COVID-19 Vaccines Position Tweens & Teens for Physical and Emotional Well-being

This article was written by Charlotte A. Moser, Assistant Director of the Vaccine Education Center at Children’s Hospital of Philadelphia.

During the COVID-19 pandemic, parents of teens had a difficult task. Because of their social inclinations, the physical and emotional safety of this age group were often in conflict. Physical separation offered the best chance for keeping family members from being infected while we waited for vaccines. On the other hand, most teens did not suffer severe COVID-19 illness. As such, the mental toll exacted by social isolation was, for some, more damaging. 

This conflict should have been resolved in May 2021 when COVID-19 vaccines became available for those 12 years of age and older. However, many adolescents and teens remain unvaccinated or partially vaccinated almost a year later. By early March 2022, the American Academy of Pediatrics reported that more than 4 of every 10 students between 12- and 17-years of age are missing at least one dose of COVID-19 vaccine.

The reasons also relate to the physical and emotional well-being of children. As parents consider COVID-19 vaccination, some feel the risk to their children from the vaccine is greater than the risk from the disease. Unfortunately, this conclusion often relies on incomplete information about the disease and unfounded concerns about the vaccine. This makes it even more difficult for families to talk openly and honestly about COVID-19 and the vaccine. Let’s take a closer look.

Teens and COVID-19 disease

Parental decision-making about COVID-19 vaccination of teens often focuses on two notions about the disease. First, people often think teens are less likely to get infected. While this was true early during the pandemic, this is no longer the case. Those younger than 18 years of age are as likely as adults to get COVID-19. Second, people think that only teens with pre-existing health conditions get severely ill. This is not always the case either. Some previously healthy teens have become severely ill, and almost 1,000 children 17 years of age or younger have died from COVID-19. Some quickly dismiss these numbers as small. Sadly, for those families, the risk is real — and life-altering. One can be a big number when it is in your own home.

The chance for delayed or lingering effects is also often overlooked. Multi-inflammatory syndrome in children (MIS-C) is a delayed condition that typically affects multiple body systems and requires hospitalization. It tends to occur 2-6 weeks after a COVID-19 infection of any severity, even mild or asymptomatic. About three of every 10 MIS-C cases occur in 12- to 20-year-olds. By late March 2022, almost 8,000 children and young adults (20 years of age and younger) were diagnosed with MIS-C.

The lingering effects of COVID-19 are not yet well understood. The symptoms, longevity, and severity vary among individuals. While young people are less likely to experience “long COVID,” some do. You can find out more about the range of symptoms and what to consider, including requesting accommodations at school, if your child develops this condition on the CDC’s “Post-COVID Conditions” page.

Teens and COVID-19 vaccine

Even if parents determine that their children should be protected against COVID-19, some continue to have concerns about the vaccine. These concerns often center on three topics:

1. How well the vaccine works – Some wonder how well the vaccine works if vaccinated people can still get COVID-19. While it’s true that some vaccinated people have gotten mild COVID-19, vaccination dramatically decreases the chance of serious illness. A study looking at COVID-19-related hospitalization of 12- to 17-year-olds found that unvaccinated teens were 10 times more likely to be hospitalized than fully vaccinated teens.
2. How safe the vaccine is – Parents of teens tend to be concerned about two specific safety issues. One is real; the other is not.
   1. Heart inflammation, or myocarditis, is a rare but real side effect of the COVID-19 mRNA vaccine. Risk varies by age, gender, and dose. While anyone can experience this side effect, 16- to 17-year-old males are at the greatest risk after their second dose. While it is scary to think about myocarditis, few who get the vaccine will experience this side effect (about 1 to 10 of 100,000 people). Fortunately, myocarditis following mRNA vaccines is short-lived and self-resolving. Importantly, the risk of myocarditis after COVID-19 infection is greater (about 40-60 of 100,000 people) as shown on this infographic, and the symptoms are more severe. So, avoiding the vaccine does not remove the risk for myocarditis.
   2. Infertility has been another concern related to COVID-19 vaccines. These concerns were born from a few different strands of misinformation and anecdotes. However, parents should consider two important points. First, millions of people have been vaccinated without any evidence that infertility is an issue. Second, the mRNA vaccine is processed near the injection site. This means neither the vaccine, nor the resulting spike protein, travel to reproductive organs. Find out more about reproductive-related concerns, long-term effects, or how the mRNA vaccine is processed.
3. Whether booster doses are necessary – Immunity from COVID-19 infection or vaccination centers on two aspects of our immune response. One offers short-term protection. The other helps with long-term protection.

Short-term protection results from neutralizing antibodies that travel in the bloodstream looking for virus particles. These antibodies bind to the virus, preventing it from entering cells. Said another way, they prevent infection. However, neutralizing antibodies decrease over time. Within a few months, they are no longer available to prevent an infection.

The good news is that we also have long-term protection in the form of immunologic memory. Our bodies rely on memory-based immunity to protect us against most diseases creating viruses  that we were exposed to by past infections or vaccinations. They are more like guards, sounding the alarm at the first signs of trouble.

In this case, memory cells monitor for the virus that causes COVID-19. Once triggered, the immune response develops over a few days. During this time, the virus has a brief window of opportunity to cause infection. We might have mild symptoms during this period. But our immune system quickly makes up for the lag time because it recognizes the virus. As a result, most people never get severely ill or require hospitalization.

The recommended booster doses increase neutralizing antibodies. But studies have shown that for most people, immunologic memory remains strong even without a booster dose. For this reason, some parents wonder whether their children need the booster. Dr. Paul Offit, Director of CHOP’s Vaccine Education Center, has discussed the considerations in this video. Parents wondering about booster doses should also speak to their child’s healthcare provider. Providers have more detailed information about the child’s overall health and medical history. As such, their guidance can be more individualized and specific.

We want our children to be physically and mentally healthy. Most people will become immune to the virus that causes COVID-19 – either by vaccination or infection. As such, we should seek information to make informed decisions and to guide our conversations with our kids, so that we can give them the best chance to become immune safely. Vaccination gives us the control to do that.

Learn more about the latest research and ways to talk with your family about the topic in this research roundup.