Everything you must know about your kids getting the Covid-19 vaccine

Kids as young as five will soon be able to be vaccinated against coronavirus — here’s all your questions on the vaccine answered.

While Australia’s vaccination rollout had a slow start, we’ve since become one of the most-vaccinated countries in the world.

More than 88 per cent of Australians aged over 16 are fully vaccinated, and more than 93 per cent of adolescents have had their first dose. But, young children are still missing from the mix.

From early next year, children as young as five will likely be vaccinated against coronavirus as the rollout expands to include those below the age of 12.

Pfizer’s Covid-19 vaccine has been provisionally approved by the country’s medical regulator and is likely to get the green light.

Some parents are worried the vaccine could have serious side effects on their kids.

We asked five experts — Deakin University chair of epidemiology Professor Catherine Bennett, Associate Principal research fellow at the Burnet Institute Michael Toole, University of Melbourne’s Nossal Institute for Global Health Professor Nathan Grills, University of South Australia epidemiologist Adrian Esterman and Doctor at the Department of Paediatrics at the University of Melbourne Daryl Cheng — to clarify any concerns.

Children aged 5 to 11 years-old will be vaccinated against the virus from early next year. Picture: AFP

WHY SHOULD KIDS GET JABBED?

Professor Catherine Bennett: Since Delta arrived, kids are no longer as spared from infection as they were previously. They generally do still have mild infections, thankfully, but a small percentage can become quite unwell, and a very small percentage, about one in 3000, can have longer-term complications with Multi-System Inflammatory Syndrome. Just over one per cent children with infections end up on hospital, but we are seeing more now because the number of infections has risen in this age group. School-aged children make up about one third of active cases now, so if we can reduce that through vaccination, we will have fewer kids infected, a smaller number ending up in hospital, and fewer school disruptions.

Michael Toole: Children can get infected and spread it to other children, parents and grandparents. About one third of Delta cases in Victoria are children under 12 years of age. While Covid-19 is usually mild in children, occasionally there is Multi-System Inflammatory Syndrome, which is very severe. One child has died in Victoria and 172 children have died in the US.

Nathan Grills: Vaccination decreases the risk of bad outcomes from Covid in kids. Children are just as likely to be infected with Covid-19 as adults, and can get very sick, although at lower rates than adults. In the US, according to the CDC, children ages five through 11 years have experienced more than 8300 Covid-19 related hospitalisation and nearly 100 deaths from Covid-19. In fact, Covid-19 ranks as one of the top 10 causes of death for children aged five through 11 years. They can also have both short and long-term health complications from Covid-19 such as long Covid. Spread Covid-19 to others, including at home and school. The vaccine is very effective against severe disease and death.

Adrian Esterman: Children rarely get sick from Covid-19. However, children with some underlying health conditions, including diabetes, obesity and asthma are at risk of symptomatic disease and potentially severe illness. Very rarely (approximately 300 in every 1,000,000 infected children) can develop a severe illness called multisystem inflammatory syndrome (MIS-C). Although we need more research, infected children including those with no symptoms can also get long-Covid — that is health problems caused by the infection three or more months after recovery. The main problem is not so much illness, but that children can and do get infected and can pass it on to others, not so much at school, but definitely within the family, especially vulnerable grandparents. Getting vaccinated can help keep your child in school and more safely have playdates and participate in sports and other group activities.

Daryl Cheng: The effectiveness and safety data have now shown that the benefits of vaccination for children aged five to 11 outweighs the chance of serious side-effects. In this age group, vaccination helps to reduce the chance of getting Covid-19, as well as any severe impact which results in the need for hospital admission or long-term complications from Covid-19.

A nurse prepares the Pfizer-BioNTech Covid-19 vaccine. Picture: AFP

IS IT SAFE?

