Encourage COVID-19 Vaccination for Kids 5 and Up

Posted November 10, 2021: Article in Progress. We’re releasing this article ahead of our December 2021 issue to quickly provide information to our readers. The information contained in this version is based on the best evidence available to us as of the date of posting. The final version may include revised recommendations.

You’ll get more questions about COVID-19 vaccines for kids...now that Pfizer-BioNTech is authorized down to age 5.

Early evidence in about 2,300 kids age 5 to 11 suggests this vaccine has about 90% efficacy at preventing symptomatic COVID-19 versus placebo...with side effects similar to those seen in older patients.

Give 2 doses, 3 weeks apart...the same as adults. For now, additional doses or boosters are NOT recommended for kids 5 to 11.

Use the ORANGE-capped vials for kids 5 to 11. Dilute with 1.3 mL normal saline...versus 1.8 mL for PURPLE-capped vials for age 12 and up.

And use a lower dose for kids 5 to 11. Give 0.2 mL (10 mcg) IM from orange vials...rather than 0.3 mL (30 mcg) from purple vials.

Tell parents of kids who are close to turning 12 not to wait for the higher dose. Base the dose on the current age...not weight.

For example, an 11-year-old should get 10 mcg for dose 1...but 30 mcg for dose 2 if they’ve turned 12. If they happen to get 10 mcg for both doses, still consider them fully vaccinated.

Clarify benefits and risks of vaccinating kids age 5 and up.

Parents may hear that about 40% of kids have had COVID-19...and may have some “natural immunity.” But evidence suggests vaccination protects from REinfection 5 times better than prior COVID-19 infection.

Also point out that vaccinating kids may reduce transmission.

Most kids who get COVID-19 have mild illness. But emphasize that serious complications are possible...and vaccine risks are rare.

For instance, about 1 in 12 kids have “long-haul” COVID-19 symptoms (fatigue, etc). Plus over 5,500 kids with COVID-19 have had multisystem inflammatory syndrome in children (MIS-C)...a possibly deadly condition that can cause severe myocarditis and organ damage.

On the other hand, risk of myocarditis with vaccination is about 70 in 1 million males age 12 to 17...and much lower in females. So far, there are no cases in kids under 12. And postvaccination myocarditis cases are mild and resolve in a few days.

Give COVID-19 vaccines with other vaccines (flu, etc) if needed.

Expect to hear about Moderna for kids in early 2022.

See our checklist, Vaccine Administration Strategies, for advice on calming fears, proper needle size, whether to “premed,” and more.

And get our FAQ, Communicating About COVID-19 Vaccination, to debunk common myths (DNA changes, infertility, etc).


  1. https://www.cdc.gov/mmwr/volumes/70/wr/pdfs/mm7045e1-H.pdf
  2. New Engl J Med. Nov 9, 2021 doi: 10.1056/NEJMoa2116298
  3. https://www.fda.gov/media/153514/download
  4. https://www.cdc.gov/vaccines/covid-19/downloads/Pfizer-Pediatric-Reference-Planning.pdf
  5. https://www.cdc.gov/mmwr/volumes/70/wr/mm7044e1.htm