The Pfizer COVID vaccine is now available for the five-to-11-year age group.

As of today, the Pfizer pediatric COVID-19 vaccine is available for children aged 5 to 11 under emergency use approval (EUA). I previously discussed this vaccine during the approval process, and the data does indicate it is highly effective in preventing illness and severe disease. However, I have received a fair amount of pushback from concerned parents about immunizing their children. Let me try to briefly make a case for these children to be vaccinated.

Data from the Pfizer 5-11 age trial showing the reduction in symptomatic infections with vaccination (BNT162b2)..

COVID-19 hospitalizations in this age group have become common. This year they exceed the number of influenza hospitalizations by 15-fold, but the influenza hospitalizations were suppressed by masks and other counter measures. COVID-19 hospitalization rates, however, have reached those seen with influenza in this age group in prior years. Given the public health implications alone, immunizing to prevent disease and hospitalization is justified as much as it is for influenza.

CDC data showing influenza (black line) and COVID-19 hospitalizations (yellow line) in 5-11 year olds this year. The COVID hospitalizations approach the levels of influenza in prior years (red, blue and green lines).

Hospitalizations in children under 12 also have significantly increased recently since the presence of the delta variant in July. While the 5 to 11 age group has lower hospitalizations than children younger than 5, their COVID hospitalizations now exceed 1 per 100,000.

CDC data on hospitalization rates from COVID-19 over time in different age groups. Note the rise after last August due to the delta variant.

Importantly, COVID-19 truly is not a benign disease in this age group. 

There are significant numbers of more severe illnesses from this virus. This includes 5,217 cases of multi-system inflammatory syndrome (MIS-C), where over 60% of children wind up in the ICU and about 2% die. In addition, approximately 8% of children develop long COVID-19 syndrome. This involves a chronic illness that includes fatigue, headaches, muscle and joint pains, and even trouble concentrating. By definition, long COVID-19 syndrome lasts more than four weeks so this can affect school performance and psychological well-being.

Finally, while death is relatively uncommon in 5 to 11-year-olds, there have been 94 children that have died from COVID-19. To put this in context, COVID-19 is now the 6th leading cause of death in this age group.

In contrast, there were no severe adverse reactions attributed to the vaccine in the entire Pfizer trial. The only significant reactions were swelling of the lymph nodes in 13 children- a common response to any vaccine- and a few rashes. Importantly, there was no evidence of myocarditis, an inflammation of the heart which has been a problem with older children, especially in males. 

This excellent side effect profile may be the result of the pediatric dose of this vaccine being 1/3 of the dose given to people over the age of 12 (10 mg vs. 30 mg).

In conclusion, while the risk from COVID-19 is much less in 5 to 11-year-old children, it is still much, much greater than the risk from the vaccine.

Published by jbakerjrblog

Immunologist, former Army MD, former head of allergy and clinical immunology at University of Michigan, vaccine developer and opinionated guy.

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