To get out of the ninth grade science period on a recent Friday, the King twins had an excuse that it’s so 2021.
© Brandon Thibodeaux for The New York Times
In Houston, Isabelle King, 14, receives her second dose of the Modern vaccine from Jallesse Flores, while her twin sister Alexandra watches.
Alexandra and Isabelle, 14, had to miss classes – including a test – because they were participating in a real science experiment: a clinical trial of the Covid-19 vaccine from Moderna to assess whether the injection is effective and safe in children aged 12 to 17 years old.
“In science, we are learning about, like, genetics and stuff,” said Alexandra during the monitoring period after they got the vaccines at a Houston clinic. “So, maybe the teacher says, ‘Oh, you really shouldn’t have to take the test, because you’re already contributing to science.'”
Adolescents contract the new coronavirus almost twice as often as younger children, but vaccines authorized in the United States are mainly for adults – modern for those over 18, Pfizer for those over 16. While teenagers don’t get seriously ill with the virus as often as adults, research suggests that, as they are usually asymptomatic and casual about social detachment, they can be effective disseminators – to each other and also to adults as parents, grandparents and teachers. While vaccinating educators is an important factor in keeping schools open, vaccinating students will also be a key element.
© Maddie McGarvey for The New York Times
Audrey, 14, and Sam, 12, brother and sister, are participating in the Pfizer study in Cincinnati.
Conclusion: in order to obtain generalized immunity to coronavirus, adolescents are essential links. They need a Covid vaccine that works for them.
But teenagers are more difficult than adults to enroll and maintain in clinical trials. They are difficult to discuss and are not so good with compliance, which includes keeping a diary of symptoms and commitments, up to six a year, which include blood collection (for some, an instant solution).
To reach students, some researchers used connections to schools, local pediatricians and social media campaigns. While waiting for consultations at vaccine research clinics, some teenagers, ignoring the advice to keep their vaccine as a volunteer outside of social media, posted TikTok videos, which inspired friends to sign up. But tests for the Covid vaccine in adolescents will be much less than those in adults – two or three thousand individuals instead of 30,000.
© Brandon Thibodeaux for The New York Times
Jonah Proctor, 15, awaits his injection at a Covid vaccine testing site in Houston.
“You want to enroll as many children as necessary, but as little as possible, to expose as little as possible,” said Dr. Robert W. Frenck, director of the Vaccine Research Center at the Cincinnati Children’s Hospital Medical Center.
To enroll in a trial, children must give “consent”, a legally required and age-appropriate version of “consent”. But researchers must also obtain parental consent or permission. Information sessions for everyone can be time-consuming and meticulous. The child’s or parent’s objection closes the application.
“Parents may be willing to participate in a study, but not their children,” said Dr. James Campbell, an expert in pediatric infectious diseases at the University of Maryland School of Medicine who conducts vaccine testing. “Your primary role in life, as parents, is to keep your children safe and they can choose to wait until a vaccine is licensed, rather than enrolling your child in a trial.”
Often, researchers give young people additional care. Because vaccine misinformation and online personal attacks are so common, young volunteers should avoid discussing their role in the trial on social media.
Although the new coronavirus has had much less impact on children than older adults, about 2.2 million pediatric cases in the United States have been reported and about 280 children have died, according to the Centers for Disease Control and Prevention. Some 2,060 children have contracted a rare dangerous coronavirus-related disease called multisystemic inflammatory syndrome, which can paralyze the heart and other organs.
And, as an enemy occupation, the pandemic has taken over most of the lives of children – closing schools, sports and socializing in person. This caused some teenagers, who otherwise felt so powerless, to volunteer for vaccine tests.
Sam, 12, who entered the Pfizer study at Cincinnati Children’s Hospital, said he wanted to participate “because it would help science and fight the pandemic. And it was my way of thanking the frontline workers who are keeping us healthy. “
His sister, Audrey, 14, who is also in the study, said: “I thought this would be a very good story that I could tell my children and grandchildren – that I tried to help create the vaccine.”