CB: The trials showed good tolerance to the vaccines, but the numbers studied, even though in the thousands, will not pick up very rare reactions to the vaccine. But are also watching the Pfizer vaccine being rolled out in other countries like the US where more than five million doses have already been given to children under 12, so every week we have access to more and more real-world safety data. Out of all those kids vaccinated in the US, there have only been for very mild cases of myocarditis so far, and they recovered very quickly.

MT: Yes. The original trial by Pfizer of 2500 kids found no severe side-effects. But now, we have real world data from the US where 4.3 million children have received one dose and one million the second dose. No severe adverse events have been reported to the US CDC including cardiac inflammation reported (rarely) in young men.

NG: Yes. Some have no side effects and some transient swelling, redness, and pain at injection site, fever, tiredness, muscle pain. Serious adverse events are very rare. There is a lower risk of myopericarditis than in adolescents and there were none in the Pfizer trial on five to 11 year olds. Long-term effects are unlikely and there is no early evidence suggesting this.

Vaccine side effects are rare, even in children. Picture: AFP.

AE: The side effects of the vaccine in children are similar to those seen in adults. They might get some pain at the injection site, feel a bit tired, have headaches, achy muscles or even a fever. However, these will nearly always clear up within 48 hours. Children, like adults, can get conditions called myocarditis and pericarditis after receiving the Pfizer of Moderna vaccine. This is, however, incredibly rare (less than 200 cases per million vaccinated children) and much rarer in younger children than older ones.

DC: Vaccination for kids between the age of five to 11 years is safe. Real-world data from more than five million doses in this age group not only shows no new adverse safety signals so far, but has also shown that children are generally experiencing far fewer significant adverse events compared to the older population.

Experts say the Covid-19 vaccine shouldn’t be mandated in children. Picture: AFP

SHOULD IT BE MANDATED?

CB: No. we had great uptake among the 12-15 year-olds even before they were incorporated into the vaccine economy in Victoria. As infection rates in the community are brought under control, and with high vaccine rates in older kids and adults, we really don’t need to go to more extreme rules to push younger kids to be vaccinated.

MT: Not at this stage. Governments need to clearly communicate the benefits of vaccination to parents so they’ll be confident to send their kids to school next year without the disruptions caused by a Covid-19 case in schools.

NG: It’s a hard one. No, I don’t. Kids have had to suffer enough during the pandemic without creating further issues. Where parents make ill-informed decisions and decide not to vaccinate, it is not fair that the kids suffer by being excluded. I’ll be vaccinating my three young children.

AE: From a public health viewpoint, vaccination against Covid-19 should be mandatory for all eligible adults and children. However, this is not an easy decision to make. Parents are naturally concerned about the safety of the vaccine for their children, and serious illness is rare in children. So, unless Omicron turns out to cause serious illness in children, I don’t believe that mandatory vaccination is necessary.

DC: As the immunisation rate across the population increases, this will improve protection against infection. But this should not be an indication for mandates to be extended to children – rather they should be potentially reconsidered for all age groups in light of greater overall population coverage. Vaccine mandates should be used as a last-resort effort for population protection, rather than as a first-line measure. Policy makers should consider carefully the impacts, both epidemiological and ethical, when evaluating vaccine mandates.

Professor Catherine Bennett said children with an increased risk of serious illness should get the Covid-19 vaccine.

WHICH KIDS SHOULD GET IT REGARDLESS?

CB: Vaccination is particularly important for children who might be at increased risk of more serious illness themselves, or who are living with someone who is more vulnerable to infection. But as vaccines will also help keep children in school, kids who do better in fact to face learning, or who are finding it hard to cope with the disruption of being sent home, will also benefit, as with more children in their class the less likely it is that the virus will be brought into class. Also, vaccinated children may be less likely to be sent home as they are at less risk of being infected after an exposure, as well.

MT: All kids aged five to 11 should receive the vaccine unless there is a medical contraindication (extremely rare).

NG: All kids really. But, especially those with disabilities and medical conditions that might make them more vulnerable to Covid. Again, they should consult their medical practitioner if they have significant health issues in order to talk through the approach which may include increased doses.

