Come fall, parents of elementary schoolchildren will make a decision that’s weightier than which backpack to buy for the new school year:
Deputize Junior as a foot soldier in the war against COVID-19’s spread in the U.S. and get the child vaccinated? Or sit this one out with the knowledge that younger kids are far less likely to get severe illness than their grandparents?
As school bells ring in September, data from clinical trials of the Pfizer vaccine on children ages 5 to 11 are expected to go to the Food and Drug Administration for emergency use authorization. Moderna’s trials in younger kids are not far behind.
But there are complexities to the vax-or-not equation for this age group that give even adults who eagerly rushed for the jabs some pause.
There are moral objections based on the global scarcity of vaccine.
There are risk objections based on extremely rare reactions, seized upon by vaccine opponents.
“Parents who were all too happy to roll up their own sleeves for shots might not feel the same for their kids,” said Richard Carpiano, a public health scientist and medical sociologist at UC Riverside. “It might not be a one-to-one correlation.”
Indeed, Suellen Hopfer, assistant professor of public health at UC Irvine, held focus groups with scores of Orange County families to understand their thinking on vaccinating children. Fewer than half — 45% — said they’d get their adolescent children vaccinated. Nearly as many — 43% — were unsure. And 11% said they definitely would not.
“The younger the children were, the more hesitant the parents were to have them vaccinated,” Hopfer said.
And this conundrum comes as a more contagious variant spreads, and as children make up a much larger portion of reported cases than they did when the pandemic dawned.
What’s right?
The World Health Organization argues that vaccinating young, healthy kids is not a priority because billions of the world’s most vulnerable people still don’t have access to vaccines.
“Though they can get infected with COVID-19 and they can transmit the infection to others, they are at much lower risk of getting severe disease compared to older adults,” said WHO chief scientist Dr. Soumya Swaminathan.
Still, the WHO says “more evidence is needed on the use of the different COVID-19 vaccines in children to be able to make general recommendations on vaccinating children against COVID-19.”
Kids who have underlying conditions that make them more likely to get very sick from COVID-19 could be prioritized, Swaminathan said. But vaccinating kids is not necessary for schools to safely reopen in the fall.
What’s safe?
On June 23, the U.S. Centers for Disease Control and Prevention said that — after more than 177 million people have had at least one dose of a COVID-19 vaccine — more than 1,000 reports of heart inflammation after vaccines had been logged over the previous two months.
That’s a minuscule percentage — less than 0.001% — of those receiving shots.
“CDC and its partners are actively monitoring these reports, by reviewing data and medical records, to learn more about what happened and to understand any relationship to COVID-19 vaccination. Most patients who received care responded well to treatment and rest and quickly felt better,” the CDC said.
Confirmed cases have occurred mostly in male adolescents and young adults 16 or older, more often after the second shot. Patients have resumed normal activities after their symptoms improved, and the CDC continues to recommend COVID-19 vaccination for everyone 12 years and older, given the risk of COVID-19 illness and possibly severe complications.
But some doctors say healthy children should not be vaccinated, or should be given a lower dose, because their risk of severe disease is so low, and complications, though rare, are still not well understood.
Dr. Monica Gandhi, an infectious disease specialist at the University of California-San Francisco, says young men 18 and older should seek the one-shot Johnson and Johnson vaccine, which hasn’t been linked to heart risk. If unavailable, they, as well as boys under 18 for whom it isn’t yet authorized, should delay the second Pfizer or Moderna shot up to 8 to 12 weeks if they’re in an area where the virus is spreading rapidly.
“It decreases vaccine hesitancy and increases trust to tell people that safety as well as protection from a new infectious disease are both paramount,” Gandhi said.
All medical interventions should provide more benefits than risks, and that’s decidedly true for older people and COVID vaccines, but not yet clear for younger people. Even a slight risk of a serious adverse reaction could tip the benefit-risk calculation in younger people, making the vaccine more harmful than beneficial, they argue.
Fear of winter outbreaks
Hopfer, the UCI researcher, is the mother of a 10-year-old with underlying health issues. Theirs is a multigenerational household, with a resident grandmother. She has seen university students who contracted COVID-19 still using inhalers to walk up stairs, six months after infection.
With everyone going back to classrooms in the fall, she worries about winter outbreaks.
More than a year ago — on April 23, 2020 — children represented just 2.6% of reported COVID-19 cases in the U.S., according to data compiled by the American Academy of Pediatrics and the Children’s Hospital Association.
On June 17, children represented 24.6% of U.S. cases.
Nationwide, there have been more than 4 million cases logged among children, more than 14% of total cases. And, even with fewer states reporting, case numbers among kids are creeping up, from 14,421 the week of June 10 to 15,763 on June 17, the data says.
Experts say vaccinating children must be part of the overall attack plan because, even if most kids don’t get terribly sick from the virus, they can still pass it on to others who can get terribly sick — and they could be the incubators where the virus morphs into more lethal forms.
They’re waiting on clinical trial data for the elementary school set, but the evidence is expected to come back strong on safety for this group, just as it has for all the others.
“What we’re hearing — for all the vaccines in all the age groups — is that there are vanishingly small risks associated with vaccination. What we need is perspective,” said Paula Cannon, associate professor of microbiology at the Keck School of Medicine of USC.
“What we do know for sure is that there is a very real and significant risk associated with COVID infection, including in young children. They get severe symptoms at a much lower rate than adults, but they still get them. Children under 12 die of COVID and can have long-term consequences,” she said.
The official death tally is 335 in the U.S., but experts believe the true number is closer to 600. And with more infectious variants spreading, there’s a very real risk that children will be more vulnerable than in the past.
“There’s a reason every other vaccine is given to children,” Cannon said. “The risks associated with the vaccine are massively smaller than the known risks associated with COVID. Vaccinating our youngest children is part of the overall, continuing effort to rid our communities of the consequences of COVID.”
Global concerns
The moral argument around global vaccine access is much more complicated than it sounds, Cannon and Carpiano said.
An American parent turning down a vaccine for a 10-year-old in no way means a shot will be available to a senior citizen in Sudan. There are complex logistics at work, from manufacturing to transportation, freezing to storage, staffing to supplies, vital to getting shots into arms that underlie at least part of the global situation right now, they said.
“We should all care about the people at high risk in other states and countries,” Carpiano said. “But the fact is, you’re not going to suddenly be able to send that shot you’re offered to India. It’s here. It has to get used. We can still have outbreaks here and with variants circulating, there’s the potential for surge. If the vaccine is available, get it.”
That’s the prevailing advice from medical professionals.
“If the vaccine is determined to be safe and effective for younger children, we would encourage parents to vaccinate their children in the interest of safeguarding their health and the health of their loved ones,” said Dr. William Towner, director of clinical trials for Kaiser Permanente Southern California, in a statement.
Hopfer’s research found that the children and parents who said yes to vaccination had trust in its development, safety, ingredients and efficacy. Those who were hesitant felt that their children were not at risk of infection or that the threat was manageable. A powerful motivator for all was the strong endorsement of their family doctors for vaccination.
She’s eagerly awaiting the data from the clinical trials on younger kids, and plans to roll up her daughter’s sleeve if all goes as planned. “As more people are vaccinated, the unvaccinated are really vulnerable,” she said.
Staff writer John Woolfolk contributed to this report.
