaccines are safe and effective for children. Statistically speaking, children have done “incredibly well with COVID-19 and for the most part, their experiences are that of either the common cold or a flu-like illness, if anything at all. Many children have a nearly asymptomatic illness with COVID-19,” Sanderson said.
Some adolescents have a “miserable flu like illness similar to their adult counterparts, but adolescents as a population have done very well with COVID-19,” he said.
“While limiting the spread of the virus is extremely important, to this point in the pandemic, the data are showing that children of all ages are doing incredibly well with this virus,” Sanderson said. “At this moment, there just isn't enough information to support the hope that the benefits of the vaccine outweigh the risks for children.”
There is concern for the Multi-Systemic Inflammatory Syndrome, which is the Kawasaki Disease-like inflammatory illness that has been associated with some children who have had COVID-19, but this is “extremely rare and a link for causation has not yet been found,” he said.
There are two reasons to immunize: to prevent disease in the patient themselves, and to prevent spread among a population.
“At this time, our children as a population are not in dire need of the vaccine to protect their own health, but if this vaccine is safe for children, it might be important for them to get it to prevent further spread of the virus to at risk populations,” Sanderson said.
Dr. David B. Wheeler, with Wyoming Neurologic Associates in Casper and current Wyoming Medical Society President, said that adults should “absolutely” receive the vaccine according to Center for Disease Control guidelines, and called COVID-19 a “serious disease” in many adult populations.
“We strongly endorse the CDC guidelines about the preferred order in which people should receive (vaccines), which populations should receive them and so forth,” Wheeler said.
Children have not yet been assigned a priority group for the COVID-19 vaccination. The Wyoming Department of Health has issued a vaccination prioritization order that begins with hospital staff, followed by EMS/EMT personnel and those associated with long-term care facilities. The goal remains to slow the spread of COVID-19 even while the vaccination effort is underway.
“The goal should continue to be to slow the spread of the disease as much as possible, through mask wearing and social distancing, and to spread out the rate at which people are getting infected so that we don’t continue to over tax the available health resources,” Wheeler said.
Wheeler said that “protecting ourselves and our loved ones from what turns out to be a pretty serious disease” by doing all the things known to curb the spread of COVID-19 is crucial, especially given that people can be re-infected within just a few months of having recovered from the illness.
“Even if you have had it, you should not presume you are resistant to being reinfected,” Wheeler said. “Until a significant proportion of the population is vaccinated, probably anywhere from 70-80%, we can’t rely on the vaccine to protect ourselves, even if you have been vaccinated.”