Covid-19 vaccines for young kids are a big step toward a new normal

More than 28 million children across the US are now eligible to receive Covid-19 vaccinations, a step that could relieve anxiety for families, bring more kids back to schools, and slow the spread of the disease.

On Tuesday, the Centers for Disease Control and Prevention endorsed the Pfizer/BioNTech vaccine for kids between the ages of 5 and 11 after an advisory committee voted 14-0 to recommend the shots. The move comes after the Food and Drug Administration last week granted an emergency use authorization to the vaccine, concluding that its benefits outweigh the risks in young kids.

Distribution of these vaccines has already begun, and the CDC expects to reach “full capacity” for pediatric vaccines by the week of November 8.

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Immunizing young children against Covid-19 would make it more difficult for the coronavirus to spread and protect kids from falling ill. It’s big news for parents and kids, in part because the vaccine could ease the return to in-person schooling. “Vaccinating younger children against Covid-19 will bring us closer to returning to a sense of normalcy,” said acting FDA Commissioner Janet Woodcock, in a statement.

The Pfizer/BioNTech vaccine currently has full FDA approval for people ages 16 and older and a separate emergency use authorization for adolescents between 12 and 16. The emergency-use designation allows health workers to administer new vaccines during a public health emergency based on data from clinical trials. Full approval requires more clinical data and allows manufacturers to market vaccines and continue selling them after the public health emergency ends.

While children are generally at much lower risk of severe illness from Covid-19 than older adults, at least 690 children from birth to the age of 18 have died from the disease in the US so far. About 8,300 5- to 11-year-olds have been hospitalized for Covid-19, and at least 146 have died. Vaccines will drastically lower the chances of that happening, while also whittling down the risk that children will pass on the virus to others.

Although vaccines are the most effective tool for containing Covid-19, the experiences of older adults show that they’re not always enough. Infections after vaccination, known as breakthrough infections, are usually mild, but they have sickened and killed some people. The protection offered by vaccines can also wane over time. Changes in the virus itself have created variants like delta, which spreads more readily and can evade immune protection. That’s why health officials have recommended that vaccinated people continue to wear masks and maintain social distance in high-risk situations, like crowded indoor environments.

It’s not clear yet how much longer such measures will remain in place in schools, but as more kids get their shots, the odds rise that students can go to class without masks.

Why Covid-19 vaccines for kids took so long to be approved

In the early days of the pandemic, doctors reported that adults were most vulnerable to severe illness from Covid-19, particularly older adults and those with preexisting health conditions like high blood pressure and other heart conditions. That trend has continued, and unvaccinated adults continue to experience the largest number of hospitalizations and deaths from the disease.

By contrast, children appeared to be at far lower risk of contracting the disease and seemed to have less severe outcomes, so young people became a lower priority for vaccinations than adults. However, as the vaccines rolled out and more adults gained immune protection, the relatively small number of infections in children started making up a larger proportion of Covid-19 cases.

“The focus was to get a vaccine for adults first,” said Kawsar Talaat, an associate professor at the Johns Hopkins Bloomberg School of Public Health, who led a Pfizer/BioNTech vaccine trial in children. “Once the trial in adults was finished, then it started going down in age.”

The initial clinical trials for the Pfizer/BioNTech vaccine, also known by the brand name Comirnaty, included participants aged 16 and up. Then the companies conducted further trials with the same vaccine formulation in kids as young as 12, which led experimenters to reconsider what dose of the vaccine was needed in young children.

“The incredibly robust immune response in the 12 to 15-year-olds made them think that maybe they didn’t need that high of a dose,” Talaat said. “There was a new study that started to look at the vaccine specifically in kids under 12, and we decided to test different doses.”

Researchers repeated the clinical trials in 5- to 11-year-olds, but with about one-third of the dose of vaccine that’s used in adults. The lower dose aims to minimize side effects and account for the fact that young children are both physically smaller and tend to have more robust immune systems than adults.

