For parents who are contemplating whether their child should receive a COVID-19 vaccine, Dr. Joseph Fraiman, an emergency medicine physician, says they should ask the following two questions to help them decide.
“The first thing that you want to do for harm/benefit analysis [is to ask], is there a mortality benefit for these vaccines for your child,” Fraiman said at a roundtable discussion hosted by Republican Gov. Ron DeSantis on March 7.
Experts say that children are at much lower risk of severe disease and death from COVID-19 compared to other age groups.
“The majority of studies haven’t been able to find a single healthy child who’s died from COVID. The studies that say they have found them, they can’t confirm that they were healthy children,” Fraiman said.
Researchers of three studies, two have been peer-reviewed and published, found that there were 25 deaths from COVID-19 in children younger than 18 in England between March 2020 and February 2021—a mortality rate of about 2 for every million children in that age group. Of the 25 deaths attributed to COVID-19, 15 had a life-limiting condition.
Fraiman, who is also a clinical scientist focused on analyzing the methodology and interpreting the risk/benefit analysis of clinical studies, was one of the health experts invited to speak at the event.
For children with underlying health conditions that may make them at risk for COVID-19, Fraiman says, “that’s a discussion with your pediatrician.”
“But if you have a healthy child, the chances of that child dying are incredibly low, essentially close to zero, if not actually zero,” Fraiman said.
Of the 73 million children under 18 in the United States, 894 children have died of or with COVID-19 during 2020–2022 as of March 9, according to the Centers for Disease Control and Prevention’s (CDC) National Center for Health Statistics. Whereas, there were 72,781 deaths from all causes within the same timeframe for this age group.
The second question that parents should ask is what are the adverse effects from infection versus the vaccine for healthy children, according to Fraiman.
As COVID-19 overall is very mild for most children, it’s important to ensure that the benefits of the vaccines outweigh the harms.
While many children experience mild to no symptoms with COVID-19, some do experience symptoms of long COVID or multisystem inflammatory syndrome in children (MIS-C) several weeks after infection. But that is very rare.
Doctors say that MIS-C—which can cause different body parts to be inflamed—is treatable with many children making a full recovery, including those with long COVID.
MIS-C has also been observed in children and young adults ages 12 to 20 after being injected with the Pfizer COVID-19 vaccine, according to a study funded by the CDC and published in the Lancet. Twenty-one cases of MIS-C were identified from December 2020 to August 2021 after receiving at least one dose of the Pfizer injection.
“Our findings suggest that MIS-C after COVID-19 vaccination is rare,” the authors concluded. “Continued reporting of potential cases and surveillance for MIS-C illnesses after COVID-19 vaccination is warranted.”
Myocarditis and pericarditis, or inflammation of the heart or the lining around it, have also been found in both infection with COVID-19 and after injection with a messenger RNA (mRNA) vaccine.
But higher-than-expected reports of myocarditis, especially in young males ages 12 to 24, following the second dose of the mRNA injection, prompted the Food and Drug Administration in June to add a warning of heart inflammation to the fact sheet for both COVID-19 vaccines from Pfizer and Moderna. Federal health authorities continue to recommend the vaccine saying that the benefits outweigh the risks.
Martin Kulldorf, a former professor of medicine at Harvard Medical School, said that it is “unethical to mandate” the vaccines for children with the risks of myocarditis and other adverse reactions that may surface in the future.
“We know that there’s a risk of myocarditis, especially for young boys and young men, but also for girls. There might be other adverse reactions that we don’t know about yet … and we don’t know what the risk-benefit ratio is. I think, under those circumstances, it’s unethical to mandate vaccinations for children,” Kulldorf said.
He added, “But for children who haven’t had COVID, the question was, we don’t know to what extent it helps against death and serious disease,” Kulldorf said. “Right now in the U.S., the Omicron wave is going down. Right now I think the benefits of vaccinating children are very small.”
Dr. Paul Offit, director of the Vaccine Education Center at Children’s Hospital of Philadelphia, said that children should receive the COVID-19 vaccine even though they are “less likely to be severely infected.”
“Although it is true that children are less like to be infected and it is true that children are less likely to be severely infected, they can still be infected and they can still be severely infected.” Offit told CNN, adding, “And if you have a vaccine which is safe, which this is, and is effective, which this is, then you give it.”
But data from New York state showed that the Pfizer COVID-19 vaccine’s effectiveness against infection declined rapidly in children 5 to 11 years old. Protection against hospitalization also declined but was not as steep as in preventing infection.
The authors of the pre-print study (pdf), waiting to be peer-reviewed, said that vaccine effectiveness against infection in the fully vaccinated declined from 66 percent to 51 percent in children aged 12 to 17, and from 68 percent to 12 percent for those in the 5 to 11 age group from December 2021 to January 2022.
Dr. Robert Malone, a pioneer of mRNA vaccine technology, says there is no reason to vaccinate children.
“There is no justification for mandating vaccines for children, full stop,” Malone said. “We’re of the strong opinion that if there is risk, there must be choice. This is fundamental medical bioethics 101.”
Malone and Kulldorf were also part of the panelists at the roundtable.