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Children aged 5 to 11 can begin to be vaccinated against Covid-19 within the next day or two after an expert panel advising the Centers for Disease Control and Prevention recommended Tuesday that Pfizer’s pediatric vaccine should be used in this age group.

The recommendation, which passed by a 14-0 vote, was approved a couple of hours later by CDC Director Rochelle Walensky.

“Together, with science leading the charge, we have taken another important step forward in our nation’s fight against the virus that causes Covid-19,” Walensky said in a statement. “We know millions of parents are eager to get their children vaccinated and with this decision, we now have recommended that about 28 million children receive a COVID-19 vaccine.

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“As a mom, I encourage parents with questions to talk to their pediatrician, school nurse, or local pharmacist to learn more about the vaccine and the importance of getting their children vaccinated,” Walensky said.

The Pfizer vaccine for children 5 to 11 years of age is the first pediatric Covid vaccine authorized for use in this country. The vaccine is one-third of the size of the adult vaccine doses; children will get two injections containing 10 micrograms of antigen given 21 days apart.

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Veronica McNally, the consumer representative on the Advisory Committee on Immunization Practices (ACIP) and the mother of a child who is now eligible to be vaccinated, noted that parents of 94 kids have had to bury a child killed by Covid-19. “I really am doing this to prevent number 95. The 95th death,” she said.​

The recommendation was applauded by the American Academy of Pediatrics. “Sharing this life-saving vaccine with our children is a huge step forward and provides us all with more confidence and optimism about the future,” AAP President Lee Savio Beers said in a statement. “Pediatricians are eager to participate in the immunization process and talk with families about this vaccine. We want to ensure that access to this vaccine is equitable, and that every child is able to benefit.”

A large and vocal portion of American parents have been waiting impatiently for this development, eager to help their children get back on the road to a safer and more predictable future. Their hope is that swift uptake of vaccine in this age group will dramatically reduce the amount of disruption kids face in their day-to-day lives.

How many parents will move to vaccinate their children at this point remains to be seen. Polling estimates vary, with between 34% and 57% of parents surveyed saying they plan to have their children in this age group immunized, CDC’s Sara Oliver, an epidemiologist, told ACIP members during a presentation Tuesday.

While some doses will be available this week, “the program will still be ramping up to its full strength, with millions more doses packed, shipped, and delivered, and thousands of additional sites coming online each day,” Jeff Zients, the White House Covid-19 response coordinator, said on Monday.

He said the kids’ vaccine campaign will be fully up and running next week, and that the administration has secured enough supply of the Pfizer shot for the 28 million kids in the age group.

Michael Hogue, a non-voting representative to the committee from the American Pharmacists Association, warned that parents who want to have their children vaccinated at a pharmacy will likely need to make an appointment and they will probably have to wait. Pharmacies, like many other businesses, are experiencing staffing shortages, Hogue said.

Covid-19 causes less severe infection, in general, in younger children. But over the past year and a half, children have been shuffled between in-person and online school, and have seen their activities restricted because of concern about Covid transmission.

“I value preventing infection in children and I think it could have a huge positive impact on their health, their social and emotional wellbeing, their educational outcomes and their long-term trajectory,” said Grace Lee, a professor of pediatrics at Stanford University School of Medicine and chair of the ACIP. “While we do have other ways to prevent infection, such as masking, we know that there is substantial variability in the use of masks in school settings … and vaccines are really the only consistent and reliable way that we can provide that protection.”

Even though the SARS-CoV-2 virus, which causes Covid, does not affect young children as badly as it does adults, they have not escaped unscathed from the pandemic. To date, 745 children under the age of 18 have died from Covid since it arrived in this country; 94 of them were in the 5-to-11 age group. That death toll far exceeds the number of deaths influenza inflicts on children each year. Flu deaths in children vary from year to year but are often within the 150 to 200 range.

Young children can also develop long Covid — persistent symptoms after recovery from their acute infection — though they do so at lower rates than do older people. And they can develop multisystem inflammatory syndrome in children, or MIS-C, a worrisome constellation of symptoms that can develop after an infection. From Feb. 19, 2020 to Sept. 23, 2021, 5,417 children in the U.S. developed MIS-C. Of those, 2,316, or 44%, were aged 5 to 11; nine children died.

Without access to vaccines, such tragic statistics would increase, experts warn. “These kids are not in a cocoon. They’re not at home,” said Norman Baylor, president and CEO of Biologics Consulting and a former head of the FDA’s Office of Vaccines. “These kids are in school and they are exposed to everything.”

There are concerns, though, about whether children in this age group will be at risk of developing myocarditis or pericarditis — inflammation of the heart or tissue surrounding the heart, respectively — an adverse event that has been associated with the messenger RNA vaccines like the Pfizer shot. The risk is highest in males aged 12 to 29.

Much of Tuesday’s discussion was spent on the issue of myocarditis, which committee members clearly expect will be a key factor when parents weigh whether to vaccinate their children. Matt Oster, a pediatric cardiologist who works for the CDC, told the group that most cases of myocarditis after vaccination are mild and of short duration. Oster told the panel that to date, there have been no confirmed deaths in children who developed vaccine-related myocarditis.

The risk of myocarditis in the younger age group is likely to be lower, Oster said, though he said the expectation is based on what is known about the risk of classic myocarditis — cases not related to receipt of the Covid vaccines. And he stressed that Covid infection is more likely to trigger myocarditis than getting a Covid shot. “Getting Covid is much riskier to the heart,” he said.

As eager as some parents are to get their children vaccinated, another portion of the country’s parents have been dreading this day. Many fear that the authorization of the vaccine for kids aged 5 to 11 will lead states to add Covid-19 vaccination to the list of jabs kids are required to get to attend school.

There are already approximately 15 million doses of the pediatric vaccine that have been ordered by states and are either in place or on their way to pharmacies, doctors offices, and other locations where children will be able to get vaccinated.

Several members of the committee expressed concern about how the pediatric vaccine will be rolled out and whether low income families and families of color will find easy access to places where they can get their children vaccinated.

It will also be critical that information on how to use the pediatric vaccines makes its way to family physicians in rural parts of the country, Glen Nowak, director of the Center for Health and Risk Communication at Grady College of Journalism and Mass Communication in Athens, Ga., commented after the meeting. In some parts of the country, Nowak said, family physicians rather than pediatricians will be vaccinating kids against Covid.

“They don’t give as many vaccines, but they’re trusted health care providers,” he said. “And the issue will be how fast and how well can information about this vaccine recommendation and these Covid vaccines get to them so that they can answer parents’ questions and concerns.”

Andrew Joseph contributed reporting.

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