Why it will take months before kids get the COVID-19 vaccine

Doses of the COVID-19 vaccine are already in short supply, but that's not the main reason it will be months before children are able to be inoculated.

"The vaccines have not been tested on children," explained Dr. Sara Goza, president of the American Academy of Pediatrics, headquartered in Itasca. "But now is the time to start enrolling children in the vaccine trials because we should not really expect them to suffer the consequences of COVID-19 without getting the vaccine as well."

Goza and other health experts say it is routine to test potential vaccines on the adult population first. But even if a vaccine is proven safe and effective for adults, that doesn't mean it will have the same results for anyone under age 18.

"There are special rules in terms of medical studies and enrolling kids. That's a special protected class, if you will," said Dr. Ngozi Ezike, director of the Illinois Department of Public Health. "I don't know if it was Pfizer for sure - I remember someone being able to go and get some older teenagers that may have been enrolled. I don't know if there was enough information from those participants. That of course would have had to have an adult guardian's consent."

In fact it was Pfizer, which has a vaccine set to roll out for prioritized inoculations of health care professionals and residents of long-term care facilities as early as next week, that has begun running trials of the vaccine on children as young as 12. So far, a few thousand children have participated in those trials. By contrast, Pfizer tested its vaccine on more than 40,000 adults before seeking approval to release it.

Drugmakers Moderna and AstraZeneca also have vaccine candidates awaiting approval from the FDA. They are currently seeking children volunteers as well.

Depending on the outcome of those trials, children in the age groups tested could be deemed eligible, but not children any younger.

"The physiology of a 5-year-old is not the same as a 16-year-old," Ezike said. "Eventually, we will get to know more about who it can be given to, from the lower age limit to if there's an upper age limit."

The U.S. Food and Drug Administration's vaccine development website notes that trials of "vaccines intended for children are generally tested first in adults, with a step-down clinical development program to children and infants."

Which is the way it should be done, health experts agree.

"Children aren't little adults," Goza said. "Children just respond to things differently. They're smaller, so their bodies react differently to doses. It's those types of things you have to think about, how their kidneys and livers break things down differently."

Once the trials are underway, researchers have to watch for an array of results. It can take months to determine the effects.

In adults, the Pfizer vaccine requires two injections separated by 21 to 28 days. Researchers examining data on children need to determine the size of dosages, the best time interval between injections and how many to administer.

"By the way it's being phased in anyway, it will be months before children are even eligible to be vaccinated," said Dr. Jonathan Pinsky, medical director of infection control and prevention at Edward Hospital in Naperville. "The good news is that by the time children do get it, there will be a wealth of safety data available."

In Illinois, COVID-19 has killed just nine people under age 20, according to IDPH figures, a fraction of the 13,666 Illinoisans who have died from the respiratory disease. However, nearly 15% of all the cases in Illinois are in that age group.

Nationally, COVID-19 has killed 528 Americans under age 25, according to the U.S. Centers for Disease Control and Prevention.

Once the vaccine is approved for children, there's no guarantee every child in an American classroom will have been inoculated.

"The problem is we don't know what the spread in schools is like," Goza said. "It's up to each state to determine if a vaccine will be required for school re-entry or not."

It doesn't appear Illinois lawmakers or public health officials are ready to make that decision just yet. Ezike said school districts already struggle to get compliance with current IDPH vaccination requirements. She complained that parents use "loopholes" to get around those requirements, which she said caused a "mini-outbreak of measles" more than a year ago.

"Before we talk about any additional mandates, we just want to get past the situation we're in now," Ezike said Tuesday. "When this is in the rearview mirror, we can talk about what we need to do to keep it in the rearview mirror, and if school mandates will have to be part of that."