When the Centers for Disease Control and Prevention announced in May that adolescents aged 12 and up could get the Pfizer COVID-19 vaccine, Jennifer was miffed. The youngest of her two sons, Charlie, was only 11, and he wouldn’t celebrate his birthday until the weekend before the first day of school in the fall.
Jennifer, who lives in a rural Midwest town and requested the use of pseudonyms for her family, was worried about that first month of seventh grade, when Charlie would be back in the classroom before his second vaccine dose. The junior-senior high school where he’d be matriculating had harbored several COVID-19 outbreaks among older students during the previous school year. “Sending my newly turned 12-year-old into that building unvaccinated just seemed extremely foolhardy to me,” Jennifer said.
At 5’5” and 130 pounds, Charlie is larger than most of his classmates, despite the fact that he’s young for his grade. As Jennifer heard about his 12-year-old friends making their vaccine appointments in May, she could not accept the notion that he was somehow less ready for the shot. “You’re looking at all these boys and he’s the tallest, he’s the biggest of all of them,” she said. “I was just like, no. If these kids who are a few months older can do it, I’m taking him.” She took Charlie to the countywide vaccination site in May. On the registration forms, she logged his date of birth as one year earlier than the true date—2008 instead of 2009. A few site administrators asked Charlie for his age; he claimed he was 12. He easily got his vaccine.
As the school year begins amid COVID-19 surges, parents of children too young for vaccine eligibility are worried. An ongoing clinical trial that is testing the Pfizer vaccine on children under 12 may not conclude for another month or more, after which the Food and Drug Administration could take several weeks to expand the scope of its emergency authorization. (Moderna’s pediatric study will take even longer to complete.) While rates of mortality and severe illness from COVID-19 among young children are still extraordinarily low, the high transmissibility of the delta variant has meant more childhood cases, which has also meant more hospitalizations and deaths.
“In our view, the rise of the Delta variant changes the risk-benefit analysis for authorizing vaccines in children,” wrote Lee Savio Beers, the president of the American Academy of Pediatrics, in an Aug. 5 letter to the head of the FDA. Since previous trials have shown the mRNA vaccines to be remarkably safe, the letter urged the agency to approve their use in children as soon as possible. The FDA has not directly responded to the letter, but its vaccine director has maintained that the process of approving a pediatric vaccine is necessarily slower for safety reasons.
Until the agency approves a childhood vaccine, parents will have to decide for themselves whether it’s worth it to defy the rules to get their on-the-cusp kids vaxxed early. When Jennifer took Charlie to her county vaccination center, the eligibility-confirmation protocols were even less stringent than she had expected. “The people in front of us had a 10-year-old,” Jennifer said. “They said, ‘She’s 10 and we want her vaccinated.’ And they did it! I was like, ‘Oh, I guess I didn’t even have to lie.’ ” But that’s not the case everywhere. The process didn’t go so smoothly for Eamon Geary, the father of 11-year-old Conor. Geary tried a few times to register Conor for a vaccine appointment at a nearby CVS last week. Each time, CVS sent him an appointment cancellation with no explanation. On Tuesday, Geary got a clarifying call from the pharmacy. Because he’d gotten other prescriptions filled at CVS, Conor was already in the system as 11 years and 10 months old. The pharmacy refused to give him the vaccine.
“Parents and guardians must truthfully attest that their child is between the ages of 12-17 when registering for an appointment at cvs.com,” a CVS communications manager said in an statement. “We will not administer the vaccine to patients under 12 until the vaccine’s authorization is expanded to younger patients.”
Geary wasn’t ready to give up. Conor returns to his Catholic school in Pittsburgh this week—and while the local diocese has issued a mask mandate for schools, Geary worries that some students and employees will comply by wearing face shields, as many teachers did during last school year’s mask mandate. (Studies have shown that face shields are not nearly as effective at preventing pathogen transmission as masks that cover the mouth and nose.) Over the summer, Geary had asked his sisters, both of whom are pharmacists, and several doctor friends whether there were any major developmental differences between a 12-year-old and an almost-12-year-old that would make the vaccine a risky bet for Conor. All agreed that being a few months shy of the cutoff wasn’t likely to pose a medical problem. “It just seemed like, well, why wouldn’t I pull the trigger and have him as close to safe as he can be,” Geary said.
For parents whose children are just a bit below it, the 12-year age threshold can feel arbitrary—and, essentially, it is. Every human body matures in its own way, and no magic switch flips on one’s 12th birthday that transforms the immune system in any significant way. The FDA’s hard line is more administrative than biological: The initial Pfizer trials had to establish boundaries of participation, so they only included people aged 12 and up in the first trials. In seeming recognition of the randomness of that line, several Canadian provinces have already made the Pfizer vaccine available to all children born in 2009 or earlier, which includes 11-year-olds who will turn 12 before the end of this year.
