Should You Vaccinate Your 5-Year-Old? Be reassured that whatever you do, the risk is extremely low. By Nicole Saphier and Marty Makary
If you’re agonizing about whether to have your young child vaccinated against Covid-19, be reassured: The risk is extremely low either way. The Centers for Disease Control and Prevention estimates that 42% of U.S. children 5 to 11 had Covid by June 2021, before the Delta wave—a prevalence that is likely greater than 50% today. Of 28 million children in that age range, 94 have died of Covid since the pandemic began (including deaths before newer treatments), and 562 have been hospitalized with Covid infections.
Serious complications are so uncommon in this age range that of 2,186 children in the Pfizer vaccine study, no child in either the vaccine or placebo group developed severe illness from Covid. Sixteen of the 663 unvaccinated children developed Covid infections, compared with only three of the 1,305 vaccinated ones—an effectiveness rate of 90.7% against infection. Thus it’s safe to assume that vaccinating a healthy child would take his extremely low risk of serious disease and drive it down even lower.
There’s an important exception, though: If a child already had Covid, there’s no scientific basis for vaccination. Deep within the 80-page Pfizer report is this crucial line: “No cases of COVID-19 were observed in either the vaccine group or the placebo group in participants with evidence of prior SARS-CoV-2 infection.” That’s consistent with the largest population-based study on the topic, which found that natural immunity was 27 times as effective as vaccinated immunity in preventing symptomatic Covid. Natural immunity is likely even more robust in children, given their stronger immune systems. An indiscriminate Covid vaccine mandate may result in unintended harm among children with natural immunity.
As with adults, pediatric Covid deaths and hospitalizations tend to come among those with comorbidities. If your child has a medical risk factor for Covid illness (including obesity), or lives with someone who does, the vaccine’s benefit outweighs the risk.
Side effects in the study were significant but not life-threatening. The overall adverse-event rate following vaccination in the Pfizer study was 10.9%. Notably, fever (as high as 104 degrees) occurred in 6.5% of kids following the second vaccine dose. One case of leg numbness was reported in the vaccine group.
We’d like to know if adverse events were clustered in children who had circulating antibodies from prior Covid infection, but Pfizer didn’t provide that data. There were no cases of myocarditis (heart inflammation), but the sample size was too small to rule out a complication that was found in 1 in 7,000 adolescent boys.
Vaccine complications in children can be mitigated by spacing out the doses. Complications are clustered after the second dose, and research on older patients shows that a longer interval between doses results in stronger immunity. Another recent study showed that delaying the second vaccine dose in younger adults not only resulted in stronger immunity but it also decreased the mild side effects following the second dose. Moreover, one Israeli study found that a single Pfizer dose alone was 100% effective against infection in children 12 to 15. Pediatricians may advise hesitant parents that one dose is better than none.
Dr. Saphier is an assistant professor at Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College. Dr. Makary is a professor at the Johns Hopkins School of Medicine and editor-in-chief of MedPage Today.
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