“And I also thought it was important to have people of different ages and races represented,” added Audrey, who, like her brother, is Asian. (Her mother, Rachel, a research nurse who volunteered for a vaccine test, asked that her last names be withheld for privacy reasons.)
In general, tests with adolescents may be less diverse, because the results of tests with adults showed no noticeable difference in results by race. And because adult testing has been so successful, up to two-thirds of teenagers can receive the real vaccine instead of a placebo.
Pfizer, whose study is fully enrolled, expects results of its studies for children aged 12 to 15 in the first quarter of this year, which will then be presented to the Food and Drug Administration for review. Moderna is still recruiting for its teen tests, with data anticipated sometime this summer. Other companies hope to start testing with teenagers soon. Shortly after, the researchers will open tests for children as young as 5, probably with more modest doses.
As with any medical study, researchers are impartial when discussing risks and benefits. Instead of lecturing to young people, Dr. Campbell, whose clinic will conduct a Modern trial for younger children, engages them in conversation.
“Do you remember your tetanus vaccine? Tell me about it, ”he could say. And then, “See how this is similar and how different.” He wants to make sure that the teenager is actively involved in making decisions. “We always say, ‘Don’t do this for your parents’. “
Dr. Sarah Hasan, principal recruiter for DM Clinical Research, which oversees the Houston Fights Covid campaign and most of the city’s vaccine tests, said the information sessions for teens and adults differ markedly. She has more fun with teenagers.
“Usually, adults flip through the form, ask a few questions and that’s it,” she said. “But children ask a lot more questions than adults and are really listening, which is really good.”
“Sure,” she added, “they also want to know if the shots will turn them into zombies.”
During tests with adults, when participants were suspicious and results were unknown, missed appointments were common, Hasan said. But teenagers “arrive on time and are being super sweet”.
Another problem with registration is remuneration. Researchers often offer money to volunteers to cover travel and time expenses, but the amount may not be substantial enough to appear to be an incentive. The current price is around $ 15 an hour. The Cincinnati Pfizer trial pays off for parents as well, arguing that they contribute time and money as unofficial drivers for young people.
In Houston, the King sisters were already fantasizing about how they would spend the money.
Alexandra’s impulses were immediately generous. Now she could buy gifts for other people that her father normally paid for. “It’s definitely going to be a cool thing to do, like, I deserved to get an injection in the arm to help people. And now I can at least buy Christmas gifts for my mom, ”she said.
Her sister Isabelle hurriedly said that, of course, she would also use the money for something selfless. Then she allowed, “Well, my closet needs an update.”
This summer, Monica Mitchell, a community health educator who works for Cincinnati Children’s, participated in a Pfizer vaccine trial. Her daughter Melanie, a sophomore in high school, was deeply curious, but at the time the volunteers must have been at least 16 years old. On the day she turned 16, Melanie called to apply.
Mother and daughter became ambassadors for the vaccine. “Someone said to me, ‘You’re doing the white man’s job,'” said Melanie, who is black. “And I said, ‘No, it’s the other way around. I’m doing the job for my people. ‘”
Dr. Mitchell, who is also a pediatric psychologist and researcher, received some criticism for allowing her daughter to participate in a vaccine test. “Some relatives asked, ” Why would you do that? ‘ But at least they understand that Melanie is quite independent and know that she made her own decision, ”said Mitchell.
Like most study volunteers, children are concerned about side effects. Certainly, after Sam received the second dose from the Cincinnati children’s hospital, he had a difficult life.
In the middle of the night, he woke up with a throbbing headache. Then chills, low-grade fever, muscle aches.
“He looked miserable,” said his mother, Rachel. “It is one thing to talk theoretically about the side effects, but it was difficult for a mother to see him feeling very bad.”
She felt guilty for encouraging him to participate. “I’m sorry,” she said.
Sam was taken aback by her reaction. “I’m so happy,” he replied. “That means I got the real thing!”
Her sister Audrey felt good after the dose. “I’m jealous,” she said.
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