The decision was hailed by President Biden “as one more giant step in our fight against the pandemic,” and he called on parents to get their children inoculated. “The bottom line is this: A vaccine for kids between the ages of 12 and 15 … [is] safe, effective, easy, fast and free,” he said. “So my hope is that parents will take advantage of the vaccine and get their kids vaccinated.”
The CDC action followed a vote Wednesday afternoon by its Advisory Committee on Immunization Practices, an independent group of medical and public health experts. The vote was 14 in favor, with one recusal. CDC Director Rochelle Walensky signed off by day’s end, giving the green light for the two-dose vaccine to be used immediately for those ages 12 to 15.
“Getting adolescents vaccinated means their faster return to social activities and can provide parents and caregivers peace of mind knowing their family is protected,” Walensky said.
The Food and Drug Administration cleared the vaccine for emergency use in that age group Monday, saying it was safe and effective at the same dose that is being given to those 16 and older.
The CDC action means the inoculation can be given immediately at any site authorized to administer the shots. Biden said that 15,000 pharmacies are ready to start vaccinating adolescents as soon as Thursday, with most of those no farther from families’ homes than their neighborhood schools. Children will be able to receive their two Pfizer shots in different places if they change locations this summer, he said.
The vaccine’s cold-storage requirements and large lot size — 1,170 doses is the minimum order — make it more challenging to be distributed immediately to doctors’ offices. Biden said officials are mobilizing to find ways to equip doctors, including pediatricians, so they can give the shots to youths coming for checkups or other services. He described these efforts as enabling parents and children to consult the doctors they trust.
Vaccinating children is key to boosting the level of immunity in the population and reducing hospitalizations and deaths, experts say. As more adults are vaccinated, adolescents 12 to 17 years old are making up a greater proportion of infections, accounting for 9 percent of cases reported in April, according to CDC data presented at the advisory panel’s meeting.
“Older children can have severe disease from ... infection,” said Kathy Poehling, a pediatrics professor at Wake Forest University and member of the advisory panel who described a teenager with covid-19 who suffered a heart attack as a result of the disease. While deaths are uncommon in children, she and others noted that there were 127 adolescent covid-19 deaths between Jan. 1 and April 30 of this year, which would have put the disease among the top 10 causes of deaths among children in 2019.
“Many parents and adolescents want to be protected by being vaccinated,” Poehling said. “And I’m so glad we have the vote to enable them to do that today.”
Arkansas Health Secretary José Romero, the panel chair, said the group’s vote brings the United States a “step closer to gaining immunity and bringing the pandemic closer to the end.”
“We still have the younger age group to deal with, and we are dealing with that,” he added. “And we still need to vaccinate the rest of the world. But we’ve made significant steps.”
Some states, including Arkansas, Delaware and Georgia, did not wait for the CDC decision, opening up eligibility Tuesday, a day after the FDA authorized the vaccine for younger teens. Many other states and providers were waiting for the recommendation; some insurance plans will not reimburse providers for the administration fee without a CDC sign-off.
Vaccination of a significant number of adolescents could also allow U.S. schools and summer camps to relax masking and social distancing measures recommended by the CDC, helping speed a return to normalcy. There are almost 17 million adolescents in the 12-to-15 age group in the United States, accounting for about 5.3 percent of the U.S. population, according to the Kaiser Family Foundation.
The only debate by the advisory panel revolved around whether the Pfizer-BioNTech vaccine should be given alongside other childhood or adolescent vaccines in the absence of data on how it might interact with them. That is an issue because routine immunizations have fallen sharply during the pandemic, with a decline of nearly 12 million doses as of May 2 compared with 2019, according to a CDC presentation.
The gap is largest in vaccines primarily given to adolescents, including the one targeting the human papillomavirus, known as HPV, and another to prevent tetanus, diphtheria and pertussis.
A CDC slide presentation at the meeting said that “substantial data” has been collected on the safety of coronavirus vaccines and also noted that “extensive experience” with other vaccines demonstrates their side effects and ability to generate an immune response are “generally similar when vaccines are administered simultaneously as when they are administered alone.”
