Types of COVID-19 Vaccines for the Pediatric Population


Pediatric experts review available COVID-19 vaccines for children and provide guidance on administration and advising parents/caregivers on when to vaccinate children.

Tina Tan, MD: While we are on the topic of vaccines, can you talk a bit about the different types of vaccines that are available for protection against COVID-19 in the pediatric population?

Sean O’Leary, MD: Sure, why don’t we start with one that you may have not even been thinking about because it goes down to age 12, which is the Novavax product. That’s a more traditional, protein subunit vaccine recommended for ages 12 and up. It’s not stocked in as many places as the Pfizer and Moderna products, so it might be a little harder to find, though it does appear to be a very good vaccine. The recommendation for that one is very similar to other vaccines in terms of the primary series. It’s 2 doses, but there’s no licensed booster at this point. For a booster, you are supposed to get either the Pfizer or Moderna product. Then there are the other 2, what I guess I would call the 2 biggies for the United States, the Pfizer and the Moderna products. They’re very similar, they both rely on mRNA technology, which we’ve all learned a lot about through the pandemic. They have slightly different dosages, but you’re not really comparing apples to apples necessarily there. The recommendations for ages 12 and up are basically the same for the 2 vaccines.

Once you get under 12, it’s a bit different. Moderna’s product is for ages 6 to 11 years, and then under 6. Pfizer’s product is for 5 to 11 years, and then under 5. The next product down is 6 months to either 4 years for Pfizer, or 5 years for Moderna. Now, the main difference between these 2 vaccines is in the younger age groups. The Moderna product is a 2-dose series, while for the Pfizer product, it’s a 3-dose series. The third dose is where it’s getting a little bit more complicated for Pfizer since it’s a bivalent product. I explained that making it sound simpler than it looks on paper, because it can be very complicated and confusing for families, and sometimes for pediatricians as well. The other thing I will say is that, at least the plan as of today is to move toward all bivalent products. There’s still a monovalent vaccine out there, a lot of it is going to be expiring, but most of what we are going to be getting in the future is going to be a bivalent product.

Tina Tan, MD: I think that is really important because we are not able to protect the younger infants as well with the monovalent as opposed to the bivalents that the older kids can get. Hopefully, things will get a little more simplified because trying to figure out if someone can get a booster dose, and which one of the vaccines you can use to give that booster dose, can get a little confusing sometimes.

Sean O’Leary, MD: Sure, yes.

Tina Tan, MD: How are you advising patients, parents, and caregivers on when they should get booster doses for their kids?

Sean O’Leary, MD: That’s a great question. The recommendation is 8 weeks from the last dose. I think given where we are with boosters right now, uptake has not been good, and that’s true across age groups, unfortunately. We’re seeing roughly 500 deaths a day in the United States, a lot of them in that older age group of 65 and older, with almost all of them not getting their booster. Many of them are vaccinated but unfortunately unboosted. So, I am trying to make a point of the importance of boosters for the whole family, including grandparents, etc. I think a lot of people, despite as much messaging as we’ve gotten out there, are still a bit confused about the recommendations and confused about whether they need a booster. I try to make the recommendations clear and why we’re doing this.

In terms of timing—now. I wouldn’t base it necessarily on when we think COVID-19 is going to circulate. I think the lag between their primary series, which they may have had well over a year ago, and this moment says, yes, for almost everyone there is some level of additional protection they might get. And so, I wouldn’t recommend at this point for anyone that’s due that they wait for the fall, for example. I’ve given up predicting when this virus is going to surge. We had a fall surge, but then we were expecting a big winter surge, and we didn’t get it. But we have seen several big surges in the summertime. I think a lot of the planning around a big booster campaign is moving toward perhaps a winter-type thing, but I wouldn’t jump to that quite yet.

Transcript edited for clarity

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