Experts say the benefit of getting the Covid vaccine for your kids is reduced risk of infection. Picture: Ian Currie

WHAT IS THE RISK VS BENEFIT?

CB: We aren’t seeing serious reactions to the vaccine in this age group, even though millions have already been vaccinated overseas. The benefits include a reduced risk of infection and of progression to serious disease. Data on the 12-15 years vaccine-induced immunity show that the protection from infection is more sustained in younger people, with the initial antibody protection lasting out to the most recent measurement at four months, compared with adults where waning began by three months. So kids may have better protection for longer than adults, reducing their risk of infection and therefore the possibility of any long-term effects, including the multisystem inflammation syndrome that is an extremely rare, but very serious condition. And of course, reduced risk of infection means reduced risk of being sent home from school.

MT: The benefits far outweigh the risks. If a child is infected with Covid there is less than one per cent risk of severe disease and hospitalisation. The vaccine poses zero risk, except for mild symptoms like pain at the injection site and headache.

Vaccination reduces the risk of infecting others.

NG: The risk is very low. It’s very safe. The usual minor, fully reversible, symptoms, myocarditis and pericarditis, are rarer than in adolescents. And it is mild and self-limiting and can be treated at home with anti-inflammatories. The benefit is clear – personal protection and for the common good. Getting a Covid-19 vaccine can help protect young children from contracting Covid-19, which can be severe. It also helps protect family members, including siblings who are not eligible for vaccination and elderly and vulnerable family members who might be at increased risk of getting very sick if they are infected. It also increases the chance of them staying in school and participating safely in sports, parties, group activities and other normal kid stuff.

AE: The Australian Technical Advisory Group on Immunisation (ATAGI) and Therapeutics Good Administration (TGA) carefully weighs up the risk and benefits when approving vaccines for adults and children. At the moment, they consider that the benefits outweigh the risks of vaccinating children.

DC: The real-world safety findings from overseas countries, including the US/Canada, for vaccinations in children aged five to 11 year olds — along with the emergence of Omicron and other variants that may have increased infectivity and impacts on children — contribute to the ongoing benefit-risk evaluation for Covid-19 vaccination in children. If the safety risks or concerns for this age group diminish, and the clinical impacts, such as infection rate, hospitalisations, long Covid and PIMS-TS on the paediatric population increase, the risk benefit pendulum swings toward vaccinating the paediatric population.

SYMPTOMS ARE MILD, WHY SHOULD THEY GET IT?

CB: The main benefits are in reducing the chances that they might be one of the one in 3000 with the more rare longer-term impacts of an infection, which are rare, but less rare than serious effects from a vaccine. As we learn to live with the virus, eventually everyone will be exposed and so protecting against infection is important, but so, too, is the extra protection the vaccine gives that can reduce the very small likelihood of having more serious illness. It also reduces risk that children in this age group will take the virus to school leading to class disruption, or bring the virus home to family and friends.

MT: Slight risk of severe disease plus risk of spreading to parents and grandparents. Omicron will emerge as the main strain next year and has been shown in South Africa to cause many “breakthrough” infections in the fully vaccinated.

Children may not get severely ill from Covid but they are still susceptible to other complications from Covid-19. Picture: AFP

NG: There is a much lower rate of severe illness than in adults but still a risk of illness and severe disease that could be prevented by a vaccine. For example one in 3000 children who contract Covid get an immunologic condition called Multi-System Inflammatory Condition, which can leave them ill for months. Certain children are specifically at high risk. About 25 children have died in the UK and 15 had a disability. Vaccinating children gives parents more confidence to send children to school, sporting events and other social activities. While the risk of bad outcomes from Covid is small for young children vaccines will protect other family members who may be more at risk.

DC: Although kids may have milder symptoms compared to older members of the population, they are still susceptible to other complications arising from COVID-19 disease such as long Covid and PIMS-TS/MIS-C. As the number of cases in the paediatric population increase, the numbers of those with these potential complications also increases. Vaccination will help to prevent these by reducing transmission and spread, and hence the overall case number in the population.

