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October 26, 2021

National Academies Offers Guidance for Boosting Confidence in COVID-19 Vaccine for Children

Author Affiliations
  • 1Consulting Editor, JAMA Health Forum
JAMA Health Forum. 2021;2(10):e214145. doi:10.1001/jamahealthforum.2021.4145

As US health authorities appear poised to approve a COVID-19 vaccine for children younger than 12 years, the National Academies of Sciences, Engineering, and Medicine (NASEM) has unveiled “actionable guidance” from experts to help build confidence in vaccination for COVID-19, especially for parents who are considering having their children vaccinated.

Some key factors playing a role in parents’ decisions about COVID-19 vaccines include concerns about possible adverse effects, how well the vaccine works in children, availability of research in the child’s age group, and recommendations made by clinicians who care for their children.

The guidance comes at a time when the Biden administration is rolling out plans for vaccine distribution in anticipation of possible authorization of a Pfizer-BioNTech COVID-19 vaccine formulation for 5- to 11-year-old children in the coming weeks.

Although US cases of COVID-19 continue to decrease, the overall level of community transmission is still high, the Centers for Disease Control and Prevention (CDC) noted on October 21, with a 7-day average of 73 079 new cases daily, and most hospitalizations and deaths occurring among people who are not vaccinated.

The authors of NASEM’s rapid expert consultation note that the rise of the highly transmissible Delta variant and the potential for other new variants emerging among unvaccinated people point to the urgent need for vaccine uptake among people currently eligible to be vaccinated and among children younger than 12 years when vaccination is approved for that age group.

“The emergence and spread of new variants also signal the need for increasing the acceptability, trust, and accessibility of vaccinations,” the authors said.

Recent data indicate that the Delta variant can rapidly spread in schools when unvaccinated adults, such as teachers and staff, come into close contact with unvaccinated children. In addition, unvaccinated parents are at risk of infecting their children, who then may spread the infection in their schools.

“Vaccinating children and youth will likely play a critical role in limiting the spread of COVID-19,” the NASEM guidance says. “This rapid expert consultation identifies actionable guidance that state and local decision makers can use to communicate with the public to build confidence in and promote the uptake of COVID-19 vaccines.”

In two earlier NASEM consultations on communicating with people who are not vaccinated for COVID-19, the authors recommended several strategies, including pointing to new events or evidence to urge vaccination, without criticizing individuals’ previous decision to reject vaccination; showing people data from 3 or more time points to highlight changes in vaccination rates among groups they relate to; using individuals or groups they trust to deliver a message about vaccination; and targeting false claims about vaccination to help build vaccine confidence, as well as other strategies.

In the new expert consultation, the authors outlined additional strategies for communicating specifically with parents. For example, to ease parents’ concerns, communications can stress the safety and efficacy of approved vaccines that are available for children, they said. Surveys of parents have found that many are concerned about potential immediate adverse effects of the vaccines, as well as the potential long-term adverse effects, including the possibility that the vaccines might affect their child’s future fertility.

“These are not unreasonable concerns for parents to have given the novelty of COVID-19 and the newness of the vaccines,” the authors noted. “Developing communications that include specific facts about side effects, such as comparisons of the frequencies of adverse consequences of vaccines in comparison with the adverse consequences of contracting COVID-19, and presented in a way that is easy to understand, such as using graphics or analogies, could help to address these concerns.”

Messages could also stress the safety data from the clinical trials for children and adolescents aged 12 to 17 years and the relatively rare occurrence of serious adverse events among the children and teens who have already been vaccinated. Describing ongoing efforts by scientists to learn more about the vaccine and to monitor vaccine risk may also help allay parents’ anxieties, the authors said.

In addition, engaging parents with offspring younger than 12 years, who may perceive these children as especially vulnerable, “could be critical for increasing vaccine confidence for parents of children in this age group,” the authors wrote. Conversations could focus on an overall description of the regulatory process and of the rigorous process for conducting clinical trials, a “reasonable extrapolation” of the data for adolescents, and the fact that the formulation for children involves a lower vaccine dose.

Encouraging parents to talk with the clinician who provides their child’s primary care is another key strategy to increase confidence in vaccinating children for COVID-19. Research has found that family physicians and other clinicians are trusted messengers and important sources of vaccine information and encouragement for parents.

To help clinicians have such conversations with parents about vaccines, the authors suggested that local, state, and national decision makers provide message templates and other resources for health professionals.

Another important strategy for boosting parents’ confidence in vaccination is engaging their social network—specifically, people whom parents consider trustworthy and influential in their communities, such as family members, friends, church members, coworkers, social media networks, and media.

“The influence of such trusted social network connections means that decision makers need to think broadly about who to include when developing communication messages for parents,” the authors noted.

The US Food and Drug Administration’s independent advisory committee is scheduled to meet on October 26 and the CDC’s independent advisory committee plans to convene on November 2-3 to consider whether to authorize the Pfizer-BioNTech COVID-19 vaccine for children aged 5 to 11 years.

On October 19, the White House announced a plan to ensure that if a vaccine is indeed given the green light, “it is quickly distributed and made conveniently and equitably available to families across the country.” The plan includes ensuring that more than 25 000 pediatric or primary care offices, tens of thousands of pharmacies, as well as children’s hospitals and health systems, school-based and community-based clinics, and rural health clinics will be ready to administer it.

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Article Information

Published: October 26, 2021. doi:10.1001/jamahealthforum.2021.4145

Open Access: This is an open access article distributed under the terms of the CC-BY License. © 2021 Stephenson J. JAMA Health Forum.

Corresponding Author: Joan Stephenson, PhD, Consulting Editor, JAMA Health Forum (Joan.Stephenson@jamanetwork.org).

Conflict of Interest Disclosures: None reported.