As the debate continues over whether we can or cannot reach herd immunity against coronavirus, there is one thing most in the public health world agree on: Kids and teens also need to be vaccinated in order to stop the spread of the COVID-19 and get back to life without masks and social distancing restrictions. 

Most health experts anticipate that, in the coming days, the CDC’s Advisory Committee on Immunization Practices will likely recommend use of the Pfizer BioNtech COVID-19 vaccine in 12 to 15-year-olds. The Food and Drug Administration (FDA) is set to authorize Pfizer's COVID-19 vaccine for children 12-to-15-years-old by early next week, according to a federal official.

Whether parents will allow their children to be vaccinated is another question.

As researchers try to gain a better understanding of why more than 13% of adults refuse to be vaccinated, parents with younger children have emerged as a major block of vaccine resistance. A report from a multi-university group of researchers finds that parents are more likely to refuse vaccines than non-parents, particularly mothers aged 18 to 35. 

To address lingering concerns and offer insights into the pros and cons of vaccinating children, we spoke to two kid experts: Dr. Sallie Permar, Chair of Pediatrics at Weill Cornell Medicine and New York-Presbyterian and Dr. Adam Ratner, Chief of Pediatric Infectious Diseases at NYU Langone Health. 

Below is a lightly edited conversation between National Health Reporter Erin Billups and Doctors Permar and Ratner.

Billups: What do we know so far about the Pfizer/BioNTech COVID-19 vaccine and how it performs in teens?

Ratner:  I'll start by saying that I am firmly in the camp of people who are excited about this. 

There's been a misconception since the beginning of the pandemic that children have not been affected by COVID, and that is simply not true. So anything that we can do to provide that group of people with protection I think is great. 

So the data that we have from Pfizer about the performance of their vaccine in younger kids, ages 12 to 15, has been very encouraging. It looks like it is just as immunogenic, which means that the vaccine is good at inducing an immune response and getting antibody levels up high. And it is protective in the studies that have been done so far. The preliminary numbers that I've seen have been up to 100% protective, which is fantastic. 

Billups: Kids are not dying from COVID at the rates we're seeing in adults. Can you put it into perspective? Do the benefits outweigh the risks?

Ratner: I think there is no question that the benefits outweigh the risk based on what we know right now in terms of the vaccine safety, which has been fantastic so far and based on the real risks of covid to children in that age range. 

You're 100% right that kids do not get the same severity of disease as adults in general as a population. But as we're seeing in Michigan now and as we saw in New York City early in the pandemic, when you have large numbers of people infected, you also get children who have severe disease. 

The other thing is that kids get this multisystem inflammatory syndrome, called MIS-C, that seems to happen a couple of weeks after covid infection. Again, rare, but if we can protect them from that by protecting them from the original covid infection, that's worth doing, too.

The other piece of this is that COVID is a major cause of death among children and is comparable to influenza in a bad flu year. We vaccinate against influenza in children for a reason, and that is when you have a severe flu season, you get pediatric deaths, including among healthy children.

Billups: What are the side effects of the vaccine among teens?

Ratner: The side effects of the vaccine have largely been exactly what one would expect. Local pain, you know, I was very tired the day after I got both my first dose and my second dose and then was fine the day after. There have not been large numbers of severe reactions. I think that in that setting and in the setting of COVID still spreading widely across the United States, including here in New York City, including in places like Michigan, I think the decision to forego vaccination or to delay vaccination is taking a risk. 

Billups: Pfizer and BioNTech found there was a more robust antibody response among 12 to 15-year-olds than among those 16 to 25 years old with its COVID-19 vaccine. Why might there be an even more robust response from this age group from what we saw in the adult population?

Permar: Starting from when you're a newborn, your immune system has to go through a big shift from being tolerant to the maternal genetics that are not completely shared with a fetus, to then when you're born, you have to be reactive to all of the pathogens that you come in contact with in the world. That immune system is still evolving throughout the first decade or so of life. We have shown, through the years, that often vaccines can work better in the younger age groups than they do in the older age groups. 

Billups: You mentioned you’ve been involved in COVID-19 vaccine trials, testing baby animals, and you have a study with the findings under journal review. What did you find?

Permar: So the closest animal model to that of humans is what we call non-human primates or rhesus monkeys, where we were able to test in a collaboration with Moderna, the mRNA vaccine, as well as a protein vaccine in very young newborn monkeys. That then gave us an idea of how the newborn immune system was going to respond to those types of vaccines.  

Preliminarily the newborn immune system of these non-human primates responded extremely well to these vaccines – made extremely strong antibody responses – and they were durable over even up to a year of time. 

Billups: I am going to shift into mommy mode. I've also spoken to a lot of other mothers and I think one of the concerns of those who are hesitant or resistant to vaccinating their children, is that kids are going through development stages where there are hormonal changes, their bodies are still growing. Are they more susceptible to adverse impacts to a new vaccine?

Permar: We know that these vaccines have been just exquisitely safe in adult populations, but you never know if there is something about the development stage or the age group that you're vaccinating. So that's why we wait for the trials before approving these age groups.

But at this point, I would say and as a mom of a 12 year old, who I'm lining up to get this vaccine, that what I want to protect my child against is the known dangers. We know that there is a danger of our children getting COVID-19. 

So there's both the chance that they could have severe disease — the small chance — but also the chance that if they do become infected, there could be long term consequences that we have seen in adults and also in some children. These vaccines have essentially had no long-term effects that have been identified to date. And so I want to protect my child against the known dangers, which again, is this virus, not the vaccine. 

Billups: Have you seen long COVID in kids?

Permar: There are some reports in the literature and there is sort of a growing experience with children that had COVID that still have some lingering symptoms, things like fatigue, things like shortness of breath. So we certainly have seen the potential for this to be really a major public health problem going forward, not just for adults, but also for children. 

Then we know that our children have been majorly impacted indirectly by just the social isolation, all the things that they normally did in life that were closed this last year. The mental health crisis in children is real and something that we are dealing with as pediatricians and health systems. And so we need to vaccinate our children to get them back out in the world so they can re-form those connections and not be afraid of congregating children for the next year.