WHAT’S HAPPENING OVERSEAS?

CB: Some are starting to rollout to the more vulnerable in this group, like France, others in the EU are starting their rollout on Dec 13, so we will also have their safety data to look at before any rollout might begin here in January. China is rolling out to this age group with their own vaccines, Canada too, and the US had already vaccinated 10 per cent, or 2.5 million, by mid-November. It’s too early to see an impact on overall infections yet in the US, and the adults rates aren’t as high as in Australia, so the impact won’t be as noticeable as here where now we have so few unvaccinated above 12, those under 12 are overrepresented among our latest cases, making up to one third of new infections.

MT: the US, Canada and Israel have most experience and all report high efficacy and good safety. China and Cuba are also vaccinating children. The EU will begin vaccinating kids in mid-December.

NG: 10 per cent of USA kids aged 5-11 are vaccinated with Pfizer with very few severe adverse events reported. Canada recently started as have many European countries

AE: Many countries including most of Europe, the USA and Israel have either started or are just about to start vaccinating children aged 5-11. Other countries still only vaccinate children aged 12 and over — but this will no doubt change in 2022. Pfizer is expected to seek approval from the FDA (America’s version of the TGA) in the first half of 2022 for the vaccine for 2 to 5-year-olds and in the second half of 2022 for the vaccine for children aged between six months and two years.

DC: Vaccination for kids between the age of 5-11 years old have been happening in countries such as the USA and Canada. So far, there have been more than five million doses of vaccine administered in the US, including more than one million second doses of vaccine. Safety surveillance of this age group not only shows no new adverse safety signals thus far, but has also shown that children are generally experiencing far fewer significant adverse events compared to the older population.

Vaccines don’t remove the risk of becoming infected, experts say. Picture: AFP

WHAT ROLE DO KIDS PLAY IN TRANSMISSION?

CB: Since Delta came along, and it looks to be the same for Omicron, kids are now just as likely as adults to be infected. Vaccines don’t remove the risk of getting infected, but they do reduce the risk, and that means vaccinated kids are less likely to have the virus to pass it on. Vaccines also reduce the infectious periods in adults and we would expect the same in children, even if they do still develop an infection, so this also reduces the risk that they will spread the virus to others.

MT: Pfizer is a very effective vaccine and reduces transmission by about 90 per cent after the second dose in children. Children can get infected and spread it to other children, parents and grandparents. About one third of Delta cases in Victoria are children under 12 years of age.

NG: Vaccines help minimise transmission in kids and families. My kids have had exposures at cricket and basketball in the past few weeks.

DC: More recent data tracking cases in Australia have shown that kids, especially in the five to 11-year-old group, are playing an increasing part in transmission of the virus through families, schools and communities. Vaccination will assist in helping to reduce the risk of transmission in the population.

DO THEY GET THE SAME DOSES AS ADULTS?

CB: The Pfizer paediatric dose is one third of that of adults each time, and ATAGI may decide for it to be given at a slightly wider interval if this might provide even better immunity, and perhaps reduce the risk of any side effects on the second dose even further.

MT: No, kids will receive one third of the adult dose.

NG: One third of the adult dose. Different vials to minimise any chance of mix-ups.

AE: The dose of Pfizer being given to five to 11-year-old children is one third of the adult dose, and consists of two injections three weeks apart. All vaccines contain inactive ingredients that help stabilise them. The Pfizer vaccine authorised for five to 11 year olds does contain some different inactive ingredients to the one used for older children and adults.

DC: Kids between the ages of five to 11 years old receive an age-appropriate dose, which is approximately one third of the adult dose.

Some vaccine side effects include pain at the injection site and mild fever. Picture: AFP

WHAT ARE THE SIDE EFFECTS?

