The Volunteers

Alexandra and Isabelle King had a pretty good excuse to get out of ninth-grade science one recent Friday. The 14-year-old twin sisters had to miss class because they were participating in an important science experiment: a clinical trial in Houston, Texas, of Moderna’s Covid-19 vaccine  to evaluate whether the shot is effective and safe in children ages 12 through 17.

“In science we’re learning about, like, genetics and stuff like that,” says Alexandra. “So maybe the teacher will say, ‘Oh, you really shouldn’t have to take the test, because you’re contributing to science already.’”

Teenagers contract Covid-19 almost twice as often as younger children,  but the vaccines in the U.S. were first authorized mostly for adults—Moderna and Johnson & Johnson* for people 18 and older, Pfizer for those 16 and up. While teens don’t become severely ill as often as adults, research suggests that because they’re often asymptomatic, they can be efficient spreaders—to one another as well as to adults.

That’s why experts believe vaccinating students will be key in defeating Covid-19. And teens like the Kings—who’ve all seen their academic and social lives curtailed by the virus—are helping make that a reality by volunteering for clinical trials across the nation.

So far, the results have been encouraging: Pfizer’s trial for ages 12 to 15 this winter found that the vaccine is extremely effective in young adolescents. If the vaccine’s performance in adults was A-plus, says Akiko Iwasaki, an immunologist at Yale University, the results in teens were “A-plus-plus.”

Other teen trials are still ongoing with other companies, however. More results are expected sometime this summer.

Alexandra and Isabelle King had a pretty good excuse to get out of ninth-grade science one recent Friday. The 14-year-old twin sisters had to miss class because they were participating in an important science experiment. They were taking part in a clinical trial in Houston, Texas, of Moderna’s Covid-19 vaccine. The trial was designed to test whether the shot is effective and safe in children ages 12 through 17.

“In science we’re learning about, like, genetics and stuff like that,” says Alexandra. “So maybe the teacher will say, ‘Oh, you really shouldn’t have to take the test, because you’re contributing to science already.’”

Teenagers contract Covid-19 almost twice as often as younger children. But the vaccines in the U.S. were first approved mostly for adults. Moderna and Johnson & Johnson* were cleared for people 18 and older, and Pfizer for those 16 and up. Teens don’t become severely ill as often as adults. Still, research suggests that they’re often asymptomatic. That means that they can be efficient spreaders to one another as well as to adults.

That’s why experts believe vaccinating students will be key in defeating Covid-19. Teens like the Kings have all seen their academic and social lives disrupted by the virus. And they’re taking action, volunteering for clinical trials across the nation. Their efforts will help make beating Covid-19 a reality.

So far, the results have been encouraging. Pfizer’s trial for ages 12 to 15 this winter found that the vaccine is extremely effective in youth. If the vaccine’s performance in adults was A-plus, says Akiko Iwasaki, an immunologist at Yale University, the results in teens were “A-plus-plus.”

But other teen trials are still ongoing with other companies. More results are expected sometime this summer.

The adolescent Covid vaccine trials are much smaller than the adult trials—2,000 or 3,000 subjects each instead of 30,000.

But enrolling and keeping young people in clinical trials can be difficult, researchers say. Participants must keep a symptom diary and show up to as many as six appointments per year, during which they must have their blood drawn (for some, an instant deal breaker).

“You want to enroll as many kids as necessary,” says Dr. Robert W. Frenck, director of the Vaccine Research Center at Cincinnati Children’s Hospital Medical Center, “but as few as possible, to expose as few as possible.”

To enroll in a trial, children must give “assent,” a legally required, age-appropriate version of “consent,” and their parents must also approve. Often the scientists give young subjects an additional caution: Because vaccine disinformation and online personal attacks are so widespread, volunteers should avoid discussing the trial on social media. While waiting for appointments in the vaccine research clinics, however, some teens have ignored that advice and posted TikTok videos, which have inspired friends to sign up.

The Covid vaccine trials for youth are much smaller than the adult trials. There are about 2,000 or 3,000 subjects in each instead of 30,000.

But enrolling and keeping young people in clinical trials can be difficult, researchers say. Participants must keep a symptom diary. They also have to show up to as many as six appointments per year. During these sessions, they must have their blood drawn. For some, that’s an instant deal breaker.

“You want to enroll as many kids as necessary,” says Dr. Robert W. Frenck, director of the Vaccine Research Center at Cincinnati Children’s Hospital Medical Center, “but as few as possible, to expose as few as possible.”

