Ensuring we give the vaccine rollout for children our best shot

Optimizing plan will require us to learn from experiences with the adult vaccination strategies

As the COVID-19 pandemic has unfolded across the globe, its impact on children has tended to be an afterthought. While the largest burden of death and disease severity was in their grandparents’ generation, children and youth have grappled with severed social ties, mounting communal stress and widespread school closures due to concerns about their role in transmission of the virus.

Last Tuesday, the National Advisory Committee on Immunization (NACI) approved the use of the Pfizer-BioNTech COVID-19 vaccine in children and youth 12 years and up in Canada. This is an exciting step toward safely opening schools and achieving herd immunity. However, as pediatricians, we have big concerns about how the vaccine will be rolled out to children and youth. Optimizing rollout will require us to learn from experiences with the adult vaccination strategies, think about specific pediatric considerations and address important barriers to equitable access.

COVID-19 vaccine hesitancy has emerged as a challenging and multifaceted issue, hampering the rollout to adults. Vaccine hesitancy in parents may prove to be an even greater consideration, since angst about short-term and especially long-term side-effects plays a much greater role in the developing child. Additionally, since COVID-19 is a relatively mild illness in children compared to adults, parents may feel that the risks of vaccination outweigh the benefits.

It’s not just parents that are worried about the vaccine, though — youth have their own opinions about vaccine safety and whether or not they should get jabbed. Determining their capacity to make an informed decision about vaccination will be an important role for health-care providers during this new phase of the vaccine rollout.

We must also take into account that young children require caregivers and child-friendly spaces with safe waiting areas, allowing room for children to move about while maintaining physical distance from others, both before and after vaccination. Long lineups, characteristic of the adult rollout, should be avoided since they may be prohibitive for young children or children with developmental needs. Schools may be a potential site to deliver vaccines to students in grades 7 and up, as is typically done for HPV and meningococcal vaccines. Large spaces, such as school gymnasiums or outdoor fields, could be designated for post-vaccination observation periods (typically at least 15 minutes).

Since some children may be apprehensive and fearful of needles, vaccinators must be prepared to address anxiety and distress. Children should also catch up on their routine immunizations before administration of the COVID-19 vaccine, since COVID-19 vaccines cannot be given within 14 days of other vaccines (e.g. the shot for measles, mumps and rubella).

Of course, COVID-19 has revealed countless inequities in how families participate in the health-care system. Families experiencing structural inequities, such as those relating to race, economic status, immigration status or literacy level, have been hardest hit during the pandemic. Relatedly, these populations have had relatively more difficulty in accessing health care and vaccination during this time. For children and youth experiencing marginalization, there is a need for very specific, targeted approaches — particularly for those families with mistrust in the health-care system that is manifesting as vaccine hesitancy. There is a need for meaningful and impactful engagement and adaptation of the approach to make sure that vaccines get to those who really need them the most.

Furthermore, children and youth with medical complexity (e.g. chronic illness, respiratory and cardiac conditions, genetic disorders, immunocompromised states) will again need targeted approaches to prioritize vaccination and ensure logistics for safe administration. Those with developmental disorders and disabilities, like autism spectrum disorder and intellectual disability, will also need to be prioritized, especially if they are likely to engage in behaviours that compromise their safety. This may include drive-thru vaccination sites, planning with child life specialists or behaviour analysts, creating sensoryfriendly spaces, training vaccination personnel and altering waiting space arrangements. Groups such as Physicians of Ontario Neurodevelopmental Advocacy (PONDA) have already released strategies to support this group’s safe vaccination.

Vaccinating our children is an important step toward population-level herd immunity. This will let us open schools, health care, businesses and borders. If we are going to be successful, we must consider how to address parental and youth concerns around vaccine safety, equitable delivery and prioritizing children and youth most at risk of serious illness. Children desperately need to get back to school — let’s give them their best shot.

Dr. Sloane J. Freeman is a pediatrician at St. Michael’s Hospital, Unity Health Toronto, and an assistant professor of pediatrics at the University of Toronto. She is also the medical lead of the Model Schools Pediatric Health Initiative in Toronto and a mother of four. Dr. Ripudaman Singh Minhas is a developmental pediatrician, the director of pediatric research at St. Michael’s Hospital, Unity Health Toronto, and an assistant professor of pediatrics at the University of Toronto. He is a physician in the Model Schools Pediatric Health Initiative in Toronto and is a dad of one.