On Oct 29, 2021, we reached another HUGE milestone in our fight against COVID-19; the Emergency Use Authorization (EUA) for the Pfizer vaccine was lowered to 5 years of age. This decision provided access of a COVID-19 vaccine to an additional 25 million people in the US and basically allows vaccination of all school aged children. Thinking back a year, it is hard to believe how far we have come. The EUA for adults and teens 16 years of age and above was granted on December 11, 2020, which provided vaccine access to over 241 million. However, as we all recall, initially the availability of vaccine was limited requiring prioritization of dosing to those at highest risk of the infection. One of the tremendous benefits of the mRNA (Pfizer and Moderna) and adenoviral vectored (Johnson & Johnson and Astra Zeneca) vaccines is the “scalability” with all the companies able to produce hundreds of millions of doses per year. Thus, by late spring of 2020 we had ample supplies of vaccines for all adults. Vaccination had an immediate impact on the pandemic with significant declines in hospitalizations and deaths among people who had been vaccinated, particularly those at the highest risk for severe infections. According to the Ohio Department of Health, as of the first week in November, 85% of adults 60 years of age and above are fully vaccinated against COVID. However, this drops to about 55% among people 20-40 years of age.

While COVID-19 vaccinations for adults were a monumental step against the pandemic and proved the effectiveness of these novel vaccine platforms, we knew that a lot more work was needed. Based on results from a Phase 3 clinical trial, on May 10, 2021, the FDA expanded the EUA to include adolescents aged 12–15 years of age. As of the end of September, about 46% (11 million) of all 12- to 17-year-olds in the United States are fully vaccinated and about 57% (14 million) have received at least one dose of vaccine. These numbers are a good start but far below where we need to be. Additionally, there are large variations in adolescent vaccination rates within regions and even within states with nine states having adolescent vaccination rates below 30%. Ohio is better than the bottom nine, but we are below the national average with only 44% of our 12–17-year old’s having received at least one dose of vaccine.

I am very encouraged by the response we have seen to get children 5-11 years of age vaccinated against COVID. In the 2 weeks since the vaccine has been available for this age group, over 2.5 million children have been vaccinated! I am hoping our younger patients can convince their older brothers and sisters about the importance of getting vaccinated. To date, we have not received any safety signals among children 5-11 who have been vaccinated. Obviously, safety will be continued to be monitored closely.

Many people have asked me about the vaccine for 5–11-year-olds so I thought it may be good to put all the answers in one place.

The vaccine given to 5–11-year-olds is the SAME VACCINE as used in people 12 years of age and above. The only difference is that we administer a 10 ug dose instead of the 30 ug dose administered to people 12 years of age and above.

The 10 ug dose is safe. The 10 ug dose has been shown to have a lower rate of side effects when compared to children who received a 30 ug dose.

The 10 ug dose is immunogenic. In a Phase 1 study, it was demonstrated that the 10 ug dose in 5–11-year-olds gave the same immune response as a 30 ug dose in 16–25-year-olds.

The 10 ug dose is protective. The Phase 2/3 study of the 10 ug dose in 5–11-year-olds showed the vaccine was 92% effective against COVID.

Lastly, the vaccine is needed (for EVERYONE!!!). While the absolute risk of any given child to get severe COVID or die from the infection is low, it is not zero! To date, over 600 children in the US have died from COVID and over 24,000 have been hospitalized due to the infection. To put this in perspective, during a BAD flu year, about 150 children in the US die from the flu. We ALL agree about the importance of flu vaccines, so how could we think differently about vaccines against COVID?

So, what can we pediatricians do in the fight against COVID?

First, provide a STRONG recommendation to your families about the need for children to be vaccinated. Numerous studies have demonstrated that medical professionals are the #1 trusted source of families seeking health information. I know at times it may not feel like that, but it is true. If people hear us give a lukewarm recommendation about the vaccine, they will interpret that to mean the vaccine is not needed.

Second, stock the COVID-19 vaccine in your clinic. We now have stability data to show the vaccine can be stored for at least weeks in a refrigerator. That GREATLY facilitates administration of the COVID-19 vaccine in your clinic. Having families come for COVID-19 vaccines also will allow kids to catch up on routine health maintenance and vaccines they may have missed due to the pandemic. And don’t forget that flu shot!!

Third, take care of your staff, your colleagues and yourself. This has been a TOUGH two years that has taken tremendous emotional tolls.

While COVID-19 is not over, each day we make strides and have more tools to fight the infection. If we successfully employ our weapons against COVID-19, the end of the major battle is in sight.

I wish everyone a safe and happy holiday season and a NORMAL 2022!!

Bob Frenck

PS, well as we all know, a day in COVID time is like a normal decade. Thus, not surprisingly, since I wrote this, we have a NEW variant; Omicron. This variant recently arose out of S Africa. We still are learning about the variant in terms of how much of a problem it will be. The World Health Organization on Nov 30, 2021 stated that it is not yet clear whether Omicron is more transmissible (e.g., more easily spread from person to person) compared to other variants, including Delta. Also, it is not yet clear whether infection with Omicron causes more severe disease compared to infections with other variants, including Delta.  At this point, it appears that our current vaccines remain highly effective against severe disease and death due to COVID-19. Recent data from the CDC still showed that the rate of COVID-related hospitalization and death was SIXTEEN TIMES HIGHER in unvaccinated compared to vaccinated people. So, to me, the bottom line about Omicron is that it is yet ANOTHER reminder of the importance of being vaccinated against COVID-19.