The U.S. Centers for Disease Control and Prevention has expanded eligibility for Pfizer's COVID-19 booster shot to include children ages 5 through 11. The shots could be available as soon as Friday, NBC News previously reported.
The CDC group that recommended the vaccine, the Advisory Committee on Immunization Practices, voted 11-1 (with one abstention) Thursday to make a third dose of the vaccine available to 5 to 11-year-olds.
CDC director Dr. Rochelle Walensky later endorsed the vote, saying in a statement Thursday that kids 5 to 11 "should receive a booster dose at least five months after their primary series."
"With over 18 million doses administered in this age group, we know that these vaccines are safe, and we must continue to increase the number of children who are protected," she added. "I encourage parents to keep their children up to date with CDC’s COVID-19 vaccine recommendations."
The U.S. Food and Drug Administration authorized the shot in this age group earlier this week.
“While it has largely been the case that COVID-19 tends to be less severe in children than adults, the omicron wave has seen more kids getting sick with the disease and being hospitalized, and children may also experience longer term effects, even following initially mild disease,” said FDA Commissioner Dr. Robert M. Califf in a statement at the time.
“Vaccination continues to be the most effective way to prevent COVID-19 and its severe consequences, and it is safe."
Pfizer requested a third dose of its vaccine be authorized in kids 5 to 11 after submitting data showing the low-dose booster shot — the same amount as the first two shots for kids in this age group, but one-third of what people 12 and up receive — is safe and could help protect this age group against variants of the coronavirus. The FDA said in a statement Tuesday that "the antibody level against the SARS-CoV-2 virus one month after the booster dose was increased compared to before the booster dose."
Data that Pfizer released in mid-April also showed that a third dose of the vaccine boosted antibodies against omicron by 36 times in children of this age group. But not every public health official is convinced that another shot is needed yet in younger children.
Are COVID-19 boosters for children necessary?
No expert told TODAY they were worried about the safety of boosters in kids, but several questioned timing for boosters and whether they are necessary as an emergency-authorized tool at this stage in the pandemic.
Dr. Phil Krause, a former deputy director of the FDA’s Office of Vaccines Research and Review, maintains that “COVID vaccines have been very safe,” and told TODAY he recommends boosters for the elderly and for people who are high risk for severe COVID-19. But he said he “questions the need for boosters in otherwise healthy people (including children) who were previously vaccinated and infected.”
Krause explained that primary, available data that supports boosters for this age group only measures increased levels of antibodies but fails to weigh other immune responses important for predicting long-term protection in children. He said that more needs to be understood about how long booster protection actually lasts.
“We’ve learned from adults that booster effects don’t usually last very long, but of course that could be different in children; we just don’t have a lot of data yet to rely on to make those types of predictions,“ he said. He added that he understands parents who choose to wait to see the long-term benefits of boosting. “Nobody wants to get a vaccine that they don’t need or where the benefit turns out not to be as good or as long as was promised.”
Dr. John Moore, a professor of microbiology and immunology at Weill Cornell Medicine, offered a similar take. “It’s likely that the first two doses are already sufficient to protect the children against severe, hospital-grade infections or worse. The booster dose may not add much extra protection here,” he said. (Moore noted that children who are immunocompromised are an exception.)
Another "key question to answer," according to Dr. Leana Wen, an emergency physician and public health professor at George Washington University, is “whether boosters in this younger age group reduce not only symptomatic infection, but also severe disease. That, ultimately, is the main reason why we have vaccinations.” She added that in children who recently had omicron, it's still unclear of "that recent infection is equivalent to the booster" or if they still need one.
The benefits of COVID-19 boosters for children
Other public health officials said that boosters in kids are important for a variety of reasons. “I continue to feel that we should do everything possible to prevent disease in children, both because some of them will get severe illness and have long-term complications from COVID infection, and many others will be able to spread the illness to those who may be more at risk,” said Dr. Jesse Hackell, a pediatrician in Pomona, New York, and the president of one of the chapters of New York state’s American Academy of Pediatrics.
Hackell explained that there seems to be “a false dichotomy” from some who oppose COVID-19 vaccines in treating COVID-19 differently than other diseases that similarly pose small but real risks to children. “It is not that we will save millions of kids’ lives by vaccinating everyone,” he said, “but we vaccinate and mandate vaccination against other diseases which are mild for most kids such as chickenpox, mumps, haemophilus and even polio because a small number of kids would otherwise be likely to suffer devastating outcomes, and no child should suffer from a preventable illness,” he told TODAY.
Dr. Arnold Monto, a professor of epidemiology and global public health at the University of Michigan, explained that boosters also offer important protections against COVID-19 variants. “In studies in other age groups, it is clear that there was little antibody produced against omicron without the booster,” he said.
Dr. Scott Ratzan, editor-in-chief of Journal of Health Communication: International Perspectives, pointed out that during the recent omicron surge, those who were boosted “were 21 times less likely to die of COVID-19 compared to those unvaccinated, and seven times less likely to be hospitalized,” he said. “Booster shots are safe and effective.”
Dr. Erin Abner, an associate professor of epidemiology at the University of Kentucky’s College of Public Health, added that COVID-19 is still concerning for children because there remains much that we don’t understand about long COVID. “The long-term effects of COVID infection are unknown,” she said.
Dr. Yvonne Maldonado, an infectious disease researcher at Stanford who advises the American Academy of Pediatrics and has helped test the vaccine for Pfizer, praised what she’s seen regarding the efficacy of boosters in this age group. “The current data shows that the boosters in 5- to 11-year-old children provide a robust increase in neutralizing antibodies to the original and the omicron variant (of COVID-19.) These antibodies are markers that indicate protection against severe COVID-19 infection,” she said.
In a Tuesday statement, Dr. Peter Marks, director of the FDA’s Center for Biologics Evaluation and Research, stressed that Pfizer's vaccine helps prevent "the most severe consequences of COVID-19" in people 5 and older. He added that the "known and potential benefits" of the booster for people 5-100 outweighs "the known and potential risks" and that the booster can provide continued protection.
The first and second dose of the COVID-19 vaccine is still a priority
Experts stressed that boosters in this age group are a moot point for many Americans as some parents still haven’t vaccinated this age group against the coronavirus at all. As of mid-May, less than 30% of the 28 million U.S. children between 5 and 11 had completed the two-dose vaccination series.
“Of primary importance is to get all kids vaccinated with their first and second dose before the summer holiday and definitely by the return to school in the fall,” said Ratzan.
Walensky also stressed in her statement that vaccination with a primary series in kids 5 to 11 has "lagged behind other age groups leaving them vulnerable to serious illness.
"With cases increasing, it is important that all people have the protection they need, which is why, today, CDC has also strengthened another booster recommendation."