Ask a Pediatrician: Is It Safe To Get My Teenager Vaccinated Against COVID-19?

Since the Pfizer vaccine was authorized for everyone 12 and older in May, the New York City Health Department has been working on getting shots into kids’ arms. The Department says it has sought to provide doses to pediatricians’ offices and has encouraged doctors to discuss the shot while conducting back-to-school check-ups.

It’s also sending letters to parents urging them to speak with their child’s health care provider about the vaccines. And the city says it’s seeking to engage with young people directly on social media channels, including TikTok, Snapchat, Twitter and YouTube.

There may also be a major incentive for kids to get their vaccines before heading back to the classroom this fall. The Centers for Disease Control and Prevention issued guidance last week saying that students and staff who have been fully vaccinated don’t have to wear masks in school. Mayor Bill de Blasio said during a press conference on July 12th that “wearing the masks is a smart thing to do in schools” but that the city health and education departments are discussing the CDC guidance to determine public school policy for the fall. And, on Monday, the American Academy of Pediatrics recommended students over age 2 and staff wear masks indoors, even if they are vaccinated.

So far, more than 200,000 New Yorkers under 18, or about 13% of the city’s minors, have received at least one COVID-19 shot. But some parents may still have reservations due to recent reports of adverse vaccine reactions.

As of July 12th, 1,047 suspected cases of myocarditis or pericarditis—inflammation of the heart muscle or the membrane around the heart, respectively—had been deposited in the CDC’s Vaccine Adverse Event Reporting System. About 633 cases had been confirmed, with most cases affecting male adolescents and young adults under the age of 30. Symptoms more often appeared after the second dose, typically within a few days. Some were hospitalized, but the majority have responded well to bed rest and treatment.

Given that more than 177 million people have received at least one dose of a COVID-19 vaccine in the United States, these side effects remain extremely rare—especially in comparison to the harms of the virus. Since August, COVID-19 has hospitalized 153,700 people under 30 years old—or about 13,900 per month. Compare that against 262 suspected incidents per month of this temporary and treatable heart condition.

The CDC still recommends vaccination against COVID-19 for young adults 12 and older, as does the American Academy of Pediatrics and a whole host of other medical associations.

For parents who still have lingering questions, we enlisted pediatrician and infectious disease expert Dr. Sean O’Leary, director of the Colorado Pediatric Practice-Based Research Network and vice-chair of the American Academy of Pediatrics’ Committee on Infectious Diseases, to discuss the risks and benefits of COVID-19 vaccination in greater depth.

His answers have been edited for length and clarity.

Since data collection on the vaccines is ongoing, some parents may think it’s better to put off getting their children vaccinated, or “wait and see.” Do you think that makes sense or should people get their kids vaccinated as soon as possible?

I think the sooner, the better, frankly, for everyone. That’s for two reasons. The first is that the higher the vaccination rate, the sooner we will get past all of this. And you're probably well aware that we're seeing COVID-19 cases rise now in most of the U.S. And that's in the summertime when normally respiratory viruses go semi-dormant.

The second reason is just to protect the adolescents themselves. We all know that this disease is more severe in adults, but it's not correct to say that it's benign in children or adolescents. For example, we know based on available data that, after COVID infection, the risk of multi-system inflammatory syndrome (MIS-C) in children is roughly 10 times higher than the risk of myocarditis after vaccination.

As we further analyze the existing data and more doses are given, we'll continue to have a more precise estimate of exactly what that risk is. But I’m not sure that will be terribly meaningful for the average parent. At this point, we can say it's very rare [to get myocarditis], and we can have some confidence in that statement. But for a parent distinguishing if the number is 10 in a million or 50 in a million--in either case, that's rare.

How should parents think about the risks versus the benefits of getting their children vaccinated against COVID-19, given the adverse reactions that have been reported?

Overall, the benefits still appear to greatly outweigh the risks. Of course, we'd all rather there wasn't this rare side effect, but it does appear to be quite rare. Just to put it in perspective, the risk of getting myocarditis or having any other issue that affects the heart is quite a bit higher with COVID infection than it is with vaccination, even in adolescents.

My second point is really just a general comment about risk. Sometimes, we see something like this and think, ‘Oh my gosh, there's a risk,’ but really, there's some level of risk in everything we do. Because vaccines are generally given to healthy people to prevent disease, they're held to a much higher safety standard than any other medicines.

How are the risks of the vaccine being assessed?

There's a robust safety surveillance system monitoring for any potential adverse events or side effects from vaccines to ensure they are safe. That’s been going on for several decades now with our routine vaccines. With these COVID-19 shots, a number of new systems are also monitoring these vaccines in real-time.

As more and more doses are given, we have more data to be able to understand what exactly the risk is and whether the benefits of the vaccine continue to outweigh that risk. So far, the answer to that appears to be yes, that the benefits continue to far outweigh the risk of this potentially rare side effect.

What do you think of the recent CDC guidance saying that fully vaccinated people don’t have to wear masks in schools?

I think they're trying to create a balance there between incentivizing vaccination and doing what the science supports. And I think the science does support, at this point, the idea that fully vaccinated people are generally protected. The implementation can get a little bit tricky, though. Some schools will be very good at being able to say who's vaccinated and who's not and enforcing masking based on that, but it can be tricky.

That said, I think requiring masks indoors where COVID is increasing is also entirely reasonable.

What else should parents be taking into account as they consider the COVID-19 vaccine for their children?

Routine vaccinations really fell off during the pandemic, and it’s important to make sure that your children are up to date on their other vaccines. As we start to gather more in groups, if we don't bring those other vaccination rates back up, we're going to see outbreaks of other diseases that are, in fact, even more severe in kids than COVID-19.