The chance to get vaccinated against COVID-19 seems like the best thing to happen in a very long time. Like most parents you’re probably wondering: What about the kids?

The U.S. Food and Drug Administration (FDA) has so far authorized three vaccines to protect people from COVID-19. The vaccine from Pfizer-BioNTech is authorized for people ages 12 and older, while the Moderna and Johnson & Johnson vaccines can be given to people ages 18 and up.

Michael Smit, MD, MSPH, Hospital Epidemiologist and Medical Director of Infection Prevention and Control at Children’s Hospital Los Angeles and assistant professor of clinical pediatrics at the Keck School of Medicine of USC, recently answered questions at the CHLA Newsroom about what the vaccination timeline for kids younger than 16 looks like.

When might children younger than 16 be able to get a COVID-19 vaccine? 

The vaccine manufacturers are currently doing studies on children ages 6 months to 16 years. If they are able to recruit enough patients, they could have a vaccine ready for distribution to this age group as early as the fall of this year. Future trials will target pregnant women. A vaccine for these children may not be ready until 2022.

When might children younger than 16 be able to get a COVID-19 vaccine? 

The Pfizer vaccine was approved by the FDA for emergency use authorization for children 12 or older in the United States in early May of 2021. Multiple vaccine manufacturers are currently doing studies on children 12-15. Trials have also started to test vaccine safety for children 6 months to 11 years of age, as well as pregnant women. A vaccine for children ages 5-11 may be ready by the fall of this year.

Is the dose different for children?

The Pfizer vaccine dose for children 12 to 15 years old will be similar to the dose used for people 16 years old and up.

Does a child’s size or age affect their ability to get the vaccine?

Scientists studying the vaccine have developed vaccines that are based on age rather than size. Children should get the vaccine recommended for their age.

How long does protection from the vaccine last?

We don’t know the answer to that yet. The medical professionals who have been studying the vaccine believe that it will last at least one year.

Could you briefly explain what needs to happen before the FDA authorizes a vaccine?

It has to go through a series of clinical trials where they do tests to learn whether or not the vaccine is safe and whether or not it is effective. They then roll the vaccine out to Phase 3 trials, where they recruit numerous individuals in the age and demographic group that are representative of the population they are trying to vaccinate.

Why does it take longer for vaccines to be available for children?

It’s important to understand that children are not just little adults. Their biology is different. For the most part, 16-year-olds and older teens have roughly the same immune reaction to a vaccine as adults, but younger children may have a very different immune response. That’s why the vaccine is being rigorously tested on different age groups of children.

Does the vaccine affect teen’s developing bodies? Could it make them unable to have children in the future?

Based on how this vaccine works, we have no concerns about it affecting children’s or teens’ development. The vaccine will not cause problems with a person’s ability to have children (known as fertility).

Is it OK for children with allergies or asthma to get the vaccine?

It is okay for children with asthma to get the vaccine. In fact, we highly recommend that they get it because it can prevent complications from an infection with COVID-19. Children who have a severe allergic reaction to the first dose of the COVID-19 vaccine or to one of the ingredients in the vaccine should not get it. Talk to your pediatrician if you have concerns about this.

Are there any medications, or health conditions that make someone ineligible for the vaccine?

Only people who have had a severe allergic reaction to a previous dose of the COVID-19 vaccine or to one of the ingredients should not get the COVID-19 vaccine.

Does the COVID-19 vaccine conflict with other vaccines my child still needs to get?

There are no safety concerns, but we do not know if the protection provided by the vaccine is the same if other vaccines are given at the same time. If possible, the COVID-19 vaccine should be given alone. Other vaccines should be scheduled 14 days before or after the COVID-19 vaccine. But if your child gets the COVID-19 vaccine within 14 days of another vaccine, they do not need to repeat the dose.

If children can’t get vaccinated for another year or so but everyone around them is vaccinated, are they safer than before? 

The concept we are referring to is herd or community immunity, whereby a certain percentage of the population has had the disease and recovered with immunity or has received a vaccine that prevents the disease from spreading. By vaccinating as many adults as possible we could provide a protective cocoon around younger children so that if we reach a certain percentage, then we can protect the younger children who can’t get the vaccine yet.

Is herd immunity feasible by fall of this year?

Because this is a new disease, we’re not sure what percentage of the population needs to have immunity to achieve herd immunity. Experts have speculated that anywhere from 70 to 85% of the population would need to be vaccinated. If we have a lot of people who choose to not get the vaccine that could be an issue because you will still have transmission in the community.

Why is it important that as many people get vaccinated as possible?

A high percentage of vaccinations will help us achieve herd immunity. We also need to disrupt the transmission of this disease as much as possible because of the mutations and variants that you may have read about in the news. There is always the chance that when you have mutations and variants in viruses like this one that they become easier to spread or become more deadly. The quicker we can disrupt the transmission of this virus, the less likely we are to see those mutations and variants increasing and spreading.

When might we know if the Moderna, Pfizer-BioNTech or Johnson & Johnson vaccines prevent people from spreading the virus?

The vaccines provide very good protection from getting serious COVID-19 symptoms. What we don’t know is how many people who are fully vaccinated can carry the virus without symptoms. Studies are looking at this right now. I’m guessing within the next several months we’ll have more information.

Moderna and Pfizer-BioNTech use mRNA in their vaccines, while the Johnson & Johnson one uses more traditional virus technology. How safe is a mRNA vaccine for children?

Studies show that the mRNA vaccine is safe in children 12 years of age and older.

The mRNA vaccine gives instructions to our cells on how to make a harmless protein that is unique to the virus. Once the cells make copies of the protein, they just destroy the material from the vaccine. Your body recognizes this protein, reacts to it and creates an immune response. That immune response gives you antibodies and protection against COVID-19. It’s important to know this is not a vaccine that integrates into your DNA.

What should parents of teens eligible to get a COVID-19 vaccine know about side effects?

Side effects can be different from person to person. The side effects, or what are also referred to as adverse reactions, are the same for 12- to 18-year-olds as they are for adults. These include soreness in the arm or at the injection site, aches and pains, or fever within 24 hours of getting the vaccine. Some people may have a high fever and feel achy and tired for a couple of days but those cases are less common.

What are the typical symptoms for normal, healthy teens who get infected with COVID-19?

COVID-19 can affect normal, healthy teens just like it can affect those who have health conditions. The symptoms of infection for teens can vary. Some have no symptoms at all, and others have severe symptoms that can be life-threatening.

Why is it important to continue to protect children from the new coronavirus?

Although children who get COVID-19 tend to have less severe disease than adults, there are children who get severe disease and end up on ventilators. And there are kids who die from it. Plus, there is a secondary condition that can occur in children after they have COVID-19 called MIS-C, which stands for multisystem inflammatory syndrome in children. Somewhere between two to eight weeks after being infected with the coronavirus some children are having immune responses that show massive amounts of inflammation; they have red eyes; reddish, red, cracked lips and some have heart damage. We want to reduce the spread in children as much as possible because if you develop those complications after getting COVID-19 you could have lifelong health issues.

I am still unsure about having my child vaccinated. Do healthy teens infected with COVID-19 ever need to be hospitalized?

More than half of all children infected with COVID-19 are teens 12 to 18 years old. They can have severe, life-threatening symptoms just like adults. The vaccine will protect you from COVID-19’s life-threatening complications, may protect people around you, and will allow you to do more activities like before the pandemic. For more information about this from the Centers for Disease Control and Prevention, click here.

— Stephanie Cajigal