CDC and FDA clear the way for COVID vaccines for kids under 5
Some 20 million babies, toddlers, and preschoolers are now eligible to be vaccinated for COVID-19, after the Centers for Disease Control and Prevention’s Director Dr. Rochelle Walensky signed off on unanimous votes from her agency’s outside vaccine advisers to recommend shots from Moderna as well as Pfizer and BioNTech for children as young as six months old.
“Together, with science leading the charge, we have taken another important step forward in our nation’s fight against COVID-19,” Walensky said in a statement.
According to CDC survey results , around a third of parents plan to get their child vaccinated. Some of the long-awaited shots could be available as soon as this holiday weekend. Federal officials anticipate that the majority of vaccinations will begin after doctors’ offices reopen Tuesday.
” We know that millions of parents and caregivers want to get their children vaccinated. Today’s decision makes it possible. Walensky said that parents and caregivers should ask questions and talk to their doctor, nurse or pharmacist to learn more about vaccinations and how important it is to protect their children.
The Advisory Committee on Immunization Practices of the CDC voted after a two-day-long meeting to review data on the benefits, risks and benefits of shots for young children. A panel of outside advisors to the Food and Drug Administration had also voted on Wednesday for back authorization.
“Those trusted with the care of children can have confidence in the safety and effectiveness of these COVID-19 vaccines and can be assured that the agency was thorough in its evaluation of the data,” FDA Commissioner Dr. Robert Califf said in a statement.
The FDA also moved on Friday to add Moderna’s vaccine as an alternative to Pfizer’s shots in children 6 through 17 years old, though the CDC said their advisers will not vote on updated recommendations for those shots until next week.
Distributing the initial waves of shots
Shipments have already begun of the vaccines from Moderna as well as Pfizer and their partner BioNTech, after the Food and Drug Administration issued authorization on Friday. As with older age groups, vaccines must be distributed by the government.
Federal officials say most jurisdictions– except for Florida — had pre-ordered doses out of the 10 million total shots that were made available; 2.5 million orders were received for Pfizer’s shots and 1.3 million for Moderna’s.
Many of those will head to places picked out by authorities, like county health departments, which are able to stockpile and redistribute smaller helpings of the 100-dose shipments. States, including Florida, have now also begun allowing all enrolled vaccinators to directly request shots through them.
Some drug stores will also offer the shots, though authorities have been planning a rollout that will lean heavily on pediatricians and family doctors over the coming weeks. Pandemic liability protections extended to vaccinators like pharmacists only cover children as young as three years old.
The Biden administration’s Vaccines.gov website will also soon include a feature to search for sites specifically offering shots for younger children as more vaccinators begin offering shots. Around half of doctors who vaccinate children are planning to offer shots even to kids who are not their regular patients, a CDC survey found.
Providers in the initial wave have ordered only one of the brands in some jurisdictions, though the Biden administration hopes that will even out as supply climbs around the country over future rounds of shipments.
Smaller doses for kids – and the differences between Moderna and Pfizer
Unlike the largely similar regimens of the first round of COVID-19 shots that were available in adults, the makers of the two mRNA vaccines have taken different approaches to immunizing young kids.
In children ages 6 months to 5 years old, Moderna’s vaccine was trialed as two shots spaced one month apart. Their doses will be 25 micrograms, a fraction of the 100-microgram primary series rolled out last year for adults.
Pfizer and BioNTech’s vaccine will come in a total of three shots administered over the course of 11 weeks, for children ages 6 months through 4 years old. Those doses are sized at 3 micrograms, just one-tenth of the 30-microgram shots for those 12 and older.
At a briefing with reporters on Friday, the FDA’s top vaccines official Dr. Peter Marks acknowledged the “nuanced benefits and risks compared to each other” but urged parents to seek out the first shots available to them.
“It is possible that the Moderna vaccine may bring an immune response slightly faster. The three-dose Pfizer regimen may result in a stronger immune response after the third dose. Marks stated that there are subtle differences in the safety profile.
Based upon the study of antibodies against the virus in blood from trial participants, FDA concluded that data in young children suggests that their immune response will at least be as strong as that seen in adults after receiving their first two shots.
Some of the children under 5 years old did not clear this threshold after receiving only two of their doses in Pfizer’s trials, the company disclosed to investors last year, so a third dose was required.
” If you want to send your child back to daycare or lower school in September you must take the Moderna vaccine. It is not possible to do it according to Pfizer’s schedule. And we know that two doses does not protect, from Pfizer,” Moderna’s CEO Stephane Bancel said last week at the Jefferies Healthcare Conference.
The FDA’s review noted that Pfizer’s smaller dose likely resulted in the lower side effects seen in the group compared to older ages.
“We already know that, in older individuals, 30% of children are getting the vaccine. There are many reasons, but one reason is reactogenicity,” William Gruber of Pfizer’s vaccine clinical research and design, explained to the FDA’s advisors. He was referring to the short-term side effects such as aches, fever, and pain at the injection site.
For Moderna, rates of fever were higher in younger kids compared to adolescents and adults, though still around levels seen in this age group with other routine vaccines, the FDA’s review noted.
Pfizer’s estimate for vaccine efficacy of three doses in fending off symptomatic infection is also much higher than Moderna’s estimate for two doses during the Omicron wave, as well as better than those seen in some older age groups who received Pfizer’s doses.
But both the FDA and CDC’s reviews raised questions over Pfizer’s estimate, suggesting it was too early to say for sure exactly how effective the three doses will be and cautioning against direct comparisons. Some trial participants also received their third Pfizer shots far later than the recommended eight weeks, the FDA noted.
In its release on Friday announcing the authorizations, the FDA said Pfizer’s analysis “was determined not to be reliable due to the low number of COVID-19 cases that occurred in study participants. I believe the vaccine works. On Wednesday, Dr. Amanda Cohn from CDC told FDA’s committee that she does not know what the final number will be.
When will younger kids get a booster
Marks acknowledged both vaccines may need to be updated over the coming months, but urged parents to begin offering their kids a “foundational level of immunity” with current versions of the shots now.
The FDA has another meeting of its advisers scheduled to weigh the topic for all ages, as both vaccinemakers have raced to ramp up production of new formulations of their shots designed to target the Omicron variant. Marks stated that if there is a major change in strains, we will adjust and ensure that there is an option for all children.
A Moderna executive said Friday to the CDC’s advisors that the company plans to start studying boosters adapted for Omicron variants in children under six months starting next week. They will be given at least three years after their second dose.
“We hope to be able by early fall to bring forward the booster immunegenicity and safety data,” Moderna’s Dr. Rituparna das told the CDC’s Committee.
Children six months and older are already authorized by the FDA to get a third dose of Moderna’s vaccine, if they are significantly immunocompromised.
Younger children are generally at lower risk of severe COVID-19 compared to their older peers and adults, and many asymptomatic cases have likely gone unreported. No severe cases of the disease were recorded in Moderna’s trial, even among children who had gotten a placebo.
However, officials and experts warn that the virus has still inflicted an unprecedented toll on children. There is a lot information out there that says, “I had the Omicron virus, or my child had it, so vaccination is not necessary.” Marks stated Friday.
During the Omicron wave, hospitalizations and deaths in young kids surged despite data suggesting many children already had some antibodies from a prior infection.
“There are emerging data to suggest that the Omicron variant does not produce the kind of excellent immune response against a wide range of COVID-19 variants that the vaccinations do,” he added.
CBS News reporter covering pandemics and public health.