For that reason, the presentation said that coronavirus vaccines and other vaccines “may now be administered without regard to timing,” including giving them on the same day, as well as within 14 days.
But several panel members said they wanted more data, asking manufacturers to study how the Pfizer-BioNTech vaccine might interact with other vaccines. Sarah Long, a pediatrics professor at Drexel University, said she was “not at all comfortable with deciding right now how these vaccines can be used concurrently with anything, without any data.”
After the discussion, panel members agreed the vaccine could be given at the same time as other vaccines but asked that the CDC spell out more detailed instructions for providers that would take into account whether a patient is behind on recommended vaccines, or at risk of becoming so, and whether certain vaccines are more likely to produce side effects.
Yvonne Maldonado, a pediatrics professor at Stanford University and the panel’s liaison from the American Academy of Pediatrics, said the pediatrics group would be issuing a statement to support the administration of multiple vaccines at the same time, “given the importance of routine vaccinations and the need for rapid uptake of covid-19 vaccines.”
The FDA based its emergency authorization Monday on a trial of nearly 2,300 adolescents between 12 and 15 years old, half of whom received the same two-shot regimen shown effective and safe in adults. There were no cases of covid-19 among fully vaccinated adolescents, compared with 16 among children given a placebo, suggesting the regimen offered younger recipients protection similar to the protection it gives adults.
The younger teens had the same side effects as adults, mostly soreness at the injection site and flu-like fever, chills or aches, especially after the second dose.
Walensky has encouraged parents to talk to their children’s health-care provider to learn more about the vaccine.
“Some parents want to be first, but I’m also encouraging children to ask for the vaccine,” she told a Senate panel Tuesday. “I have a 16-year-old myself, and I can tell you he wanted to get the vaccine. He wants his life back. These kids want to go back to school.”
In Alaska, some school districts already have scheduled vaccination clinics for Thursday and Friday, because parents are eager for their children to get the shots before the school year ends, state officials said.
“States have been planning and preparing for and are now rolling out their plans for vaccinating this group of adolescents,” said Nirav Shah, director of the Maine Center for Disease Control and Prevention and president of the Association of State and Territorial Health Officials.
There is no federal legal requirement for parents or guardians to give consent for coronavirus vaccinations or any other vaccination. But the vaccines must be given according to state vaccination laws.
Most coronavirus vaccines worldwide have been authorized only for adults. Pfizer’s vaccine is being used in multiple countries, including the United States, for teens as young as 16. Canada recently became the first to expand use to those 12 and older. Parents, school administrators and public health officials have eagerly waited for shots to be made available to more children in the United States, particularly with the growing gap between what vaccinated and unvaccinated people may do safely.
Although adolescents are less likely than adults to be hospitalized or have severe illness because of coronavirus infection, there is no way to predict the few who will become critically ill or develop a rare, dangerous inflammatory syndrome. Out of more than 581,000 covid-19 deaths in the United States, only about 300 have been among those younger than 18. But that exceeds the number of children who die in a bad flu season.
Parents’ eagerness to get their children vaccinated varies. A CDC presentation, citing four surveys, said about half of parents plan to get their children vaccinated.
A Kaiser Family Foundation survey found 3 in 10 parents of children ages 12 to 15 say they will get their children inoculated as soon as a vaccine is available; one-quarter say they will wait to see how the vaccine is working; 18 percent plan to get their children vaccinated if their schools require it; and nearly a quarter say they will definitely not have their children vaccinated.
Biden said his administration would launch a public education campaign about the vaccine and partner with a variety of organizations to encourage children to get vaccinated.
Sara Oliver, a CDC medical officer and the lead of the advisory panel’s covid-19 working group, said officials plan to promote adolescent vaccination.
They hope to expand vaccinations to 12-year-olds at existing sites as part of an “early summer sprint” in May and June, followed by increased access at children’s hospitals and large health-care providers serving adolescents in June and July. A back-to-school campaign will kick off later in the summer and include school-based vaccination programs and pharmacies before the start of the school year.