Will parents vaccinate their kids against COVID-19 when one becomes available?

As pharmaceutical companies race to produce a COVID-19 vaccine, one might not be available for kids until late next year, experts predict. Clinical trials for children have yet to begin in the United States, and likely won’t start until an adult vaccine is proven safe and effective.

But once a coronavirus immunization is released for children, will parents be reluctant to get them vaccinated? If two-thirds of adults say they won’t get the vaccine at first, what would such an attitude mean for their kids?

I talked to Dr. Kristin Oliver, a pediatrician and childhood vaccine expert at the Icahn School of Medicine at Mount Sinai in New York, about how clinicians and the public health community might overcome those potential hesitations. (Our interview has been edited and condensed for clarity.)

Q: Why couldn’t an adult COVID vaccine just be used on kids? Do trials have to be done separately for children to figure out either a specific dose or an entirely new vaccine?

A: The dosing is part of it. Also, as you will often hear people say, “Children aren't just small adults.” Their physiology is different and there is a lot of going on in terms of development, so both efficacy and safety risks may be different in children. This is true for medications as well as vaccines.

Q. If and when a COVID-19 vaccine comes along that’s approved for children, do you see it being a challenge to convince parents to get enough kids vaccinated to make it work?

A. There's so many unknowns right now. One is making sure we get an adult vaccine out, and I think everyone has to feel comfortable that that's safe and effective — especially safe. 

So if that all goes well, and if everyone is comfortable with the data, and people are comfortable with the approval process and the rollout, I think we'll be in a good position, certainly, when the childhood vaccine eventually comes out. Everyone's concerned about vaccine efficacy right now.

Q. Have you encountered hesitancy among parents for vaccines that have arrived in recent years?

A. One that comes to mind, and it’s not new anymore, is the HPV vaccine. That's the one that we see the most amount of hesitancy around.

What we know in terms of that vaccine is the most important thing is the recommendation that's coming from the provider to the parents, and I've certainly seen that in my practice as well. 

So the key component here in terms of thinking about a COVID-19 vaccine is making sure that not just the public but also physicians and administrators feel comfortable that it's safe and can give a strong recommendation for it. So we need to have the data. 

We also need to do a very good job of messaging pediatricians on how to give him a strong recommendation for vaccines, which we've had success with doing around HPV.

Historically, we also get more hesitancy around the flu vaccine. So it'll be a little bit similar to that probably as well. 

A lot of what we call hesitancy is parents asking legitimate questions about vaccines. Parents just need more information. We have to recognize that there's going to be lots of questions about a potential COVID-19 vaccine, and we need to be prepared to take them seriously and respectfully.

Q. As far as the HPV vaccine, some of the reluctance over that was because HPV is a sexually transmitted disease. Do you think that a COVID-19 vaccine might be different because it’s a disease that can affect anyone?

A. Everything's different about COVID-19. There’s been so much time for negative press around the vaccine development process that there's even more time for people to develop concerns. So that's different than any other vaccines in the past.

There wasn't a big buildup of people opposed to the HPV vaccine before it even came out. With COVID-19, we've had a chance for that. There’s been a lot on social media already about concerns about a vaccine that doesn't even exist yet. So that's going to make it particularly challenging.

Q. How would you get around those challenges in your own practice or how would you recommend other pediatricians approach that?

A. Assuming a perfect world — where we have large trials, the vaccine is effective in children, it’s also safe in children, the adult rollout went well, and ACIP (the Advisory Committee on Immunization Practices) goes through their usual process. — then I think it's like any other vaccine you recommend: “Today your child's going to be due for the COVID-19 vaccine. I’m recommending this to all my patients.”

That's what you can do at the individual practice level: Be considerate about answering questions, take the time to do that, and just address any concerns the parents may have and go from there.

Q. Do you think there could be some parents who decline the vaccine since kids don't get COVID-19 as frequently or severely as, say, elderly people? Parents might say, “Why does my kid even need this?”

A. It’s different from most of the vaccines that we give for kids right now. A lot of vaccines have secondary benefits for adult populations. With the pneumococcal vaccine, we’ve seen huge decreases in pneumococcal disease among adults and older adults especially. Same thing with varicella chickenpox.

Certainly with COVID-19, kids aren't as affected, they don't get as sick. But they do pass it along to everybody else. So that'll be an important component.

I hear from families who say they're going to want to wait, they don't want to be seen as the guinea pigs. Which is why ACIP is putting a lot of processes in place. We already have an incredibly good process in the U.S. for tracking vaccine safety and are putting even more processes on top of that for a COVID-19 vaccine.

Q. Anything else you want to add on the topic?

A. There’s a concern from pediatricians and people in the vaccine space that there’s been so much attention to the COVID-19 vaccine and the process and (Operation Warp Speed) that there’s been a hit to vaccines in general. 

We certainly lost ground during the COVID-19 shutdowns, when kids were not going into the doctor and not getting vaccines. They’re slowly coming back now, but we need them to come back at higher rates to make up for the loss of vaccines that we experienced over the spring and summer. 

My big plug would be to make sure that we're as vocal as possible about how good the the vaccines we have now are, and how important they are to prevent illness and death in children.