Some Teens Are Ready To Enroll in COVID-19 Vaccine Trials
But other adolescents feel hesitant, signaling that researchers must build trust among young people.

by Claire M. Moore

As the first phases of COVID-19 vaccine distribution continue for those deemed most at-risk in the U.S., it will be imperative for other groups to have access to the vaccine once trials confirm its safety and efficacy. Currently, Moderna is beginning the first all-adolescent trial including ages 12-17. Teen studies are critical in examining the under-explored effects in young people, since Pfizer’s vaccine is reported to have been tested in only 138 adolescents during 2020 trials, a small percentage of total participants. Through interviews with teenagers and additional research, I argue that the biomedical community must increase education and outreach efforts with young people in order to build trust and transparency. Without concerted efforts addressing the unique concerns of adolescents as more trials begin, young people from a diversity of backgrounds will not be adequately represented in vaccine research, leading to further public health consequences.

Natasha Matta, a junior at the Harker School in California and student member of the Vaccine Working Group on Ethics and Policy, expresses that enrolling in a teen vaccine trial would be a bit “nerve-wracking,” but agrees she would be open to enrolling if she was properly informed of all known risks. Although she’s not aware of any trials in her area, she and her peers are ready to get vaccinated once it is their turn: “[Vaccination] will be a weight off our shoulders. Once it’s more widely available, it will be a relief to see my grandparents. I’m excited to get vaccinated so I don’t have to worry as much about spreading the virus to the people around me.”

Other young people, however, express hesitation about enrolling in experimental vaccine research for fear of side effects or, worse, lifelong health impacts. Pierce Madison, an eighth grade student at St. Paul’s Episcopal School in Northern California, says, “I’m excited that the virus will be somewhat contained because of the vaccine, but I am afraid that it might shorten life expectancy.” Victoria Anthony, a junior at Ocean View High School in Southern California, sums up these concerns when I asked if she and her friends would consider enrolling in a youth vaccine trial: “We are young and not fully developed yet. If the trials go wrong, young people could be affected for the rest of their lives.” In other words, young people have the most years of life to lose in the rare case that vaccines do not prove safe during trials.

Steven Street, a junior at Langston Hughes High School in Georgia, does not wish to enroll in a vaccine trial for teens, and he does not believe his peers would either: “My biggest fear about trials is that the vaccine isn’t actually ready to be tested yet.” Despite his fears, Steven says he is excited about “going back to normal” once more teens get vaccinated: “I won’t have to worry about the disease as much.”

These opinions underscore the unique perspectives of young people during the pandemic. While many are missing out on critical in-person social and educational experiences, teens also bear the burden of being impacted by unforeseen consequences in vaccine trials for the longest amounts of time. Additionally, young people may adopt skepticism due to distrust in authority and feelings of being overlooked by adults. Furthermore, Ross D. Silverman, JD, MPH and colleagues argue that adolescent recruitment for trials will prove difficult for pharmaceutical companies since many teens fear vaccine research due to “larger societal issues of pervasive racism and discrimination, medical mistrust, and systematic misinformation programs addressed to social media platforms widely used by young people.”

Indeed, Black, Latinx, and/or Indigenous youth may feel particularly concerned about the safety of vaccine trials due to historical human rights abuses against marginalized racial and ethnic communities in biomedical settings. Outside of a clinical environment, communities of color may also mistrust American institutions in general due to long standing legacies of racism at the hands of the U.S. government. These breaches of trust and consent, such as during the infamous Tuskegee Syphilis Experiments, continue to have harmful generational impacts on young people that must be continually recognized and ameliorated.

These insights underscore that one of the biggest hurdles facing researchers in 2021 will be building trust and relationships with young people in order to mitigate fears regarding research participation. Trials must not only weigh ethical considerations regarding minor consent, but ought to take into account other aspects of youth experiences, such as fears about lifelong impacts, generational trauma, and skepticism cultivated on social media platforms. Ultimately, if we aim to reach wide scale immunity in the U.S., researchers must not assume that young people are more willing to enroll in research and become vaccinated in comparison to other age groups. Rather, teens have the potential to continually serve as leaders during the pandemic by shedding light on key concerns, and we ought to listen.