WASHINGTON - Anna Gueorguieva had big plans for 2021: After she and her 10-year-old daughter Amelie got the coronavirus vaccine, they would visit Gueorguieva's parents in Bulgaria and maybe also travel through Asia. In the fall, Amelie would return to school for the first time since the start of the pandemic.
But when Gueorguieva, a World Bank senior economist who lives in the District of Columbia, asked her doctor when children in D.C. would be immunized, she learned that there are no vaccines yet available for kids her daughter's age, and none on the horizon.
"I sort of assumed that they would be providing them," Gueorguieva said. "I honestly called all my friends and said, 'Did you realize kids are not getting immunized?' It was a huge shock. . . . All our imaginations of what we're going to do once this is over, that's not going to happen."
While trials are recruiting or already underway for children age 12 and older, companies have yet to enroll younger children. It probably will be another year before vaccines are available for them, said Robert Frenck, the principal investigator for the Pfizer coronavirus vaccine trial at Cincinnati Children's Hospital. He also oversees the Oxford-AstraZeneca vaccine clinical trial there.
At least four companies - Pfizer, Moderna, AstraZeneca, and Janssen - are planning to start trials for younger children this spring, according to Yvonne Maldonado, a professor of pediatrics and epidemiology and chief of the Division of Pediatric Infectious Diseases at Stanford University's medical school. It is "critical to include all populations including infants and young children in safety trials," she said in an email, adding that doing so "will be important to prevent individual pediatric infection as well as transmission to family members, teachers and other caregivers."
Trials for younger children probably will happen in descending order of age, calibrating the best dosage for each cohort. (For very young children, the coronavirus vaccines will also need to safely fit into the schedule of standard early-childhood immunizations.)
In the meantime, even as families with older children start planning for a return to in-person social activities, travel and school, many parents of younger kids feel trapped between the prospect of another homebound year and the risk of letting their young children return to a world where no one their age is vaccinated.
"For school-age children, this return to normalcy that we're all waiting for is going to be a lot farther off than we expected," said Ray Rosencrance, the father of a 9-year-old in Buckhannon, W.Va., who was surprised to learn last week that there are no vaccines for children.
There are several reasons for the later rollout. Unlike polio, which killed or paralyzed thousands of children in the 1950s and sent families lining up for a vaccine, the coronavirus has a relatively mild effect on most children. So parents, policymakers and vaccine developers may feel less urgency than if children were getting seriously ill or dying at higher rates.
About 2.82 million U.S. children have tested positive for the virus as of Jan. 28, according to the American Academy of Pediatrics. That does not include an unknown number of mild or asymptomatic infections. The Centers for Disease Control and Prevention estimates that, adjusting for underdetection, the rate of infection among children 5 to 17 is basically the same as for adults.
The rates of coronavirus infection are highest among minority children, said Emily Erbelding, director of the Division of Microbiology and Infectious Diseases at the National Institute of Allergy and Infectious Diseases, who stressed her desire for pediatric coronavirus vaccine trials in a presentation last month.
"There's a disproportionate burden among children in minority communities, and there's both direct and indirect effects to children and all of society," she said. "This burden will continue if we don't vaccinate and if we just wait for herd immunity to occur over time."
In the United States, at least 11,000 children and teenagers have been hospitalized and at least 215 have died, according to a Jan. 28 report from the American Academy of Pediatrics. Covid-19, the disease caused by the virus, can have lingering effects in children and is also associated with a rare but serious illness called multisystem inflammatory syndrome, or MIS-C, which can be fatal or leave children with lasting heart damage. Children with underlying health conditions such as obesity and asthma have a greater risk of severe cases of covid-19.
But even if most children do not get seriously ill, vaccinating them may be important for everyone else's safety, said Stanley Perlman, a professor of microbiology and immunology and a professor of pediatrics at the University of Iowa. "You have this pool of little children running around who have a mild form of the disease and all these snotty noses, giving it to people who are more vulnerable, so for altruistic societal reasons, you'd want them vaccinated."
Another reason trials are slower to get underway for young children is that it is harder to recruit them. While teenagers can make informed decisions about whether to participate, "a 6-year-old can't put all this together and consider it and say, 'Should I get a vaccine?' " Frenck said. "I couldn't look at you and say, 'I want to enroll your children in a study,' before being able to show you what we've done with adults in terms of safety and efficacy."
When a children's vaccine does become available, not all families will rush to get in line.
"I believe it's too soon to vaccinate children, when there's not longitudinal studies," said Daphne Radfar, a mother of three in Los Angeles, where many people she knows are leery of vaccinations in general. "You're asking for parents to make that decision in the dark."
Octavia Exum, 37, who lives in D.C., thinks she had covid-19 in late December 2019. She was hospitalized twice and had a cough that lasted for two months. She said she does not plan to get a vaccine and will not be in a hurry to get one for her 4-year-old son, Izaac.
"I feel like this is a trial run with the vaccine, and with him being so young I don't want to trial-and-error with him," she said. "Maybe in the future, when more results and more studies come in, I might be a little more comfortable."
Exum's older son, Izaiah, 17, has decided to get the vaccine. "I'm not happy with his decision, but he's done more research than me, and if he feels that's something he wants to do to protect himself [as] he starts college," she said, she would not stop him.
For some, the reluctance is tied to a troubled past with the government and mistrust of the health-care system.
Anita Cisneros, a fifth-grade teacher in San Antonio, is cautious about vaccines for her daughters, who are 12, 9, and 8.
"We're Native American and Mexican American, and just the U.S. history of bringing diseases to the continent and sterilizing our women" makes her worry. She cited early European settlers bringing smallpox to North America and reports that immigrant women had been subjected to unwanted reproductive organ surgery.
"So I want to wait," she said. "I won't be pushing them to be the first."
Rosencrance, the father in West Virginia, said that while he is "ever so slightly twitchy" about the idea of giving such a new vaccine to his son, "my wife and I trust the process [and] as soon as Sabastian has the opportunity to take the vaccine, we will allow him to do so."
For Vohntryce Allen, 31, of D.C., there is no question about whether to vaccinate her children. Her 2-year-old son and 3-year-old daughter have chronic respiratory conditions, and she has kept them masked and shielded and learning remotely throughout the pandemic.
When Allen first heard that a vaccine had been developed, she assumed it was for children and adults. Learning that was not the case left her in "disbelief."
"I feel as though they need to figure out a vaccine for these children soon, because my children are sickly and there are so many sickly children out here," she said.
But until then, she will continue keeping hers at home. "At the end of the day," she said, "safety comes first."