EDITORIAL

COVID-19 vaccines for children

E
arlier this month, the US Centers for Disease Con- care. Moreover, both in Israel and the United States, the Jeffrey S. Gerber
trol and Prevention (CDC) recommended Pfizer’s incidence of myocarditis in children 12 to 15 years of age is an associate
COVID-19 messenger RNA (mRNA) vaccine for receiving mRNA vaccines is less than that in the 16- to professor of
children between 5 and 11 years of age—that’s 28 25-year-old age group. And because the dose of Pfizer’s Pediatrics and
million children. Yet surveys show that 42 to 66% of mRNA is one-third that given to older adolescents, myo- Epidemiology,
parents of these children are reluctant or opposed carditis in the younger age group will likely be even rarer. University of
to seeking this protection. Without vaccination, it is Myocarditis is only one piece of the risk-benefit analy- Pennsylvania
likely that almost everyone—including young children— sis. Children need to go to school, play with friends, and Perelman School
will be infected with severe acute respiratory syndrome participate in extracurricular activities for their social and of Medicine,
coronavirus 2 (SARS-CoV-2) at some point in their lives. emotional development. This is their life. Since August
Philadelphia, PA, USA
So, the question for parents and caregivers is: Which is 2021, more than 2000 schools in the US have been forced
and deputy director
worse, vaccination or natural infection? to close because of COVID-19 outbreaks, affecting more
of the Center for
Make no mistake—COVID-19 is a childhood illness. than 1 million students. The disruption of school activities
When SARS-CoV-2 entered the United States early in has harmed children more than any detectable vaccine Pediatric Clinical
2020, children accounted for fewer than 3% of cases; side effect, including worsening of mental health, wid- Effectiveness at
today, they account for more ening education gaps, and de- Children’s Hospital
than 25%. More than 6 million creased physical activity. These of Philadelphia,
US children have been infected harms have disproportionately Philadelphia, PA, USA.
with SARS-CoV-2, including 2
million between the ages of 5
“…a choice not affected people of color, Indig-
enous persons, and individuals
[email protected]

and 11. At the end of October to get a vaccine is not of lower socioeconomic status, Paul A. Offit

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2021, about 100,000 children further exacerbating inequities. is the director of the
per week were infected. Of the
tens of thousands of children
a risk-free choice; Avoidance of routine health care
and routine vaccination has also
Vaccine Education
Center in the
who have been hospitalized,
about one-third had no preex-
rather, it’s a choice emerged, with potentially devas-
tating future consequences. Fur-
Division of Infectious
Diseases at
isting medical conditions, and
many have required the inten- to take a different and thermore, children live closely
with and rely on adults to whom
Children’s Hospital
of Philadelphia,
sive care unit. Almost 700 chil-
dren have died from COVID-19, more serious risk.” they can pass SARS-CoV-2 infec-
tion—adults who can be over-
Philadelphia, PA,
USA and a professor
placing SARS-CoV-2 infection whelmed by this infection. And in the Department of
among the top 10 causes of death children grow up. Countries are
Pediatrics, University
in US children. No children have died from vaccination. going to need a highly protected population for as long
of Pennsylvania
Many parents are concerned that Pfizer’s mRNA vac- as COVID-19 exists in the world, which will likely be for
Perelman School
cine was not adequately tested in young children. In a years if not decades. Vaccinating all children against
study of approximately 2400 children between 5 and SARS-CoV-2 could be among the most impactful public of Medicine,
11 years of age, performed when the Delta variant was health efforts the US has seen in decades. Philadelphia, PA,
the dominant strain, vaccine efficacy was 90.7% against Although it is true that most children experience USA. [email protected]
symptomatic disease. However, Pfizer’s phase 3 study in asymptomatic or mild disease, some will get quite sick,
adults involved about 40,000 participants. How could and a small number will die. It’s why children are vac-
the CDC be certain that the vaccine was safe in children cinated against influenza, meningitis, chickenpox, and
given the small size of the study, specifically regarding hepatitis—none of which, even before vaccines were avail-
the problem of myocarditis? In postauthorization studies, able, killed as many as SARS-CoV-2 per year.
myocarditis occurred in approximately 5 per 1,000,000 Some parents are understandably hesitant to vaccinate
individuals receiving mRNA COVID-19 vaccines, possi- their young children. However, a choice not to get a vac-
bly as high as 1 per 10,000 in young men. But context is cine is not a risk-free choice; rather, it’s a choice to take a
important. Vaccine-associated myocarditis has been rela- different and more serious risk. The biomedical commu-
tively mild and self-limited—an outcome fundamentally nity must strive to make this clear to the public. It could
different from the cardiac effects associated with acute be one of the most important health decisions a parent
COVID-19 or multisystem inflammatory syndrome, which will make.
typically involve cardiac dysfunction and require critical –Jeffrey S. Gerber* and Paul A. Offit

*J.S.G. is site principal investigator for the Moderna–National Institutes

of Health KidCOVE trial at Children’s Hospital of Philadelphia. 10.1126/science.abn2566

SCIENCE science.org 19 NOVEMBER 2021 • VOL 374 ISSUE 6570 913

 COVID-19 vaccines for children
Jeffrey S. GerberPaul A. Offit

Science, 374 (6570), • DOI: 10.1126/science.abn2566

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