Dr. Doug Campbell

For over two years, parents and caregivers have been anxiously awaiting a COVID-19 vaccine for children under five. With Health Canada’s approval, their hopes will soon become a reality.

Dr. Doug Campbell is Director of the Neonatal Intensive Care Unit (NICU) and Deputy Chief Pediatrics at St. Michael’s Hospital. He’s responsible for the care of the youngest and sickest patients at St. Michael’s, and as a neonatologist, helping parents navigate difficult decisions on behalf of their babies is a big part of his work.

We spoke with Dr. Campbell about the COVID vaccine for kids under five, how well it works and why he says parents should feel ‘great comfort’ about vaccinating their kids.

How do you feel about a COVID-19 vaccine becoming available for children under five?

It’s really exciting that the youngest patient population will soon have access to a vaccine that is safe, provides an immune response and reduces infection. This will be especially helpful and of comfort to families who are understandably worried about the ongoing spread of COVID in our community. Especially to families with those at risk of severe disease, such as the immunocompromised and the elderly. It’s hard for these populations to protect themselves and unfair to ask them to shoulder the burden, when we can safely give the vaccine to healthy individuals to prevent the spread. This way we can enjoy each other’s company and get on with living – and many people haven’t been doing that the last few years.

An antibody or immune response; preventing infection; preventing severe symptoms or hospitalization. All of these measures of how well the vaccine works can be so confusing. What do they all mean?

I can see how this can be a bit of a confusing picture because there are a number of things that scientists look at when trying to understand ‘does a vaccine work.’ If we can generate an immune response from a vaccine that’s one outcome, but what most people are interested is in preventing a COVID infection in the first place. If we can’t prevent all infections, at the very least we want to prevent severe disease in vaccinated individuals. These are all different outcomes from a vaccine study, so when we read articles we need to be clear about the outcome we are talking about.

An immune or antibody response is a blood-level response that tells scientists that the body seems to be making a defense against the COVID infection. It doesn’t mean they will never get COVID, but it means that most children who got this vaccine seemed to generate a response, and that should help them be safe. It’s an important differentiator. With new strains of the virus, we know that an immune response may be helpful at preventing infection, but you can probably still get it. If you get the infection despite the vaccine, at the very least we hope you are still preventing severe disease and/or spread to others.

How well does this vaccine work?

The Moderna vaccine that’s been requested to be approved by Health Canada looks promising. The dose for children under five is one-quarter of the dose of the adult version, and the data suggests a good immune response. Some effectiveness data also showed it prevented children from getting infected with COVID.

I personally would recommend it based on what I’ve seen so far. It seems to be safe and there doesn’t seem to be any severe side effects in this initial population. It seems to produce an immune response and already somewhat effective at preventing infection – these are all good things.

It should bring great comfort to parents knowing they are keeping their child safe and preventing spread in the house – and that might be the more important reason why you want to get your child vaccinated as soon as possible.

If a child already had COVID, do they still need a vaccine?

We know in adults and older children, if you get COVID you can get re-infected in a matter of weeks. The short-term response that natural infection seems to give you – although the immune response is probably helpful – doesn’t seem to protect you long-term from recurrent COVID infection or a potentially more severe infection from another variant which we have not yet seen.

Vaccines seem to help your body develop a long-term protective response and prevent infection over many months, if not longer. More data is needed to understand how long protection can last after receiving a COVID vaccine, and how often we’ll need boosters, et cetera. At the end of the day, these newer COVID vaccines seem to provide an added benefit that a natural infection cannot do alone.

Will children constantly need new vaccines as new variants emerge?

It’s true that no matter what we do, there will likely be some new variants that emerge. However, the better we can protect ourselves as a population from preventing COVID, the less new variants will develop. It’s all of our responsibility to protect ourselves, our peers and fellow citizens by vaccinating to create a better herd effect and preventing more generations of new variants.

Having said that, there’s lot of places in the world where vaccination rates are unfortunately low and where new variants will be produced, and will eventually come into the Canadian context. One of the things that we’ve learned though, is that vaccines that were effective against the earliest strains of the virus seem to continue to provide protection against severe disease even with the Omicron variant, for example. It’s logical to protect yourself as best you can, knowing that previous vaccines have confirmed better safety against severe disease with upcoming strains. The good news about this recent pediatric data submitted to Health Canada is that the study was done when Omicron was circulating, and that provides more comfort to me as practitioner to recommend it for my patients today.

Should parents be worried about potential long-term side effects from the vaccine?

To be fair, the COVID virus, both in children and in adults, does cause long-term problems and that’s not a good thing. If we can prevent a COVID infection, clearly we should be able to prevent long-term complications from natural infection. The science tells us that the risks of long-term problems are actually so much higher from natural infection compared to any vaccine.

Vaccination and needles can be really frightening for young children. Any tips?

We know that vaccines can be difficult and something severely anxiety-provoking for both children and adults. There are many proven ways to reduce the anxiety, stress and even pain associated with vaccines.

For really young infants, one strategy that can be helpful is if they can breastfeed during the vaccine. For older children, a variant of a distraction technique can minimize the pain associated with the vaccine, for example, toys and pictures. Regardless of the strategy used, I recommend talking to your healthcare provider. For children who are old enough to understand needles and vaccines, it’s important to be honest. It’s not fair to surprise or trick them, and conversations should happen so they are aware that even though there is a vaccine that will be administered and there might be some pain, there are ways to manage it. It’s for their own health and you’d be surprised, a lot of kids can really understand that benefit!

By: Jennifer Stranges