It’s a moment many parents have been anxiously awaiting for months: Children under the age of 5 are now eligible for vaccination against the coronavirus, one of the last Americans to qualify.
Without access to vaccines, parents of young children have made nearly impossible choices since the start of the pandemic. Many children were kept away from schools, family gatherings and other activities, and were deprived of normal childhood experiences. Now that could all change.
On Saturday, the Centers for Disease Control and Prevention recommended the Moderna and Pfizer-BioNTech vaccines for children as young as 6 months. The decision means these young children will be getting shots for the first time, perhaps as early as Tuesday.
Sunny Baker, 35, a mother of two in Oxford, Miss., said she vaccinated her oldest daughter, Hattie Ruth, 5, at the first chance, and has been eagerly awaiting her 2-year-old daughter, Alma Pearl, to qualify .
“Yes yes yes! We would like to be first in line,” she says.
But Ms. Baker may very well be outnumbered: A recent Kaiser Health poll found that only one in five parents will immediately have their young children vaccinated. Many are planning to wait it out for now.
As the pandemic extends into a third year and Americans weigh the risks they are willing to live with, the CDC’s decision puts parents of young children on the spot.
Vaccines have lost some of their potency against infection with new variants, although they still protect against serious illness and death. And vast numbers of Americans were infected during the Omicron wave, contributing to the misconception among many that the battle was over.
Shift advice also contributed to a lack of enthusiasm. Daryl Richardson, 37, of Baltimore, said he had no plans to vaccinate his three children, in part because of the constant changes in the number of recommended doses.
“First it was a shot, then it was a booster, and then another booster,” he said.
After navigating the dangers of the pandemic with their children for so long, parents are now faced with new questions, some of which are so complex that they have baffled even regulators and experts. Which vaccine is better? How well and how fast will they work? And why bother, when the majority of young children have already been exposed to the virus?
Both the Pfizer-BioNTech and Moderna injections are considered safe for young children and both deliver blood levels of protective antibodies comparable to those seen in young adults. But neither offers the miraculous protection that adult vaccines provide in the early days of the pandemic.
Moderna’s vaccine appears to elicit a strong immune response in young children and its protection is completed within 42 days of the first dose. But the vaccine causes a fever in one in five children, and fewer providers are likely to offer it as an option over Pfizer’s vaccine.
The Pfizer-BioNTech vaccine is better known and causes less fever, but children will need three doses to be protected against the virus. Although it takes 90 days to achieve maximum protection, the effect can last longer compared to Moderna’s regimen.
“Implementing these two implementations will be incredibly challenging,” said Katelyn Jetelina, a public health expert and author of the widely read newsletter, “Your Local Epidemiologist.”
“There will be a lot of proactive communication about the difference between the two and the implications of adopting one over the other,” she said.
A direct comparison of the two vaccines may give parents some answers, but it’s neither possible nor advisable, experts said in interviews. There are just too many differences in the way the vaccines are formulated and evaluated.
“It’s really impossible to say one is better than the other,” said Dr. William Towner, who led vaccine trials for both Moderna and Pfizer at Kaiser Permanente in Southern California.
The choice may depend more on whether parents are willing to go for three doses rather than two, and what vaccine their suppliers have on hand, he said.
Many providers are not used to Moderna, as until now they have only relied on the Pfizer-BioNTech vaccine. In total, about 350 million doses of that vaccine have been administered to Americans, compared with 223 million doses of the Moderna vaccine and about 19 million of the Johnson & Johnson vaccine.
For young children, states have so far ordered 2.5 million doses of the Pfizer vaccine and 1.3 million of the Moderna vaccine. Those numbers are lower than expected, given the 18 million children in this age group.
Even in older children, absorption has been slow. The Pfizer-BioNTech vaccine was approved in November for children ages 5 to 11, but less than 30 percent in that age group have received two injections.
The vaccines have generally been shown to be very safe, but many parents remain hesitant for various reasons. Some are wary because the vaccines are relatively new, or because they consider the risk of Covid-19 to their children negligible.
Some parents may be disinterested because their children were among the 75 percent thought to be already infected. But vaccination offers stronger and more consistent protection, even if a child is already infected, CDC scientists noted Saturday.
Still other parents have left the pandemic.
In Middletown, Ohio, some parents were more concerned about staying cool during the summer heat wave than about the risks of the coronavirus. Tori Johnson, 25, has not been vaccinated and said she had no plans to vaccinate her two daughters, 7-year-old Liliana and 9-month-old Rosalina.
