Mālama i nā Keiki: A Pediatrician Answers Questions about the COVID-19 Vaccine for Keiki

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Photo: Jasmine Waipa
Dr. Jasmine Waipa

We have been through a lot these last two years. The challenges and tragedies associated with the pandemic have often been unbearable, and especially heartbreaking is the toll that it has taken on our keiki.

Now that the Pfizer COVID-19 vaccine has been approved for children, we have the option of protecting our keiki against this disease. And because the vaccine is new, it makes sense that parents will have lots of questions.

So let’s start with the basics: vaccines provide immunity by safely imitating the infection so your body’s natural immune system can create tools to practice responding to the real infection, should you be exposed to it in the future.

The Pfizer vaccine approved for keiki 5-11 years old uses mRNA (Messenger Ribonucleic Acid) technology. Ribonucleic acid is a molecule. The mRNA vaccine works by teaching the muscle cells (in your arm where you get injected) to create a protein similar to a protein on the COVID-19 virus. When your body detects this foreign protein, it activates your immune system to practice fighting the COVID-19 virus. This prepares your body to defend itself if you are ever exposed to the actual virus.

Ethnic minorities have been more severely affected by COVID-19, so being Native Hawaiian puts us all at higher risk. One of the best, safest ways to protect ourselves and each other is to get vaccinated and consider getting your children vaccinated as well.

I know it can be scary when something is so new, but these are scary times, and no matter what you decide about vaccination, you’re taking a risk either way. It’s important to consider all the facts so that you can choose the risk that feels most pono to you and your family.

For more information about how mRNA vaccines work in children, watch this video from the American Academy of Pediatrics: www.youtube.com/watch?v=YOlrNlvEiMw.

  1. Aren’t the children’s COVID-19 vaccines still experimental?

    mRNA technology is not new and has been studied extensively for several decades, which is why the COVID-19 vaccine could be developed so quickly.

    The COVID-19 vaccine has gone through the same rigorous scientific trials that all vaccines and medications go through to get authorized. Thanks to government resources and funding and safely overlapping study steps to speed up collecting data, the vaccine could be produced and tested quickly. But researchers didn’t skip any steps, and the data stands up to the high expectations of the scientific community and the FDA.

  2. There are no long-term studies of the impact of the COVID-19 vaccine on children.

    Because the virus that causes COVID-19 is new, the vaccine is also new, and there are no long-term studies yet. But so far, billions of adults and 2.6 million children younger than 12 have safely received the vaccine and there have been no serious or life-threatening side effects.

    Vaccine reactions usually happen within four weeks of getting vaccinated, so the studies extended the observation time frame over twice as long, just to be safe.

    It’s understandable that some parents may be tempted to wait for final FDA approval or for the vaccine to be less new, but there’s no scientific reason to delay the availability of a safe and effective vaccine in order to collect more data. Delaying puts more children and people at risk than necessary. And based on what we know, the benefits of the vaccine – which are over 90% effective in protecting against serious illness and death from COVID-19 – far outweigh any real or theoretical future risk.

  3. What are the possible long-term side effects of the vaccine on my child?

    Based on current data after billions of injections, the vast majority of COVID-19 vaccine side effects are short term and not serious or dangerous. If your child has allergies, you should discuss the risks with your doctor.

    In general, side effects from vaccines are very rare. And side effects, if any, will normally show up within two weeks of vaccination, and always within two months. There are no known long-term side effects associated with the COVID-19 vaccine.

    The side effects from COVID-19 vaccination have been similar to other routine vaccines, including sore arm and redness at the injection site, fatigue, fever, chills, headache, and body aches. The side effects are temporary and mild or moderate. Side effects may be worse after the second dose in some children.

    For more in-depth information, you can review the COVID-19 Vaccine Fact Sheet at www.fda.gov/media/153717/download.

  4. Will the vaccines affect puberty or my child’s future fertility?

    The COVID-19 vaccine will not affect puberty or fertility in your child. The mechanism of the vaccine has nothing to do with the reproductive system.

  5. I’ve heard that the vaccine can cause heart problems (myocarditis), especially for boys.

    In one study of 2 million people who received the COVID-19 vaccine, just 20 people developed vaccine-related myocarditis (heart muscle inflammation), so the risk is extremely low.

    Teenage boys seemed to be at slightly higher risk of developing myocarditis, usually within seven days of getting the second dose of the COVID-19 vaccine.

    Most importantly, 100% of the cases were mild, self-resolving, and significantly less severe than the myocarditis that is sometimes caused by the COVID-19 infection itself. No vaccinated children younger than 12-years-old have developed myocarditis following vaccination.

  6. Aren’t lots of children having bad reactions to the vaccine?

    Of the nearly 3,000 children younger than 12-years-old that participated in studies of the COVID-19 vaccine before it was approved, and the more than 2.6 million children in America who have since been vaccinated, there have been no credible reports of any significant or bad reactions.

    As noted earlier, the most common side effects following vaccination are the same as what adults experience, including soreness at the injection site, fatigue, body aches, headache, and sometimes fever within 1-2 days of receiving the vaccine.

    In our office, we have administered 70 COVID-19 doses so far, and there have been no bad reactions.

  7. COVID-19 is rarely serious in children, so is it really important for them to be vaccinated?

    The American Academy of Pediatrics recommends that all eligible children get vaccinated as soon as they can.

    As we’re still learning, COVID is multi-faceted. Children who are infected (but asymptomatic) can still pass on the potentially deadly virus to elderly or vulnerable family or community members.

    Children who are infected could develop multi-system inflammatory syndrome, be hospitalized, and (rarely) die. However, the risk of hospitalization with COVID-19 as well as death from COVID-19 is dramatically reduced when you’re vaccinated.

    Sadly, nearly 700 children have died from COVID-19 in America since the pandemic started. The number may be “small” compared to the number of children that have been infected, but it’s not “small” for parents who have lost their child to this disease.

    As more people get vaccinated, the virus will have fewer opportunities to find a “host” in which to mutate and create variants. This means fewer surges of COVID-19 infections. The more people that get vaccinated, the closer we get to life as usual…can you imagine?


Dr. Jasmine Waipa is a Native Hawaiian pediatrician in Honolulu. Her father is from Molokaʻi, her mother is from Pearl City, and she was raised in Honolulu, the eldest of four. She is a graduate of Kamehameha Schools Kapālama, Harvard College, and Stanford Medical School and Residency. She returned home to practice medicine as a Native Hawaiian Health Scholar in 2011 specializing in pediatrics. In 2020, she started her own practice, Keānuenue Pediatrics, with two other Native Hawaiian female pediatricians, focusing on a comprehensive, whole-health approach to patient care.