But according to Sean O’Leary, a pediatric infectious diseases specialist who serves on the CDC’s Advisory Committee on Immunization Practices for COVID-19 vaccines, there are a few good reasons for 11-year-olds in the U.S. to wait until they get the official go-ahead. In recent weeks, he has gotten dozens of versions of the same question, from parents and pediatricians alike: Should this child get an unauthorized vaccine? “Some of them make a pretty compelling case: either the child has some underlying condition or there’s someone in the home who has a significant underlying condition,” O’Leary said. But “what I have generally counseled folks is that, honestly, if it was my child, I wouldn’t do it.”
Safety is O’Leary’s first concern, and Pfizer hasn’t yet released the safety data from its under-12 trial. The dose the company is now testing on these children is one-third the size of the one currently available. At least one rare side effect of the mRNA vaccines, myocarditis—an inflammation of the heart—is most common in younger patients. (It’s still highly uncommon—it’s been documented in 76 cases per million doses given to adolescents aged 12–17.) O’Leary believes there could be a lower risk of myocarditis and other side effects if 11-year-olds wait to get the smaller dose. O’Leary also cautions against judging a child’s readiness based on size, based on what we know about how the immune system matures over the course of childhood. “We do see, in vaccine clinical trials, differences across age groups in terms of how children respond to vaccines that appear more based on age than weight,” O’Leary said.
After he and his son were turned away from CVS on Tuesday, Geary confirmed with one of his pharmacist sisters that there was no national pharmacy database that would make Conor’s age widely known. He then brought Conor to their local grocery store pharmacy, only to find out it didn’t have the refrigeration capacity to store the Pfizer vaccine, the one brand approved for 12-year-olds. So Geary scheduled an appointment at a Rite Aid his family had never visited that had Pfizer. On Thursday evening, Geary emailed me a selfie from the pharmacy, with Conor standing behind him making a wacky face under his Star Wars mask. “We got it!!” the email said. “The false birthday with no other provided medical info was the trick.”
For Michelle and Mike, a Seattle couple with five children, getting their 11-year-old Andrew the vaccine meant asking him to lie about his age. They didn’t have any qualms about coaching their son to fib, especially during a crisis that demands more shots in arms. The pandemic had already provided the parents, who requested I omit their last name and use a pseudonym for their son, with a bevy of teachable moments about ethical living in an interconnected society—like staying home to stop the spread in 2020, or prioritizing high-risk people when the vaccine was still scarce in early 2021. “Because we’d already had that conversation about jumping the line and what it means,” Michelle said, when it came time to talk to Andrew about fudging his age, “we could say, ‘OK, well, if there’s a surplus and people are not taking it, we felt OK about that.’ ”
They decided to get Andrew, who turns 12 in October, vaccinated in midsummer, partly because his school hadn’t yet issued a vaccine mandate for teachers and staff. “We knew we would be kicking ourselves if he got COVID in September,” Mike said. He signed Andrew up for a vaccine through a county portal, subtracting a year from his 2009 birth date.
Andrew was asked for his birthday three different times at each of his two appointments. Every time, he eagerly declared that he was born in 2008. “He, fortunately, is an extremely accomplished liar,” Michelle said.
There are some logistical challenges to getting a child vaxxed early. Geary’s pharmacist sister told him that clinics could lose access to the vaccine if they are caught giving unauthorized shots to kids under 12. But there’s also plenty of room for plausible deniability: For the most part, vaccination centers aren’t asking for proof of age, because a birth certificate or other document would be a high barrier to entry for a public health intervention that benefits from speedy, widespread implementation. The fact that the vaccine is free makes it easier still, because no one has to present an insurance card. The main remaining issue that some parents have broached on social media is that lying about a child’s birthday might pose a future paperwork problem when, for instance, the information on a kid’s vaccine card doesn’t match his passport. That doesn’t worry Geary. “The whole reason I’m doing this is for my child’s safety,” he said. “If it ends up being kind of a logistical nightmare or headache, so be it.”
Parents of 11-year-olds who’ve been vaxxed say any amount of hassle is worth it, because they’ve seen their children grappling with COVID-related anxieties that could be mitigated by the vaccine. And some, including Jennifer, know young people who contracted the virus before vaccination and suffered severe and lasting symptoms. It’s still true that the vast majority of children with COVID-19 will experience asymptomatic or mild cases, but favorable statistics don’t feel as concrete when the means to protect their kids is sitting at the drugstore down the street.
At a recent visit to the pediatrician, Jennifer admitted that Charlie had been vaccinated early. The doctor was surprised. “She was like, ‘They let you?’ And I said, ‘Well, I lied to them,’ ” Jennifer said. The doctor has kids of her own in the junior-senior high school, where there had been COVID-19 outbreaks last year and where Charlie began classes last week. She confirmed that Charlie hadn’t had an adverse reaction to the shots, Jennifer told me. “Then she said, ‘I’m glad you did it.’ ”