When will kids be eligible for COVID-19 vaccines, and how do we keep them safe in the meantime?

Although children are much less likely to become seriously sick from COVID-19 than adults, they can still become infected without symptoms, and potentially transmit the disease to higher-risk people.

• By Hannah Chin, Nina Feldman, Zöe Read/WHYY

(Philadelphia) — Sarah Frack just wants to know: Why isn’t anyone talking about the kids?

A resident of Collegeville, in Montgomery County, Frack will be fully vaccinated by the end of March. But her 5-year-old son won’t be. Since there isn’t a COVID-19 vaccine approved for him, she’s not sure what to do.

“I’m very confused about what we are able to do safely and what we are not at this point,” she told WHYY News. “I’m safe. My husband’s safe. A lot of the adults in our family at this point are vaccinated. But it’s just — he’s a very active little 5-year-old boy. How can I get him out in the world safely?”

As more vaccines are approved and eligibility opens up, there’s still one critical group left out of the equation: kids. The Moderna and Johnson & Johnson shots are only approved for those 18 and up, and the Pfizer vaccine is approved for those 16 and up. That means kids under the age of 16 can’t get any vaccine,anywhere — at least, not yet.

Although children are much less likely to become seriously sick from COVID-19 than adults, they can still become infected without symptoms, and potentially transmit the disease to higher-risk people. Reporters from WHYY’s Health Desk Help Desk looked into the vaccine timeline for kids, and talked to experts about staying safe.

Why can’t kids get vaccinated along with everyone else?

Children weren’t included in the initial vaccine trials, so we can’t be sure it’s safe for them to be vaccinated yet.

From an ethical perspective, it’s normal to exclude young people from drug or vaccine trials, in case of serious side effects. But now that scientists know the Moderna, Pfizer, and Johnson & Johnson vaccines all have strong safety profiles, they are starting trials on kids.

How will those trials work, and how long will they take?

Trials for young people will have a slightly different design than the trials for adults. During the adult trials, tens of thousands of people were enrolled around the world. Some got a vaccine, and some were given a placebo. Then, scientists waited until enough people got COVID-19 to produce a statistically significant sample, and looked to see how many of those people had been given the vaccine to determine how effective it was.

A couple of things are different for the kids’ trials. First, scientists already know the vaccine is safe and effective for adults, so they don’t need to repeat the efficacy trials for children. Second, because children are less likely to show symptoms from COVID-19, a study that relies on people becoming sick would require an enormous enrollment. So instead of checking for symptoms, scientists will look for immune responses that show the vaccine is working — usually by testing for antibodies that fight COVID-19 infection, and measuring at what point kids develop enough antibodies to effectively fight off the virus. They’ll also, of course, watch for side effects to make sure the kids are safe.

For children ages 12 and older, trials have been underway since earlier this year, and Pfizer and Moderna are hoping to release results later this summer. Depending on how strong the data is, Food and Drug Administration authorization could come this fall.

For children under 12, both companies are still testing. Moderna launched its trials for young children, with Children’s Hospital of Philadelphia as one of the sites, earlier this month, and Pfizer launched its trials just last week. Assuming everything goes well, we’re still probably not looking at authorization for those until sometime next year.

In the meantime, what should concerned parents and guardians do to keep their children safe? How can they keep their kids from getting sick?

In general, we know that kids aren’t as vulnerable to COVID-19 as older adults — the majority of COVID-19 deaths have been people age 65 or older. That doesn’t mean that kids are immune, but it does indicate that, in general, they’re at lower risk for severe symptoms, hospitalization, and death.

Experts warn that while vaccinated parents may feel they can let their guard down, the risk doesn’t change much for their children until transmission rates drop substantially or vaccines for kids become available.

“When kids are interacting, they’re interacting with the people they’re interacting with, and everybody they’ve ever breathed with … and everyone they’ve ever breathed with,” said Rutgers University pediatric expert Dr. Lawrence Kleinman.

He worries that the early consensus that COVID-19 was not a high risk for kids has colored the interpretation of health guidance that’s followed with regard to them.

“I think that that’s really been a terrible disservice to children,” said Kleinman. He pointed to the Centers for Disease Control and Prevention’s recent decision to allow just 3 feet distance between students in schools as opposed to 6 feet, noting he thinks it’s a hasty and risky choice since we still don’t know the long-term effects of severe acute COVID-19 in children, or of MIS-C, the rare but at times fatal evolution of COVID-19 in children.

What about transmission? Can my child give the virus to someone else even if they don’t get sick?

Another mother and WHYY listener, Lauren, also from Montgomery County, called in to say that she’s worried about her kids getting COVID-19 too. WHYY agreed to withhold her last name for privacy reasons. Lauren’s kids are 5 and 7, and while the majority of her family has gotten the jab, her father refuses to be vaccinated. She’s worried her kids could get her dad sick.

“Thinking ahead to Easter and Christmas … I mean, I want my kids to see my dad,” she told WHYY. “But, you know, I need him [and them] to be safe.”

In this case, Kleinman said, obviously it would be best if the grandfather were vaccinated. But experts agree that there are many other ways to reduce the risk of both infection and transmission: wearing masks, physical distancing, gathering outdoors or in well-ventilated spaces, and generally limiting exposure.

Dr. Emily Souder, a pediatric infectious disease specialist at St. Christopher’s Hospital for Children in Philadelphia, said the goal is risk reduction, not complete avoidance. With infectious disease, the risk levels will almost never be at zero.

“Children can absolutely transmit the virus. There’s been studies that have shown that,” Souder said.

“I think that’s part of why it’s important for children to be in these vaccine studies, and to eventually be able to vaccinate them, is partially we want to get to herd immunity in this country and they’re a big part of the population — and also so that they’re protected as well, because of the potential for them to get sick.”

Children make up roughly 25% of the global population. Scientists have estimated that to reach herd immunity to the point that the virus runs out of hosts to infect, as much as 70% of the world’s population could require immunization.

As vaccination numbers go up and coronavirus transmission slows, Souder said, risk will go down as well. In the meantime, it’s a good idea to keep gatherings and activities outdoors and masked whenever possible.

WHYY is the leading public media station serving the Philadelphia region, including Delaware, South Jersey and Pennsylvania. This story originally appeared on WHYY.org.