Why a COVID-19 Vaccine for Children May Take Awhile

An adult vaccine will happen more quickly
Child receiving vaccine at doctor's office

It feels like the whole world is waiting on a coronavirus vaccine. And although there are several promising possibilities in clinical trials, there is still a long way to go – especially for a children’s vaccine.

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Pediatric infectious disease specialist Frank Esper, MD, explains the ins and outs of developing a vaccine for children and why the first COVID-19 vaccine likely won’t be approved for kids.

The rush for an adult vaccine

“In order to get this pandemic somewhat under control, we’re going to need some sort of vaccine for both adults and children as quickly as possible,” says Dr. Esper. “But right now, most vaccine manufacturers are focusing on an adult version.”

And why is that? Because data shows that severe illness from COVID-19 tends to happen to adults (especially in older adults). We’re not seeing the same sort of response or sickness in children.

That’s not to say that children are immune to COVID-19, because they aren’t, but they tend to be more resilient and fare better if they get sick, notes Dr. Esper. (Although a very small number of kids have developed a serious inflammatory condition linked to coronavirus.)

Some manufacturers are already working on a children’s vaccine, but the majority are focusing on an adult version first. Once that is available, many of the companies will likely move onto developing one for children.

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One of the reasons for focusing on an adult version is because when children are involved in clinical trials, there is oftentimes more layers of protection to go through. For instance, the child and both parents typically have to agree to participate in the trial or study.

“Kids are a special and vulnerable population and we try to protect them because they can’t make decisions for themselves,” says Dr. Esper. “In clinical trials – whether for a vaccine or any type of treatment – we don’t want to speed things up because it’s a matter of protection and safety.”

So the priority right now is for an adult vaccine, not only because of the outcomes we’re seeing, but because an adult vaccine is going to be faster to create due to the potential risk and rigorous safety precautions needed for the development of a children’s vaccine.

Children’s immune systems are different than adults

Immune systems in kids can vary greatly depending on age. A 16-year-old is going to have a much different immune system than a 16-month-old. Because of this, additional data and research is needed when evaluating a vaccine for kids.  

It’s even true for the flu shot. Babies 6 months and older should get a flu shot every year, but some kids 6 months through 8 years of age may need two doses for more protection. This is because of differing immune system responses at different ages.

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“Children’s immune systems are growing up just as they are,” explains Dr. Esper. “We often split kids up by age groups and stages. We can’t just say all kid’s immune systems are the same at any given age.”

For adults, we’re often lumped together from age 18 to 65 and then 65 and over. With children, there is a much wider range in terms of stages and ages because they are still growing and developing. All of this has to be taken into consideration with a vaccine since kids at varying ages will likely respond differently.

Because of all the challenges with kid’s immune systems and the protection and safety protocols in clinical trials, when a COVID-19 vaccine is available, it likely won’t be approved for children. However, it’s still important to note that in order to get a handle on the pandemic, it will require vaccinating both adults and children.

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