“Kids are not just little adults,” said Jennifer Nayak, an associate professor of pediatrics at the University of Rochester Medical Center. “Their size is different, but their immune systems are also different.”

Children who received the low-dose Pfizer/BioNTech Covid-19 vaccine, 10 micrograms, experienced an immune response comparable to adults who got the higher dose, according to the Pfizer/BioNTech trial. After the second injection, the trial showed, the vaccine was 90.7 percent effective at preventing symptomatic cases of Covid-19.

The trials, however, included just 4,600 children, compared to the trial in adults that included 44,000 participants. The pool of children in the trial was smaller because the Pfizer/BioNTech vaccine has already been administered to hundreds of millions of people around the world with a strong safety record.

However, some complications did emerge. For instance, the Pfizer/BioNTech vaccine is not recommended for people who are severely allergic to any vaccine ingredient, or who had an allergic reaction to the first dose. Researchers have also found that some recipients of mRNA vaccines, like the one from Pfizer/BioNTech, may be linked to rare cases of myocarditis, an inflammation of the heart muscle.

The trials in children showed no serious side effects, but some reported symptoms like pain at the injection site, redness, swelling, chills, and fever, with more side effects reported after the second dose.

While the wait for Covid-19 vaccines for 5- to 11-year-olds has been agonizing for kids and adults alike, this is still a record-breaking pace for vaccine approval. The previous record for a pediatric vaccine was held by the mumps shot, which took four years to develop.

Only 18 months have passed since the World Health Organization declared the start of the Covid-19 pandemic, and 11 months have passed since the FDA granted its first emergency use authorization for a Covid-19 vaccine.

What vaccinating children means for the US epidemic

It’s clear that children have suffered greatly from the Covid-19 pandemic. Beyond the kids who have been sickened and killed by the disease, millions more have lost caregivers and family members or struggled to keep up with their education as schools shifted to remote learning. The pandemic has also taken an enormous toll on mental health.

And though almost all children survive coronavirus infections, they can still infect others who are more vulnerable to some degree. That not only threatens to make other people sick, but also increases the chances that the virus will acquire dangerous mutations. So vaccinating children is likely important not just to protect them individually, but to limit the further spread of Covid-19.

Yet the current stage of the US epidemic is different from when Covid-19 vaccines began distribution to adults in December 2020. At that time, there were critical limitations on US supplies of the vaccine, so health officials debated exactly who should be at the front of the line.

Now, the US has stockpiled lots of Covid-19 vaccines, and some adults have become eligible for booster doses. Young children do remain at a lower risk of severe Covid-19 than adults, so health officials recommend that children receive their first injections at doctor’s offices rather than mass-vaccination sites.

“As a mom, I encourage parents with questions to talk to their pediatrician, school nurse or local pharmacist to learn more about the vaccine and the importance of getting their children vaccinated,” said CDC director Rochelle Walensky in a statement.

One concern, however, is that families will decide whether to vaccinate their children, likely along the same fault lines that have defined Covid-19 vaccinations for adults. Age, income, ethnicity, and political beliefs are key variables shaping whether Americans get vaccinated, and some families seem especially hesitant about vaccinating young kids. (Having only an emergency-use vaccine authorization for young kids may contribute to hesitancy, despite safety data backing it.) School districts around the US will also come to different conclusions about whether to mandate, encourage, or remain indifferent about children getting their shots.

“I imagine there is going to be a huge amount of geographic variability on this,” said Nayak.

So far, vaccination rates are highest in older people and lowest in younger people, and if the pattern holds, it’s likely that 5- to 11-year-old children will have some of the lowest rates of vaccine uptake. Getting those numbers up will take time.

Another hurdle is that not every child has good access to medical professionals and can easily get to a doctor to receive a shot. Misinformation about Covid-19 vaccines, like the myth that they cause reproductive harm, could interfere with the rollout as well, according to Nayak.