To enroll in a trial, children must give “assent,” a legally required, age-appropriate version of “consent.” Their parents must also approve. Often the scientists make another request of young subjects. They ask the young volunteers to avoid discussing the trial on social media. That’s because vaccine disinformation and online personal attacks are so widespread. But some teens have ignored that advice and posted TikTok videos while they wait for their appointments. Through these social media posts, they’ve inspired friends to sign up.

Sam, 12, who entered the Pfizer trial at Cincinnati Children’s Hospital, says he wanted to participate “because it would be helping science and beat the pandemic. And it was my way of saying thank you to the frontline workers who are keeping us healthy.”

His sister, Audrey, 14, who was also in the study, says, “I thought this would be a really good story I could tell my children and grandchildren—that I tried to help create the vaccine.

“And I also thought it is important to have people of different ages and races represented,” adds Audrey. She and her brother are Asian American. (Their last names have been withheld for privacy reasons.)

Overall, the teen trials may be less diverse, because results from adult trials showed no discernible difference in outcome by race. And because the adult trials were so successful, up to two-thirds of teenagers may be offered the actual vaccine rather than a placebo—compared to the adult trials, where about 50 percent of the participants got the real thing.

Sam, 12, entered the Pfizer trial at Cincinnati Children’s Hospital. He says that he wanted to participate “because it would be helping science and beat the pandemic. And it was my way of saying thank you to the frontline workers who are keeping us healthy.”

His sister, Audrey, 14, was also in the study. She says, “I thought this would be a really good story I could tell my children and grandchildren—that I tried to help create the vaccine.”

“And I also thought it is important to have people of different ages and races represented,” adds Audrey. She and her brother are Asian American. Their last names have been withheld for privacy reasons.

Overall, the teen trials may be less diverse. That’s because results from adult trials showed no clear difference in outcome by race. And because the adult trials were so successful, up to two-thirds of teenagers may be offered the actual vaccine rather than a placebo. In the adult trials, about 50 percent of the participants got the real thing.

Dr. Sarah Hasan, lead recruiter for DM Clinical Research, which oversees most of Houston’s vaccine trials, says that information sessions for adolescents and adults differ strikingly. She has more fun with the teenagers.

“Usually adults will skim the form, ask a few questions, and they’re done,” she says. “But kids ask way more questions than adults, and they’re actually listening, which is pretty nice.”

During adult trials, when participants were leery and much was still unknown about the vaccine, no-shows for appointments were common, Hasan says. But teens “come on time and are being super compliant.”

Like most trial volunteers, young people worry about side effects, which, if they occur, usually last a day or so. After Sam got his second dose, he woke in the night with a headache. Then chills, a low-grade fever, and muscle aches.

“He looked miserable,” says his mother, Rachel. “It’s one thing to talk theoretically about side effects, but it was hard as a mom to see him feeling really bad.”

She felt guilty for having encouraged him to participate.

“I’m so sorry,” she said.

Sam was mystified by her reaction. “I’m so happy,” he replied. “This means I got the real thing!”

Dr. Sarah Hasan is a lead recruiter for  DM Clinical Research, which oversees most of Houston’s vaccine trials. She says that information sessions for adolescents and adults differ strikingly. She has more fun with the teenagers.

“Usually adults will skim the form, ask a few questions, and they’re done,” she says. “But kids ask way more questions than adults, and they’re actually listening, which is pretty nice.”

During the adult trials, participants were hesitant and much was still unknown about the vaccine. At that time, no-shows for appointments were common, Hasan says. But teens “come on time and are being super compliant.”

Like most trial volunteers, young people worry about side effects. If these occur, they usually last a day or so. After Sam got his second dose, he woke in the night with a headache. Then chills, a low-grade fever, and muscle aches.

“He looked miserable,” says his mother, Rachel. “It’s one thing to talk theoretically about side effects, but it was hard as a mom to see him feeling really bad.”

She felt guilty for having encouraged him to participate.

“I’m so sorry,” she said.

Sam was mystified by her reaction. “I’m so happy,” he replied. “This means I got the real thing!”

^{*As Upfront was going to press, the federal government had issued a recommendation to pause the use of the Johnson & Johnson vaccine amid reports of rare blood clots developing in a very small number of recipients.}

^{*As Upfront was going to press, the federal government had issued a recommendation to pause the use of the Johnson & Johnson vaccine amid reports of rare blood clots developing in a very small number of recipients.}

With reporting by Apoorva Mandavilli of The New York Times.

With reporting by Apoorva Mandavilli of The New York Times.