Roberta Satill helps children Jaydon and Talia with their homework in Longwood, Fla. (Jacob M. Langston/For The Washington Post)
When a coronavirus vaccine became authorized for emergency use in the United States, Roberta Satill and her husband took it without hesitation.
But as advisers to the Food and Drug Administration endorsed the use of the Pfizer-BioNTech vaccine in children 5 to 11 Tuesday, Satill is wavering on whether to vaccinate her children, who fall within that age group. The 45-year-old mother from Longwood, Fla., said she has kept her kids up-to-date on their other vaccines, but she worries about possible short- and long-term side effects from the coronavirus vaccine and whether it's worth any perceived risks, especially given that infections have been declining nationwide.
The advisory committee, which voted 17-0 to back the vaccine, found that the benefits of the shot for the 28 million children in that age group outweighed the risks of a rare cardiac side effect.
"It's extremely nerve-racking," Satill said. "You want to make the best decision for your children."
Some parents, even those like Satill who have been vaccinated themselves, are struggling to decide whether to immunize their children. They wonder whether their kids really need it and worry that it may be risker than the disease, which is typically much less severe for children — though not always. They said they have a hard time finding reliable information to make an informed decision. And they said they want to make one for the right reasons — to protect their kids against disease, which vaccine company data show the shot does extremely well — not simply to reduce mitigations such as wearing masks.
In a Kaiser Family Foundation survey this month, about 27% of parents of children ages 5 to 11 said they planned to get their kids vaccinated immediately once the shots are authorized. Another 33% said they would wait and see how the rollout goes for other children.
What they ultimately decide may impact the trajectory of the pandemic in the United States. Federal officials have said achieving a high childhood vaccination rate will be key to tamping down the coronavirus' spread, especially in light of a recent study showing that children are transmitting the virus as frequently as adults.
The White House has launched a campaign to educate parents about the vaccinations, as federal health officials anticipate signing off as soon as early November on administering a reduced dose of Pfizer-BioNTech's vaccine. The companies have said their trials show the immunization is safe and 91% effective in children ages 5 to 11.
But reliable information from official sources will have to compete with a maelstrom of rumors and social media claims, many of which are untrue.
"This is probably the most publicized vaccination campaign ever and there are torrents of misinformation out there. So it's absolutely understandable why parents would have some questions," said Sean O'Leary, vice chair of the Committee on Infectious Diseases for the American Academy of Pediatrics.
Several parents cited a feeling that they lacked reliable information as a main source of their hesitation.
John Lyons, a 39-year-old father from Chicago, said he and his wife got vaccinated against the coronavirus as soon as they became eligible because they both work in the medical field. But, he said, they feel that there's a lot to consider and no easy answers when making that decision for their children.
"It's a risk-versus-reward decision," said Lyons, whose children are 7, 6 and 3. "And I guess my hesitation comes in that I don't know what the real risk of COVID-19 illness is for my children. Information seems to be very difficult to come by — good information, reliable information, seems difficult to come by in terms of pediatric risk."
Many parents who are nervous about vaccinating their children are struggling to decipher the validity of conflicting information they have heard, said Krupa Playforth, an Alexandria, Va.-based pediatrician and mother of three. They tend to worry that the vaccines are too new to have been thoroughly vetted, and they cite lower rates of serious COVID-19 in children than adults.
While children are much less likely to become severely ill from the coronavirus, they are still at risk. Nearly 6.2 million children in the United States have tested positive since the pandemic started, resulting in tens of thousands of hospitalizations and more than 500 deaths, according to the American Academy of Pediatrics. Some children who had COVID-19 are now showing long-haul symptoms.
Nationwide, more than 45 million people have tested positive and more than 738,000 have died.
Some parents also incorrectly worry that the vaccines will affect their children's future fertility or make them shed parts of the coronavirus and infect others, Playforth said. Neither fear is true: The vaccines do not cause infertility or release any of their components.
"I think we are more willing to take risks with ourselves than we are with our children," Playforth said. "That protective instinct kind of kicks in."
For many, pediatricians are a trusted source of information. Playforth suggested that parents ask doctors whether they plan to vaccinate their own children. For her part, she said she plans to get a vaccine for her 6-year-old daughter, as long as the FDA approves vaccination for that age group without reservation.
Cydney, a mother in Rapid City, S.D., said she got vaccinated against the coronavirus last winter and that her husband had received his first dose. Her sons, who are 7, 5 and 2, have received all their other recommended vaccines, she said.
But Cydney, who spoke on the condition that her last name not be used to protect her privacy, said she worried that the sample size of 2,268 participants in Pfizer's trial was too small and that the vaccine was not studied for long enough. She also cited the lower rate of hospitalization from the coronavirus in children than in adults.
"I have been advocating for childhood vaccinations for nearly a decade, attempting to assure parents who are unsure of getting their children vaccinated against measles, tetanus, polio, etc., that the vaccines are well studied, safe, and effective," Cydney wrote in an email. "I cannot confidently say that about the COVID vaccines yet, so I will not be vaccinating my children with the COVID vaccine at this time."
