By Sharon LaFraniere and Noah Weiland, The New York Times
WASHINGTON — Pfizer and BioNTech said Thursday morning that they had asked federal regulators to authorize emergency use of their coronavirus vaccine for children ages 5 to 11, a move that could help protect more than 28 million people in the United States.
The companies have said they were submitting data supporting the change to the Food and Drug Administration. The agency has promised to move quickly on the request and has tentatively scheduled a meeting Oct. 26 to consider it. A ruling is expected between Halloween and Thanksgiving.
Parents across the United States are anxiously awaiting the regulators’ decision, which could affect family life and the operation of schools. Clearance depends not only on the strength of the clinical trial data, but on whether they can prove to regulators that they are able to properly manufacture a new pediatric formulation.
Dr. Janet Woodcock, the acting FDA commissioner, said last week that children might require “a different dosage or formulation from that used in an older pediatric population or adults.”
Pfizer has proposed giving children one-third of the adult dosage. That might require adding more diluent to each injection or using a different vial or syringe. The company was expected to describe the method it intended to use in its FDA submission.
Regulators will have to examine the purity and stability of mass-manufactured doses of the vaccine and determine that it matches the quality and potency of doses given to children in clinical trials. A pediatric dose will also most likely require new labeling, with special codes that would allow the Centers for Disease Control and Prevention to track specific lots in case of reports of serious side effects.
Children rarely become severely ill from COVID-19, but the delta variant drove nearly 30,000 of them to hospitals in August. According to the American Academy of Pediatrics, nearly 5.9 million Americans younger than 18 have been infected with the coronavirus. Of the roughly 500 Americans under 18 who have died, about 125 were children ages 5 to 11.
“It really bothers me when people say kids don’t die of COVID,” said Dr. Grace Lee, an associate chief medical officer at Stanford Children’s Health who also leads a key advisory committee to the CDC. “They die of COVID. It’s heartbreaking.”
About 1 in 6 Americans infected since the beginning of the pandemic was younger than 18. But with the surge of the delta variant, children accounted for as many as 1 in 4 infections last month, according to the American Academy of Pediatrics. The FDA authorized emergency use of Pfizer’s vaccine for 12- to 15-year-olds in May.
The infection rate in the United States is currently falling, prompting hope that the delta variant is ebbing. But public health experts worry that the onset of colder weather could result in increased transmission.
Although federal regulators are under enormous pressure to quickly review Pfizer’s application, they also face other pressing decisions. Next week, they might rule on whether people who received the Moderna and Johnson & Johnson coronavirus vaccines should receive booster shots, both potentially contentious decisions.
Public health experts have said that the agency’s review of a Pfizer pediatric dose would be closely scrutinized. According to a recent survey conducted by the Kaiser Family Foundation, roughly a third of parents of children between ages 5 and 11 said they would wait and see before allowing their children to receive such a shot.
Dr. Walt A. Orenstein, an epidemiologist at Emory University and a former director of the U.S. immunization program, said that given the competing pressures on the FDA to make vaccine decisions quickly but carefully, public discussion was essential.
He said many parents were wavering between fear of COVID-19 and fear of side effects of a pediatric vaccine. If they were less worried about the consequences of coronavirus infection, he said, safety would be their top priority. If they were more worried, the vaccine’s effectiveness would matter more. As with other vaccines, Orenstein said, pediatricians would play a critical role in easing parental anxiety.
Pfizer’s clinical trial for children was not intended to draw meaningful conclusions about the vaccine’s ability to prevent disease or hospitalizations. Instead, researchers looked at antibody levels, comparing them with levels in adults that had conferred high protection. Regulators are expected to compare those immune responses to vaccine efficacy data in the adult population.
The trial included 2,268 children, two-thirds of whom had received two doses of the vaccine three weeks apart. The remaining volunteers were injected with two doses of saltwater placebo. Regulators over the summer asked for the trial size to be expanded to 3,000 children.
At a virtual panel on COVID-19 last week, Norman Baylor, the former director of the FDA’s vaccines office, said that the number of participants in Pfizer pediatric study was noticeably small. The adult trial involved about 44,000 people.
“It does beg the question of the size, given what we have for the adults: Would one expect more for the pediatric population?” he said. “They may be thinking, ‘Well, we know the vaccine is safe, because look at how many people we had in the adults.’ But as we know, things may shift in that pediatric population.”
The Pfizer-BioNTech and Moderna vaccines have been tied to increased risks of myocarditis, or inflammation of the heart muscle; and pericarditis, inflammation of the lining around the heart, particularly in younger men. In August, the FDA published results from an analysis of Pfizer-BioNTech’s vaccine that used a U.S. health care claims database and found that the risk of the conditions in 16- and 17-year-old vaccinated boys could be as high as 1 in 5,000.
The cases in the database were unconfirmed, but they were considered a reasonable estimate of possible risk, the agency wrote.
A lower dose of the vaccine for children could alleviate those concerns.
Officials in a number of countries have recommended a single dose of the Pfizer-BioNTech vaccine for children ages 12 and older, which would provide partial protection from the virus, but without the potential effects occasionally observed after two doses. Sweden and Denmark joined those countries, announcing Wednesday that adolescents should get only one dose of the Moderna vaccine.
This article originally appeared in The New York Times.