Still, the more people who are vaccinated against Covid-19, the harder it is for the virus to spread. As more children head back to schools in person and more people gather indoors, having 5- to 11-year-olds vaccinated could blunt another winter spike in infections across the whole population. “We’re seeing that in places with high vaccination rates, transmission is lower than in places with low vaccination rates,” Talaat said. “I’m really excited about vaccinating my 10-year-old.”

Researchers are still planning to keep an eye on the children who participated in clinical trials for more than two years, to keep track of their level of protection and to monitor for any potential long-term complications. Some fraction of vaccinated children are also likely to experience breakthrough infections, and over time, protection from the vaccine may wane.

There are also Covid-19 vaccine clinical trials underway in children as young as 6 months old, so even more kids in the future may be eligible to get these shots. But again, even if they gain approval, the vaccines will only make a big difference if kids actually get them.

The curious case of the ancient whale bones

Every year, thousands of whales strand — meaning that they wind up trapped on beaches or in shallow waters — and it’s really hard to figure out why.

It’s not for lack of trying. Teams of forensic researchers investigate stranded whales, studying organs, analyzing body parts with CT scanners, digging through stomach contents, and checking skin for scarring. But these meticulous whale detectives still often don’t find any answers.

“We can only about 50 percent of the time, if that much, give you a solid answer of why that animal died and why it’s stranded,” says Darlene Ketten, a marine biologist at Woods Hole Oceanographic Institution who refers to her work as “CSI: The Beach.”

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One reason it’s hard to figure out how whales die is that scientists don’t know that much about how they live, Ketten explains on the latest episode of Unexplainable, Vox’s podcast about mysteries in science. They range widely across the planet and dive deeply. There are many things about their complicated bodies we don’t yet understand. And these researchers are often working with whale carcasses that have been decaying for days, which can distort the evidence left behind.

Some beached whales are even more difficult to study because they’re really, really old. In 2011, Nick Pyenson, the curator of fossil marine mammals at the Smithsonian National Museum of Natural History, took on a cold case that had gone unsolved for a long time — seven to nine million years, to be precise.

Pyenson, who is also the author of Spying on Whales, was on a research trip in the Atacama Desert in Chile, a beautiful expanse of rock and sand that’s flecked with orange, beige, and purple because of the presence of iron and other minerals. He was there to research the origins of a nearby ocean current — but along the way, he got distracted.

“There’s all these whale skeletons by the side of this hill,” Pyenson says one of his colleagues, Mario Suarez, told him one day. “You need to check it out! It’s amazing!”

The hill was known locally as “Cerro Ballena,” or “Whale Hill,” because fossilized whale bones had been found there in the past. Bulldozers had just come through to cut a path for a new highway, and they exposed more skeletons. When Pyenson went to look, he was completely overwhelmed.

“It was whale skeleton after whale skeleton after whale skeleton, complete from nose to tail. Some of them stretched out almost like snow angels the kids make,” Pyenson recalls. “It’s as if they had died and their skeletons were not disturbed.”

This was almost unheard of: full, beautifully preserved skeletons, stretching out for 40 feet in every direction. “In the field, you spend a lot of time searching, and often times you just find a boulder with a few bits of bone — and that is a good day,” Pyenson says. “A really good day is finding more than just a few bits of bone, or a partial skeleton. If you find a head with that skeleton, that’s a home run.”

Once he’d processed what he was seeing, Pyenson realized that he was going to have to start a whole new research project to figure out what exactly had happened to these whales. It seemed like an ancient stranding — possibly one of the best-preserved ones — but it wasn’t going to be easy to solve. There were no tissues to study, so he couldn’t analyze organs or skin, as Ketten and her fellow researchers do with modern whales. Fossilization also changes the minerals in the bones, and rock layers compress them into new shapes, so the bones were somewhat unreliable witnesses.

