Eight-year-old Christian Mugera went first, extending his arm for a blood draw and then a needle stick for a dose of a COVID-19 vaccine. His brother, 11-year-old Gerald, wanted to follow, but staff struggled to get a blood sample.
Their father, Dr. Charles Mugera, called them stoic in their potential contribution to science, as they were among the first scheduled to participate in a trial at the University of Maryland School of Medicine’s Center for Vaccine Development and Global Health. The study is assessing the safety and efficacy of the Moderna vaccine in young children.
“We did explain to them about the trial,” Mugera said. “But more importantly for them, they think getting the vaccine will bring life back to normal. That’s more convincing for them. They know they get to go to school and see their friends.” While Christian got a shot Tuesday, Gerald wasn’t able to because the staff never could obtain his blood sample. That’s needed to test participants for antibodies.
Scientists running the trial say it’s important both that individual kids and society are protected. Children are the last and potentially pivotal group in the vaccination effort to end the pandemic.
“Without children, we are unlikely to have enough people vaccinated to completely turn the epidemic,” said Dr. James Campbell, a pediatric infectious disease specialist in the medical school and the site’s principal investigator.
As vaccinations for adults proliferate, COVID cases among kids have been inching back up in Maryland and in many states.
The Maryland trial and others underway could mean mass vaccinations begin in older children during the summer and in younger ones soon after school resumes in the fall.
“My impression and expectation is that as more and more data are available, more and more people will be willing or interested in having their children vaccinated,” said Campbell, adding the trial has drawn far more children than can be accommodated.
The Moderna trial, among children aged 6 months to 11 years, is being conducted among 6,750 children at several sites around the United States and Canada. It joins other vaccines being studied in children, including one from Johnson & Johnson for those as young as age 12.
The Pfizer-BioNTech vaccine has had emergency authorization for use in those age 16 and older since December, and those companies asked the U.S. Food and Drug Administration earlier this month to expand that to age 12.
Some already are considering how mass vaccinations of children would be possible and see urgency in local data.
In Maryland, state figures show there have been more than 24,000 COVID-19 cases and three deaths in children age up to age 9 and more than 45,000 cases and seven deaths in kids age 10 to 19.
While the cases are only about 15% of the more than 444,000 cases reported across the state, they are becoming a larger share as more adults are vaccinated, according to a Baltimore Sun analysis.
Children up to age 9 now comprise 10% of cases, up from 5% in January, and older children comprise 14% of cases, up from 10%.
It’s not just the share of cases, as data also shows that the number of cases in children is rebounding the fastest since cases dropped considerably in every age group after a post-holiday winter peak.
Campbell said that is likely because children are unvaccinated, but also because there are more contagious variants circulating and many kids have returned to school and other social settings.
Tiffany Tate runs a nonprofit that works with local health departments to vaccinate children against the flu and said she is already thinking about ways to get doses to the youngest residents.
The timing of COVID vaccine availability could be challenging for doctors’ office and schools because it could overlap with other vaccination efforts, said Tate, executive director of the Maryland Partnership for Prevention.
Doctors’ offices and schools typically schedule vaccinations required by the schools in late summer and begin voluntary flu vaccinations beginning in October. This year, there also will be makeup vaccines for the large swath of kids who got behind on their childhood immunizations during the pandemic.
“This will take all hands on deck,” Tate said. “There will likely be other vaccinations needed around the same time as the COVID vaccine, and they have specific intervals required between first and second doses that are three or four weeks apart.”
Tate said the best arena for clinics would be schools so officials can properly control timing of the two-dose COVID vaccines and non-COVID vaccines. And she said schools also could help gauge interest in COVID vaccines for planning and supply parents with messaging from trusted community leaders to combat any hesitancy.
Normally, she said parents are more willing to get their children vaccinated than themselves, but COVID vaccines may not track that way.
Polls show many parents, particularly Republican ones, do not want the COVID vaccine for their children. An Axios-Ipsos poll released earlier this month found that 52% of parents would get their children vaccinated when they are eligible. That’s far lower than a typical year for the flu vaccine.
State health officials say they have not determined how they will inoculate children in Maryland, or whether vaccinations will take place in the same venues available to adults. Those include mass vaccination sites, hospitals, health departments, drugstores, some doctors’ offices and mobile clinics.
“We look forward to the day when everyone can be vaccinated, especially children,” said Charles Gischlar, a spokesman for the Maryland Department of Health.
“The department continues to monitor the clinical trials of the vaccine manufacturers and reviewed by federal agencies,” he said. “It is too soon to speculate about what method will be used to vaccinate children, although it is common for children to get other vaccinations through their pediatricians.”
Campbell said doctors will rely on advice from the U.S. Centers for Disease Control and Prevention and groups such as the American Academy of Pediatrics on scheduling.
Normally, there are studies to show when taking certain vaccines together is OK or when one could be delayed, but such studies with COVID vaccines won’t be ready in time. Instead, advisory panels will use safety data they do have and expertise in vaccines, which is how the panels came to suggest pregnant women should get a COVID vaccine.
But, Campbell stressed that there will be a lot of safety and efficacy data on individual COVID vaccines in children from trials such as the one at Maryland, which is running at sites in Baltimore and Frederick to determine the best dose level for specific ages. Children are either getting full adult doses or half doses.
The next round of the trial will use the optimal dose, as determined largely by reactions and antibody levels found in participants’ blood. Two of every three kids will get the vaccine and one will get a placebo.
Data that shows the vaccine is safe and good at preventing disease likely will convince hesitant parents to get their children a shot, Campbell said.
“We need this not only for herd or societal protection,” he said, “but each of those children need vaccination so they can be protected.”
Mugera, an internal medicine doctor from Montgomery County, said he’s “seen the ugly side of the pandemic.” But he felt reassured about the COVID vaccines for his sons after millions of adults were vaccinated without lasting ill effects.
“One of the things I say to parents is, ‘Trust the evidence. Trust the scientists. These are people who have kids like you and me, and if they are putting kids on the line, that means they believe in it and the science.’ And it’s proving itself to be true,” he said.
“There are fewer cases, hospitalizations and deaths, and the only difference is the vaccine.”