One Massachusetts mother, who did not want her name used to protect her children's medical privacy, said all her children have received their routine vaccinations, including some that were optional, such as the human papillomavirus (HPV) vaccine. Initially, she also planned to vaccinate them against the coronavirus.
But in the weeks after her 17-year-old son received the second dose of the Pfizer-BioNTech vaccine, she said, her son's appendix ruptured. Appendicitis, which if left untreated can cause the appendix to rupture, was reported as a rare adverse event observed in clinical trials. But in clinical trial data that Pfizer submitted to the FDA, Pfizer concluded that "there is no clear basis upon which to suspect" that the seven reported instances of appendicitis were related to vaccination. In fact, the incidence rate of appendicitis observed in a surveillance study of 6.2 million people who got vaccinated was lower than in a study of the general population.
Because of her son's experience, the woman said she has decided to forgo the shots for her two younger children.
She said she had asked her son whether he was worried about getting the coronavirus and he told her he thought he had already contracted it but that getting vaccinated would remove obstacles such as having to wear masks and undergo things like in-school coronavirus testing and quarantining.
"I think we were all kind of misled that by getting vaccinated, life could go back to normal. But that turned out not to be true," said the woman, 40. She said she and her husband were also vaccinated against the coronavirus.
Other parents are worried not only about immediate adverse reactions, but also potential long-term side effects — which doctors said there is little precedent for with vaccines.
Jeff Phipps, of Crossville, Tenn., said he and his wife were on the fence about whether to get vaccinated themselves but ultimately did and finished their immunizations last month. He said he doesn't reject the idea of vaccinating his children, ages 16, 14 and 10, but "there's still so many question marks."
"I was willing to do it for me, but when I think about my children, we're just still searching for answers," he said.
Randall Hayes, who lives in the same city, said he and his wife are both pro-vaccine. The couple were vaccinated against the coronavirus and have gotten all other recommended vaccines for their 2-year-old and 9-year-old daughters. But they have differing opinions on whether to vaccinate their oldest when she becomes eligible for the coronavirus vaccine.
Hayes, 38, said he is not against getting the vaccine for his daughter, but he is concerned about potential adverse reactions such as myocarditis, a condition characterized by inflammation of the heart muscle. He said he was willing to accept possible risks for himself, but he does not want to make that decision for his child.
If the vaccine were to result in long-lasting effects, he said, "I'm going to have to stand and look my girls in the eye in 10 years or 20 years and say, 'I thought I was making the best decision for you.' And if it wasn't, then that's something that would be hard to live with."
His wife, Amanda, 35, said she wants to vaccinate their 9-year-old but she can empathize.
"I have not sat down and pored through all the research behind every vaccine that both of my daughters have gotten, but this is new and it's also coming at a time where there's a lot of mistrust that surrounds it. So it is just very hard, I think, for most people to accept," she said. She added that even she wonders, "Ten years down the road, what are we going to find out that we don't know right now?"
Health experts said serious adverse reactions to vaccines are generally rare and typically become clear quickly. O'Leary said the notion that children may suffer consequences from the vaccine down the line is "based on a mistaken assumption that the vaccines actually can cause long-term side effects."
"There's really not a precedent for that," he said. "When a vaccine causes an adverse reaction, it's in the days to maybe weeks after the vaccine. It doesn't happen years down the road, and there's no reason to think that these vaccines would be any different than all of the other vaccines."
In the case of myocarditis, a heart condition that in rare cases may be linked to the mRNA vaccines in young people, Playforth said the side effect did not become apparent until months after vaccination began because it's so uncommon.
While delayed effects from vaccination are unlikely, contracting the coronavirus can have long-lasting impacts. Long-haul COVID-19 in children appears rare, but estimates of how many kids suffer from it vary widely. And more than 5,200 children have gotten a rare but serious condition called multisystem inflammatory syndrome (MIS-C), which the Centers for Disease Control and Prevention states can cause inflammation of the heart, lungs, kidneys, brain, eyes and other organs.
Still, experts said parents' concerns about vaccination are understandable.
"Even if you got the vaccine for yourself, I think feeling that nervousness about getting it for your child is very normal," said Jennifer Kusma, an instructor of pediatrics at Northwestern University's Feinberg School of Medicine.
Kusma recently led a study on parental reluctance toward a future coronavirus vaccine for their children. One-third of parents reported hesitancy — meaning they were unsure or unlikely to get the vaccine for their children. Non-Hispanic Black parents reported significantly higher odds of vaccine hesitancy for their children, compared to non-Hispanic white parents.
Kusma, who is also a pediatrician at Lurie Children's Hospital of Chicago, said she and other doctors were working to learn more about the vaccines in children so they can better answer questions from parents.
"If parents are feeling nervous or apprehensive, we want them to come to us with their questions," she said. "We want to help them work through their concerns because their concerns are valid and we're preparing ourselves to be able to answer them."
The Washington Post's Scott Clement contributed to this report.