Pyenson and his colleagues used 3D-scanning technology to make models of the whale skeletons to study them back home. They carefully analyzed the soil and layout of the surrounding area, and finally landed on three big clues.

First, the skeletons were entangled in each other and almost entirely unscavenged, which suggested that these animals had died suddenly. Second, there were many species at this ancient graveyard — whales, but also other adult and juvenile animals, which told Pyenson that the die-off was not limited to whales.

The third big clue came from a close study of the local geology, which suggested these creatures had died in four separate events over the course of around 10,000 years. So whatever was killing the whales had happened several times. That essentially ruled out an infrequent natural disaster like a volcanic eruption.

Pyenson began thinking about cyclical changes to the ocean that could kill off lots of different animals, and fast. I started moving towards the idea of harmful algal blooms being a cause,” he says. Algal blooms, or red tides, are troublesome to this day. They occur when populations of microorganisms explode in a body of water — sometimes when agricultural runoff floods a lake or ocean with nutrients like nitrogen. These tiny organisms can produce toxins that can prove very deadly, very quickly.

Pyenson theorized that runoff from mineral-rich surrounding areas — minerals that still lend the sands of the Atacama their vibrant colors — could have periodically caused algal blooms in the ocean that once covered this area. But he wanted evidence that would hold up in the court of scientific opinion.

If this were a fresh crime scene, he could have rooted around in the whale’s guts, found a bunch of toxins, and caught the red tide red-handed. But because his crime scene was millions of years old, he could only study his photographic models instead. Those kept showing that the whale skeletons were surrounded by rings of orange sediment — mats of iron oxide, which Pyenson interprets as possible algae in the fossil record. “I kept on wondering, is this the algae of death?” Pyenson says with a laugh.

His team brought samples of this orange sediment back to the US and examined them under an electron microscope. The images included tiny spheres that were the right size to be an algae of death, Pyenson says, but all their distinguishing features had been wiped away by millions of years.

“We are so close to a smoking gun,” he says. “It’s tantalizing. But that’s how a lot of historical science goes. You struggle with it and you want to get at the answer. But sometimes the evidence you’re able to find to answer your questions is not entirely satisfying.”

Jeremy Goldbogen, a marine biologist at Stanford University, read Pyenson’s paper in 2014 and told the journal Science that the positions of the various skeletons seemed consistent with a stranding.

David Caron, who has researched algal blooms at the University of Southern California, was also asked about Pyenson’s research in 2014 and told National Geographic that present-day algal blooms also wipe out a wide range of marine animals. “There’s certainly thousands of sea lion deaths, dozens to hundreds of dolphins, untold hundreds of pelicans that all have been wiped out with the same toxic event,” he told the magazine.

According to Pyenson, these parallels between the past and the present flow in both directions. “I find studying past worlds to be a kind of time travel,” he says. “You get to go these past worlds that almost seem like alien worlds.”

Even if he’s never able to definitively pinpoint what happened at Cerro Ballena, Pyenson says the site suggests that whale strandings were occurring millions of years before modern humans evolved. That’s helpful context for researchers who are trying to prevent strandings in the present day.

For example, a large proportion of the fossils come from baleen whales, even though baleen whales make up only a small fraction of whale strandings today. So what’s changed between then and now? For one thing, centuries of whaling have decimated populations of baleen whales, Pyenson says.

These strandings have been happening “ever since there were whales,” says Ketten. But humans are now contributing to the problem, whether through whaling, plastic pollution, or climate change. “What we have to be responsible for is actions that we take in the ocean that may be … causing animals to become less fit, to be less healthy, to be less able to reproduce, to mate, to find food.”

Whale fossils like the ones Pyenson studied in the Atacama Desert can serve as a sort of snapshot or baseline, revealing how whale strandings looked before humans ever came along. And more researchers can establish about the distant past, the more they may know about the effects that humans are having on these majestic mammals.