Life was back to normal, she said.
Simone Williams, 32, said she was hesitant to vaccinate her 1-year-old twins, Caidon and Arissa, and 4-year-old Bryan. “I’d get it for them if they needed to, but I’m in no rush other than that,” said Ms Williams.
Some pediatricians prepared to explain to parents the benefits of the vaccine. Even routine vaccinations are a fraught topic in many parts of the country.
Pediatricians “have struggled with this for many, many years with the flu vaccine and the standard dosage for the measles, mumps, rubella, and varicella,” says Dr. Lindsey Douglas, a pediatrician and medical director of quality and safety at Mount Sinai. Kravis Children’s Hospital in Manhattan.
“There is certainly a lot more information available in the past two and a half years,” added Dr. Douglas. “But there’s also a lot more misinformation.”
In some ways, the odds were high against using the vaccines in the youngest children.
The Moderna and Pfizer-BioNTech vaccines both offered spectacular estimates of efficacy in adults, far beyond expectations, and raised hopes for a virus-free future.
But as the vaccines were gradually tested in younger children, the virus quickly changed, with each new form more elusive and challenging than the last.
The latest versions of the Omicron variant have evolved to partially evade not only the two-year-old vaccines, but even the immunity produced by an infection with the form of Omicron circulating just a few months ago.
The original estimates of efficacy in adults were on the order of 95 percent. That figure has now given way to 51 percent for two doses of Moderna’s vaccine in children ages 6 to 23 months, and just 37 percent for children ages 2 to 5.
As low as that may seem, two doses of Pfizer’s vaccine failed to even meet the Food and Drug Administration’s bar for an immune response, justifying the agency’s decision in February to delay the evaluation of the vaccine until it was released. company had tested three doses.
“As a mother, I find it unacceptable that it has taken so long to give our little ones the vaccine,” said Dr. jetelina. But “as an epidemiologist, I also know the value of doing clinical trials in depth and finding the right dosage.”
Based on the data, the FDA this week approved two doses of the Moderna vaccine and three doses of Pfizer-BioNTech as the “primary series” for young children.
If officials determine that even the youngest children need booster shots against future variants, children should be given a third dose of Moderna and a fourth Pfizer.
In press releases and in data reported to federal regulators, Pfizer estimates an efficacy of 80 percent for three doses of its vaccine. But that calculation was based on just three children in the vaccine group and seven who received a placebo, making it an unreliable measure, CDC advisers noted at a meeting Friday.
“We just have to assume we don’t have efficacy data,” said Dr. Sarah Long, an infectious disease expert at Drexel University College of Medicine. But dr. Long said she was “easy enough” with other data supporting the vaccine’s potency.
Parents of the youngest children may be more willing to opt for a Covid vaccine if it can be offered alongside other routine immunizations. dr. Towner said any vaccine would be better than none, but he predicted more parents might opt for Moderna.
“I’ll be honest, that can be a little difficult for some parents to do three doses instead of two,” he added. “If they have a choice, and if both are available, that could bring some parents to the Moderna.”
Some parents don’t need persuasion. In Alexandria, Virginia, Erin Schmidt, 37, said the news was “life-changing” because her family has been living in a “kind of alternate isolated reality.” After vaccinating her 2-year-old daughter Sophia, she plans to open a bottle of champagne, take Sophia to a museum and “amaze her mind about the world.”
Brendan Kennealy, 38, of Richfield, Minnesota, said after his daughters, 4-year-old Hazel and 1-year-old Ivy, were vaccinated, he and wife Jocelyn, 35, would drive them to the lakeside town of Duluth, where they plan to try out new restaurants and attend an outdoor concert by a local folk band called Trampled by Turtles.
The family has had to avoid spending time indoors with his mother, who has lupus and is vulnerable to severe Covid. His children missed the state fair, stopped swimming lessons and stopped gymnastics.
“I’ve been very, very happy a few times in the past, and then they took the rug off again,” said Mr. Kennealy on the FDA’s halting progress on childhood vaccines.
“Those shocks of hope were so unnecessarily depressing,” he added. “Until we get to the Walgreens or wherever we take them to get their pokes and their patches, I try to keep that at bay.”
Adam Bednar contributed reporting from Baltimore, Christina Capecchi from Richfield, Minnesota, Ellen B. Meacham from Oxford, Miss., and Kevin Williams from Middletown, Ohio.