Q&A: Should children be included in COVID-19 vaccine trials?
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According to the authors of a recent paper in Clinical Infectious Diseases, the “true burden” of SARS-CoV-2 in children may be underrepresented based on a number of factors that make them less likely than adults to be tested.
“While the role of children in the chain of transmission of SARS-CoV-2 remains to be fully defined, they likely play an important role based on our knowledge of other respiratory viruses,” Carol M. Kao, MD, assistant professor of pediatric infectious diseases at Emory University School of Medicine, and colleagues wrote.
As a result, Kao and colleagues argued that to achieve herd immunity, COVID-19 vaccine trials should include children.
Healio spoke with Kao about why it is important to advance SARS-CoV-2 vaccines in children.
Question: Why is it “likely” — as you write in your paper — that children play an important role in the transmission of SARS-CoV-2?
Answer: We believe that children likely play a role in the spread of SARS-CoV-2 based on available data and our experience with other respiratory tract infections. Although children comprise a small amount of overall confirmed COVID-19 infections and hospitalizations, they are more likely than adults to be asymptomatic or have minimal symptoms and thus less likely to be seen by a health care provider or be tested. In addition, early school closures may have temporarily mitigated the disease burden in children. Until large-scale population studies are complete, the true burden of SARS-CoV-2 in children remains unknown.
Q: By how much could the “true” burden of SARS-CoV-2 in children be underestimated?
A: It is difficult to estimate the true burden of SARS-CoV-2 in children until the completion of large serosurveys in communities impacted by COVID-19.
Q: Why should children be a target of any vaccination efforts against SARS-CoV-2?
A: Children have been linked to the community spread of other respiratory and gastrointestinal pathogens, and their role in transmitting these pathogens to adults was underappreciated until after the implementation of widespread pediatric vaccination. For example, decreases in pediatric and adult hospitalizations for gastroenteritis occurred after introduction of infant rotavirus vaccination. There is also limited evidence for fecal-oral transmission of SARS-CoV-2, which would place caregivers and those that interact frequently with children at high risk for acquisition.
Q: Is there an indication right now that they will not be included in vaccination efforts?
A: There are a number of current and upcoming COVID-19 vaccine clinical trials in adults. We advocate that planning for clinical trials in children should begin now and studies should be implemented as soon as preliminary data are available about safety in adults from phase 2 trials.
Q: What are some potential barriers to vaccinating children against SARS-CoV-2 if or when a vaccine is available?
A: Particularly early after licensure, there may be a limited supply of vaccine and a need to prioritize high-risk populations. Additional information regarding which age groups are first affected would be helpful to inform whether vaccination should target young children or school-aged children. Even after a vaccine becomes widely available, educational campaigns to inform health care providers and parents will be vital to minimize barriers to immunization.
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