COVID-19 cases are surging again in the United States as experts warn of a “third peak” that could be particularly devastating while much of the country rides out the winter indoors.
Even if case counts begin to fall, there’s no real chance of life getting back to anything close to normal until a COVID-19 vaccine is available. And until a vaccine is available for kids, there’s little chance of families settling back into functioning routines.
Unfortunately, experts seem to agree that it’s unlikely a vaccine for COVID-19 in children will be available as soon as one (or several) is available for adults. Some are predicting we will not get a vaccine for kids until next fall.
That’s not an easy prediction to hear as a parent. But grappling with that extended timeline — however theoretical it may be — can influence the decisions parents are making right now as they navigate the pandemic with their children.
HuffPost Parents reached out to a few experts to talk a bit more about children and a potential COVID-19 vaccine. Here are a few things to keep in mind:
COVID-19 vaccine trials have focused exclusively on adults so far.
Vaccine makers have been working furiously to develop an answer to COVID-19, but until this week, no children have been involved. On Wednesday, CNN reported that Pfizer plans to start enrolling teenagers in its current experimental vaccine trials immediately and that it has also been granted permission from the FDA to start including kids as young as 12 in those efforts. So far, it is the only vaccine trial in the U.S. to include children.
It’s not necessarily unusual that potential vaccines are being tested in adults first. For one, health care workers and certain groups of older adults who are more vulnerable to severe illness from COVID-19 are likely to be given priority whenever a vaccine is available. Also, traditionally, the process of developing a vaccine usually involves testing it in progressively larger groups of adults, followed by older children, then younger kids. And that process often takes several decades.
But nothing about the speed and global scale of developing a COVID-19 vaccine is typical. And as pediatric COVID-19 cases climb (nearly 700,000 children have tested positive for the virus in the U.S. since the pandemic started), some researchers are arguing there’s an urgent need to make sure children are included in trials.
“If there were tests done in adults that proved safety and efficacy, we would not just say ‘OK, now you can just open up the doors and give this to children, too.’”
– Dr. Yvonne Maldonado, epidemiologist and infectious disease specialist
In September, a group of physicians wrote commentary arguing that “clinical trials for children remain stuck in neutral,” which also affects kids’ ability to return to school and child care centers. “An approved COVID-19 vaccine for children could have far-reaching positive ramifications on health and educational equity,” they wrote.
Dr. Priya Soni, a pediatric infectious disease specialist at Los Angeles’ Cedars-Sinai Medical Center, told HuffPost that excluding children from vaccine trials could undermine prevention efforts overall. “Children could likely remain a large reservoir for infection,” she argued. “This would in turn undermine all our other pandemic mitigation efforts.”
For parents, though, the fact that trials are so far focusing primarily on adults probably matters most because it means experts like Soni believe “with confidence” that a vaccine will not be ready for kids at the same time one is ready for adults.
“The hope is that vaccine developers have sufficient data to start enrollment in children by the end of 2020,” she said. “But even if that pans out, it’s hard to imagine a globally efficacious vaccine available at the same time for both adults, children, and other vulnerable populations.”
Children aren’t mini-adults, and their immune systems are very different.
Clinical trials in children are essential because children are not simply little adults, explained Dr. Yvonne Maldonado, an epidemiologist and infectious disease specialist at Stanford Medicine who chairs the American Academy of Pediatrics’ Committee on Infectious Diseases.
“Their immune systems are very different than adults. Especially in children under 5, the immune system is still evolving,” said Maldonado. “There have been studies that have shown children respond differently to vaccines. Younger children have very different responses, in some cases, than older children — in some cases better, and in some cases worse.” Younger children are “evolving” many of their basic biological responses in a way older children and adults aren’t.
Also, children appear to respond to COVID-19 in different ways than adults for reasons that are not yet understood.
“We need to do very rigorous safety-based studies in children before we can endorse a vaccine in children,” Maldonado said. “If there were tests done in adults that proved safety and efficacy, we would not just say ‘OK, now you can just open up the doors and give this to children, too.’”
Some kids have a rare inflammatory response to COVID-19—which complicates things.
For months now, doctors have been tracking a condition called multisystem inflammatory syndrome in children, or MIS-C. It appears to be a rare inflammatory response in children who are infected with COVID-19 that develops weeks after that initial infection, and that can make them extremely ill.
MIS-C received significant media attention when it first emerged, but it has dropped largely out of the spotlight, partly because it happens so infrequently.
For physicians and vaccine makers, however, it has been top of mind — and is one reason why they have been advocating for research to roll out slowly and extremely carefully.
“It’s the first thing most of us who are pediatricians thought of when we heard about this syndrome,” Maldonado said. “We don’t really know what it is … the underlying immune mechanism there is important to understand, because we would not want to see a vaccine that might enhance that response.”
Layering protective measures is still the best way to prevent spread.
Again, at this point, no one really knows when a vaccine will be available for adults or children, so our best options for preventing the spread of COVID-19 remain the same: maintaining social distance, washing hands, and wearing masks.
And there has been some good news recently when it comes to kids and the virus. This week, researchers released the first major study to look at COVID-19 spread in child care centers that remained open throughout the pandemic, and it found that kids did not seem to pose much of a risk to the staff who watch them all the time. And at this point, as school districts have returned to in-person learning in much of the country, it doesn’t look as though K-12 schools are a huge driver of the virus.
Even so, the experts who argue for increased focus on COVID-19 vaccine development for children say that parents should understand that things won’t really turn around until a vaccine is available for children — and again, that could be some ways off.
“We must make vaccines for children a priority if we have any hopes to return to normalcy,” Soni argued.