CB: As in adults, most common side effects are short-lived, mild reactions, including sore arms around the site of the vaccination, fatigue, headaches, muscle pain and a mild fever.

MT: Perhaps pain at the injection site, mild fever and headache and fatigue lasting 24 to 48 hours.

DC: The majority of the side effects seen in children after Covid-19 vaccine are expected effects that signal their immune system is building protection. These may include pain, redness and swelling at the injection site, or more generalised symptoms, such as muscle pain, chills, fever and tiredness.

WHAT’S THE INFLAMMATORY HEART CONDITION?

CB: None of the 3100 children in the five to 11-year-old trials across four countries developed myocarditis, and only four cases have been confirmed in the US roll out that now includes five million five to 11-year-old children. Fortunately they were all very mild cases and resolved quickly.

MT: The TGA has reported 8.5 cases of myocarditis per 100,000 doses of Pfizer in teenage boys aged 12-17 and much lower rates in older age groups. About one half were hospitalised but most were discharged after four days. No deaths occurred. The risk of myocarditis is much higher with Covid-19 infection than from the vaccine.

DC: Myocarditis and pericarditis are inflammation of the heart muscle or heart lining. There have been an increased number of cases above the expected population rate of both conditions in individuals who have received mRNA Covid-19 vaccines.

Young males are at most risk of this condition, and thus the community was concerned that this side effect may also extend to younger children. Thus far, there has been no indication that there is a similar safety concern for children receiving a Covid-19 vaccine aged five to 11.

In South Africa, there has been a spike in hospitalisations of kids under four for Covid-19. Picture: AFP.

HAS OMICRON LED TO MORE KIDS IN HOSPITAL?

CB: We have only heard this from one province in South Africa so far, and so we are awaiting more information to know whether this is a true pattern or not. Early reports attributed some of this to precautionary admissions as it was unusual now to see kids with any symptoms. It is certainly something we need to watch, for if Omicron increases the risk of more serious symptoms in kids, that would shift the risk benefit ratio even further toward vaccination.

MT: In Gauteng province of South Africa there has been a huge spike of hospitalisations among children under 4. However, we don’t yet have data on the severity of their illness.

NG: There is no evidence yet as they are too few cases. Kids are immunised at low rates so they are more likely to get infected and therefore higher number in hospital.

DC: Ongoing investigation into the Omicron variant is under way, including its impacts on the paediatric population. If there are signs that there is a greater impact on children, it further strengthens the benefits for vaccination in the paediatric age group.

Increased vaccination among children will hopefully stop the spread of the virus in schools. Paul Jeffers

WILL VACCINATED KIDS REDUCE SPREAD IN SCHOOLS?

CB: That is the hope, fewer kids infected means fewer kids to take the virus into a school, and less risk the virus will spread even if they do. Vaccination status will also come in to the risk assessment among kids in the same class as a case, and may make it more likely that your child will be allowed to test and stay in class than if not vaccinated. Kids will benefit collectively and individually as the proportion who do get vaccinated rises.

MT: Yes, Pfizer is a very effective vaccine and reduces transmission by about 90 per cent after the second dose in children. We don’t yet know if it will be as effective against Omicron. But reduced infections will lead to fewer disruptions in schools. But we need a vaccines-plus approach and must continue to improve ventilation in schools.

NG: Yes. Vaccine effectiveness means a roughly 50 to 60 per cent decrease in infection risk – in addition to 90 per cent decrease in severe disease. So the chance of a vaccinated child being positive and at school is decreased by 50 per cent. If they are positive then the chance of them passing it on to another vaccinated child is again reduced by 50 per cent.

DC: Vaccination of the population is primarily designed to reduce the chance of severe Covid-19 disease or clinical outcomes (such as ICU admission or death). However, the vaccine has also been shown to have an impact on helping to reduce of transmission of Covid-19 disease between people. Vaccination will definitely help to reduce the spread between close contacts at school for teachers and students in a situation where there has been exposure to a positive case.