After Kari Raymer Bishop’s eight-year-old son had his first dose of the Pfizer-BioNTech COVID-19 vaccine last month, she began calling friends across the border in Lewiston, N.Y., to help her find a pharmacy in the United States where she could bring him for a second dose after three weeks.
“We were just trying to figure out what we were going to do to get him his second dose in three weeks because it was really important to us,” she said.
Canada’s advisory body on immunization, the National Advisory Committee on Immunization (NACI), recommends eight weeks between doses of the COVID-19 vaccine for children aged five to 11 based on emerging evidence that longer intervals between the first and second doses of COVID-19 vaccines result in more robust and durable immune response and higher vaccine effectiveness.
Raymer Bishop considered the recommendation by NACI, weighed the risks and benefits to her son, and chose to provide informed consent to have her son vaccinated sooner.
“We really felt strongly even before Omicron showed up that we were going to want the protection as soon as possible,” she said.
“Informed consent means a parent feels safe enough … to make a decision that differs from the NACI guidelines. It’s really important that patients and parents feel that they’ve received enough information to make that decision,” explained pharmacist Kristen Watt.
Watt said she is advising families who do not have strong feelings about the interval between doses to “stick with the NACI guidelines” but acknowledged many have chosen to have it sooner.
“There are many families with parents who are exceptionally well-informed that are physicians or scientists who are opting for the three-week interval in the interest of keeping their kids as safe as possible against COVID-19 at this time, especially with the Omicron variant,” she said.
Watt has decided to give her children the second dose of the COVID-19 vaccine after three weeks.
“If you want to have a conversation about an earlier dose interval and what the risks versus benefits are, we have that conversation with a parent and they feel that they understand that enough to make a decision to vaccinate earlier. That’s what informed consent is,” said Watt.
When Health Canada authorized the Pfizer vaccine for children, making it the first in Canada to receive regulatory approval for that age group, it noted the two doses can be offered three weeks apart.
In the United States, where the first shots went into young arms on Nov. 3, many have already received a second dose after three weeks.
“We had the CDC director over the weekend essentially say that they haven’t seen any concerns with respect to myocarditis in these two million plus children who have now received a second dose at three weeks. So I think all of this is really important to take into consideration … and I think parents should be able to choose what’s right for them,” said pharmacologist Sabina Vohra-Miller.
NACI’s recommendation is “discretionary,” she said, “in that parents should be able to choose for themselves based on their family circumstances what is the ideal timing for the second dose.”
Vohra-Miller said, given the rising number of COVID-19 cases in schools, there may be merit in having children fully vaccinated sooner.
“As we see cases are creeping really fast in schools, especially in children who are under the age of 12 and largely unvaccinated … we’re seeing outbreaks occurring across the city in schools, I think that also given that we are now facing a new variant, all of that information has to be taken into consideration,” she added.
Global News reached out to the office of the Minister of Health, which provided the following statement.
“To provide the strongest protection possible against COVID-19 and variants, the province continues to strongly recommend an interval of eight weeks between first and second doses for children aged five to 11. This is in alignment with the National Advisory Committee on Immunization, and is based on evidence that suggests longer intervals between doses results in a stronger immune response and higher vaccine effectiveness that is expected to last longer.”
Toronto Public Health (TPH) also continues to follow current NACI guidance on second dose administration for the Pfizer-BioNTech COVID-19 vaccine for children.
“NACI advises that children should get their second dose eight weeks after receiving their first dose. This interval is recommended because it allows for a better immune response to the second dose, is associated with a lower rate of side effects, and provides better protection against COVID-19 infection, including variants of concern,” a spokesperson for TPH told Global News in a statement.
Vohra-Miller said having a longer interval is always recommended with any vaccine because it “results in better efficacy.”
But, she added, in a pandemic, with a rising case count, families do not have the luxury of time to wait to provide children with greater protection.
“If my child was heading back to in-person school in January, I would absolutely be opting for a shorter interval between first and second doses,” she said.
“You can be exposed to the virus in a variety of different spots, like in pharmacies and grocery stores, doctor’s offices — all of these are avenues for exposure … so there is advantage for being fully protected faster.”
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