A doctor and parent weigh Covid vaccine options for children under 5

AAfter months of delays and setbacks, there finally seems to be hope that a Covid-19 vaccine will be approved for children under the age of 5. Next month, the Food and Drug Administration plans to convene its vaccine advisory panel, known as VRBPAC, to review both Moderna and Pfizer-BioNTech shots for the youngest.

The vaccines are not identical: Moderna is two doses of 25 micrograms each, a quarter of Moderna’s adult dose. Its effectiveness ranged from 37% to 51% in a study against symptomatic Covid during the Omicron wave. The Pfizer and BioNTech vaccine consists of three doses of 3 micrograms each, a tenth of the adult dose. A preliminary efficacy number based on just 10 cases seen in the study was 80%, although that could change as more cases are added.

So how should parents consider these two possible options when vaccinating young children against Covid? The presenters of The Readout LOUD spoke to Jeremy Faust, an emergency room physician at Brigham and Women’s Hospital, an instructor at Harvard Medical School and a father of one child under the age of 5, who is going through all of this himself.


This interview has been edited for length and clarity.

Walk us through how to review the available information on each of these vaccines and which one, if any, you might choose for your child.


I think the most important thing is that one of them is available as soon as possible. It was quite a drudgery and as a doctor I don’t have to say that. I’m only saying that as a parent.

I’m having a really hard time deciding between Pfizer and Moderna, because I actually think Moderna has a real advantage here. While the readings we have so far suggest that Pfizer appears to be more effective for symptomatic Covid, I’m not really convinced of that. I think this could be a short term mirage and in reality they are probably both quite similar.

Given the differences in vaccines, how do you balance the potential differences in efficacy and administration? How do you think doctors will view this compared to parents?

Well, one thing is timing. That’s what’s on my mind. We’ve been through so much for so long that the delayed gratification of a product like Pfizer could be a little better, but we’re not even sure. With Moderna, we could get the first dose and 28 days later a second dose. Then, basically for the next week, you can assume that the child will be protected from serious illness. At Pfizer, we know that the first two doses, which would come in a similar time frame, wouldn’t offer that. And then you would have to wait two, three months for the third dose and then another week after that.

I just want my child not to end up in the hospital like literally 100,000 children, 125,000 children in this country have been hospitalized either because of or with Covid. I have no interest in adding anything to that. So for me the immediate gratification of getting it done in a month versus two or three months outweighs it. Other people might like this early number [co-host Meg Tirrell] mentioned Pfizer’s 80% figure and say, well, I’ll wait two or three months. I’m hesitant that maybe a third dose of Moderna is in the pipeline and would do so. That’s why I lean more towards Moderna. But we’ll see what happens when the data comes out.

Based on the safety and tolerability of these vaccines, they can have different profiles. How do you balance what you know about them so far against the fact that many people will point out that young children are at much lower risk of ill effects from Covid than adults?

One thing is the dosage differences for this particular age group. It’s really a lot less [than for adults] – it’s a quarter for Moderna, a tenth for Pfizer. And if you look at the results that really made headlines, post-vaccination myocarditis — which is real but rare — which was really occurring mostly in young men, 12-year-olds, 15, 16-year-old men, 25, 30, we’re talking here by teenaged teenagers and young adult males who basically got the full adult dose just like everyone else. … And we also know from Israeli and other studies that separating the vaccine in time with respect to myocarditis is another way to make it even rarer. The only place I’ve really seen a problem is in a group that’s been on the full adult dose, which might be on the lower side of the male age range. So for the kids, the little ones, I haven’t seen anything worrying yet.

As for whether they really need it, I’ve been looking at the data very closely for two years now. And I keep seeing this virus being downplayed for children, resulting in you having 125,000 children hospitalized. And look, maybe half of them are random. That’s still a very high amount. That’s one in a thousand children at the population level. Then you have this horrible multi-inflammatory syndrome in children that has hospitalized thousands and killed some. This virus is one of the worst things I have ever seen a child do. And I look forward to absolutely protecting my child from these numbers.

There was a lot of debate and outrage from some parents about the timing of all of this. There have been many delays in clinical trials and FDA reviews. Recently, there was a suggestion that the FDA would hold back its review of Moderna’s vaccine in order to simultaneously evaluate Pfizer’s. This frustrated many parents who just wanted a good option as soon as possible. What do you think of all this?

It looks bad, doesn’t it? They claim they didn’t, that the FDA didn’t hold anything back to wait for Pfizer. But in reality, the timing was between Moderna’s first read of her data in March. Here we are almost in June before a VRBPAC meeting was due to take place. I’m led to believe that some of these were management errors or management inefficiencies in Moderna and that they are new to it. I’ve heard some of it, but that’s not the whole story. It seems a little too perfect, doesn’t it? That there was a feeling that they would wait, and then it was longer than usual, the pause between reading the press release and the FDA’s VRBPAC meetings. And then, lo and behold, at the end of May, Pfizer shows up at the party. It will be difficult for parents like me to look at the entire timeline and think that it was just completely coincidental that they both lined up for the same meeting.

How did you and your family cope with all of this? You know, only thinking about the safety of children instead of trying to give them a normal life. How do you do that when you’re the last group not to have access to a vaccine?

We were careful, we were lucky, but we weren’t at the extreme. But we really chose our seats. Our 4-year-old has been going to preschool since autumn 2020. And they did weekly tests first, and then weekly tests, followed by middle rapids. They took this very seriously. They made masks for kids over 2 years old all the time. Then they finally dropped the masks outdoors. They still make masks indoors. And there were cases at school, in her classroom. We were lucky. We were delighted that she would accompany us on trips across the country to see her grandparents. And, you know, she masks up on the plane for five hours, and she’s good at it. But we didn’t take them to anything inside, like eating inside. Last summer, when she was 3 years old, she once said, “I want to go to a restaurant one day.” And we were like, “Oh my goodness, oh my goodness, OK.”

It was so sad. And so we’re just like, OK, well, wait a minute. There is an outdoor restaurant nearby that serves amazing tacos. We literally took her outdoors to dinner the next weekend and it was fine. And so we just pick our spots, and we ourselves don’t eat much inside just to protect them. We only took her out of school for a week, which was the pinnacle of Omicron when I did the math and found that statistically it was almost impossible to put her in school for seven days. As many parents know, it’s just a matter of choosing what matters. But once she’s vaccinated, it’ll probably be the children’s museum, and it’ll be music lessons with a teacher who didn’t take a rapid test. However, apart from that, we have done many quick tests for people coming into the house.

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