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Should I be concerned about the efficacy of COVID-19 vaccines in kids? An expert weighs in

Dr. Azar breaks down what the new numbers really mean.

With changing mask guidelines and some disappointing new findings on COVID-19 vaccines in kids, parents are left with plenty of questions.

The new data, which comes from the New York Department of Health and has not yet been peer-reviewed, found that protection against COVID-19 infection from the Pfizer-BioNTech vaccine dropped from 68% to 12% in December 2021 and January 2022 for kids between the ages of 5 and 11. Those numbers dropped for the 12- to 17-year-olds as well, but less dramatically (from 66% to 51%).

These new results are "definitely startling," Dr. Natalie Azar, NBC News medical contributor, told the 3rd Hour of TODAY. But it's encouraging that the vaccines still appeared to protect quite well against hospitalization in kids aged 5 to 11, she said.

"Remember, this was never meant to offer 100% protection against infection," Azar said. "But (the vaccine) still held up very, very well against severe disease — even in this age group."

Why did protection from the vaccines against infection drop in this age group?

The new study is just the beginning, so we don't have concrete answers right now about what might be contributing to the reduction in protection. But experts have a few theories in mind.

First up? The dose. "The kids ages 5 to 11 got about a third of the dose that their 12-year-old and upper counterparts got," Azar explained. "That's a significant difference." 

The timing of the two doses may also have been a factor, she said. Experts are now considering whether or not the usual three weeks between Pfizer shots is the ideal timing.

"And then it brings up the question: What about a booster?" Azar said. The Centers for Disease Control and Prevention currently recommend boosters for eligible adults and, as of January, kids ages 12 and older. The vaccines were just approved for kids 5 to 11 at the end of October, Azar said. "So they're at about four months right now. We'll see once the CDC actually looks at this data if they make a change in recommendation."

Experts previously told TODAY that variants might also be playing a role here. During this study period, omicron was circulating widely, Azar said.

The study authors also note that they observed this drop in efficacy when omicron was taking over, so the change in dominant variants may be playing a role as well. Ultimately, the authors say their results "highlight the continued importance of layered protections" for children, including the use of masks.

With the CDC's new mask guidelines, should kids still wear masks in schools?

The latest mask recommendations from the CDC rely on a new measure called community COVID-19 levels. When the local level in your area is low or moderate, masking is not required in most indoor settings.

"About 70% of Americans, based on the new CDC criteria, would no longer need to be wearing masks indoors and that is including our school," Azar explained, adding that individual school districts will ultimately make the choice of whether or not to continue enforcing mask policies.

We do know at this point that one-way masking — wearing a mask even though no one else around you is wearing one — can still provide some protection, especially if you're using an N95 or KN95 respirator.

"If masks are optional, which most places will probably do, they're not going to suddenly say you can't wear a mask. We're going to say masks are optional," she said. "I've said what I've said from the very beginning: You as a family are going to make the decision that's right for you based on your children's risk factors who lives in the home." 

For some, the change in recommendations may bring a sense of relief. For others, though, it might bring anxiety. "Every community is different and every family is different," Azar said.