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Now that the age for administration of Pfizer-BioNTech’s COVID-19 vaccine has been approved for adolescents aged 12 to 15, new questions are being raised, including who will get it and how to make distribution most equitable.

Children are less susceptible to the disease caused by the virus, but they are likely to spread it to the adults in their lives if they are exposed, even though they may not seem ill or have a very mild case, so there is benefit to families and groups to having children vaccinated.

Clinical Trials on Adolescents

Like all medications, the vaccines under development were tested on adults first. Clinical trials on children are only permitted after medications or vaccines are determined to be effective and safe in adults.

The clinical trial of Pfizer’s vaccine included 2,300 adolescents and showed 100% protection from COVID. Moderna and Johnson & Johnson are testing their vaccines on this age group but have not yet received approval.

Pfizer and Moderna are currently testing on children from 6 months to 12 years of age, but approvals are not expected until early next year.

Concerns for Vaccinating Children

Even parents who are vaccinated may hesitate to have their children receive the vaccine for several reasons. Rather than personal belief in the benefit of the vaccine, they may have gotten their shots because they were requested to do so by their employer or heard that it will be mandatory in the future and want to be sure to get it done while it’s free.

One major factor that causes hesitation is that the vaccines are only available under an emergency use authorization and have not undergone the same rigorous testing that is normally required. While large-scale clinical trials have been done, there is no way to know if there will be any side effects of the vaccines that show up later, and parents are often willing to take more risks themselves than they are for their children.

Since children are more likely to spread the virus than actually become seriously ill themselves, families with immune-compromised members who can’t be vaccinated may be more inclined to have the young ones vaccinated so the family can feel safer about being all together.

Multisystem Inflammatory Syndrome in Children (MIS-C)

A less common but important consideration in favor of vaccinating children is that, in rare cases, children recover from COVID-19, then later develop symptoms like adults known as COVID “long-haulers,” and are affected long after the disease would normally have passed. These can include fatigue, shortness of breath, headaches and more.

In some children, this may be followed by a serious condition called multisystem inflammatory syndrome in children (MIS-C) which can be fatal. The cause isn’t known, and can show up a month later, after it looks like the virus is long gone. With MIS-C, the child experiences inflammation in the lungs, heart, brain, eyes, kidneys, skin or gastrointestinal organs.

MIS-C symptoms are the same as many childhood illnesses: fever, vomiting, diarrhea, abdominal pain, fatigue, etc. Identifying MIS-C involves blood tests, chest x-rays and ultrasound tests, and can be an expensive process. Most children with the condition will have to be hospitalized, some even requiring treatment in pediatric intensive care units (ICUs).

Equitable Distribution of the Vaccines

The US has almost 17 million children between the ages of 12 and 15, comprising 5.3% of the population. Of those adolescents, nearly half are people of color, with about 25% of those being Hispanic, almost 5 % Asian and a little over 13% are Black, according to statistics reported by the Kaiser Family Foundation’s report, Latest Data on COVID-19 Vaccinations Race/Ethnicity.

When COVID vaccines first became available and appointments were difficult to get, it quickly became clear that a disproportionate percentage of the shots were being given to white people relative to the population. The gap has narrowed, and Asians now receive the largest number of vaccines for the percentage of the population they comprise, but it is still the case that a smaller percentage of Black and Hispanic people are getting vaccinated.

In addition to the general equity concern, getting vaccines to people of color is especially important because the risk of severe disease is higher for Black and Hispanic adolescents than for those who are White.

Of the approximately 2,000 cases of MIS-C that have been diagnosed in the US, 69% are Black or Hispanic, which is a far greater percentage than it should be based on the population.

Government agencies and advocates are working together to address questions and concerns people of color have about the vaccine in campaigns to increase the number of vaccinated adolescents.

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