The Delta wave hit children hard over the summer and into the early fall. According to a September CDC report, the weekly COVID-19 hospitalization rate for children and adolescents rose five-fold for the week ending in the middle of August compared to late June 2021. Moreover, for the first time since the pandemic exploded in March 2020, we started to see sharp rises in pediatric intensive care unit (PICU) admissions, and even PICUs overwhelmed. In some cases, younger children became co-infected with COVID-19 and another respiratory virus pathogen known as respiratory syncytial virus in an especially devastating combo.
Because the rise of pediatric COVID-19 appeared to intensify with the late summer openings of schools across the South, it was apparent that the nation needed to respond. It was not necessarily the case that Delta was selectively targeting school-aged kids, but more likely that the extra transmissibility of the variant compared to previous lineages meant these children were getting swept up in a firestorm causing a massive surge in COVID-19 cases and deaths among all age groups.
And while the estimated 700 children who have died from COVID-19 in the United States is dwarfed by the 700,000-plus adult mortality figure, that number is still devastating and exceeds—possibly by several-fold—the number of children who typically lose their lives in an annual flu season.
All of which is to say the need for a safe and effective COVID-19 vaccine for kids has never been clearer, even as the pandemic shows signs of easing nationally. And now that the FDA has authorized the Pfizer-BioNTech vaccine for 5-11 year old children, and the CDC formally green-lit the rollout on Tuesday evening, relief is in sight.
The only problem is that we’ve already seen resistance to the shot among adults and the parents of teenagers—and getting it to the young kids who need it means navigating a minefield of disinformation and fear, both among anti-vaxxers and more mainstream families.
The good news is that the Pfizer-BioNTEch vaccine looks as though it is highly protective of kids: approximately 90 percent effective versus symptomatic COVID-19 in the 5-11 age category, which is similar to the vaccine’s effectiveness in adults. Moreover, the vaccine appears to be safe in the studies reported, although the number of children receiving the vaccine, around 1,500, might not be sufficient to fully assess the risk of myocarditis complications, currently estimated to be between 6 and 15 per 100,000 in young men and teenagers.
Exactly how much parents will accept COVID-19 vaccinations for their school-aged children 5-11 will depend on a number of factors. A recent Kaiser Family Foundation (KFF) study found that only one third of parents planned on vaccinating their 5-11 year olds “right away.” Moving forward, this will likely depend on the trajectory of COVID-19 cases. In most of the country, cases are declining sharply from this past summer’s wave, just like last year. If the trend continues, then parents may not feel the urgency to vaccinate now, and may try to hold off for a few weeks.
Or, if the cases start to rise after the Thanksgiving holiday as they did last year, it might prompt parents to vaccinate sooner.
Still another factor is the regionalization of COVID-19 vaccinations. Vaccination rates among the 12-17 year olds in Southern states (where vaccine hesitancy is high) are about one half the rates in the New England and Mid-Atlantic states. We might expect that the parents in the South, who are reluctant to vaccinate their teenagers, will feel the same way—or even more resistant—about their younger children.
We have already seen how school-board meetings have been contaminated with virulent protests around masks and other COVID prevention measures. Asking parents to agree to yet another measure like pediatric vaccinations will have its challenges. This could be especially problematic in conservative stronghold areas in the South or Mountain West.
But if anyone needs another reason—besides avoiding transmitting or catching a potentially deadly illness—to get the shot to their young kid, so-called Long COVID represents a looming nightmare the country is only starting to consider or fully understand.
We know that adults with Long COVID may experience significant gray matter brain degeneration and cognitive declines. Whether or not these neurological impairments will extend to younger age groups, especially children, is under active study. But one recent study from London’s Great Ormond Street Children’s Hospital found that 14 percent of children remained symptomatic with COVID even 15 weeks after infection. Further studies are pending, but in the middle of a pandemic, it is especially important to err on the side of preventing COVID infections that might lead to neurodevelopmental impairments in the brain of a growing child.
Unfortunately, the mandates we know can get vaccines into arms faster are barely reaching any young people.
Right now, school mandates for COVID-19 vaccinations are not a major phenomenon except in a few scattered school districts in California and elsewhere. That state has announced that mandates could be implemented for K-12 schools pending formal approval of COVID-19 vaccines for kids. However, states such as Texas—where the anti-vaccine lobby is strong—are unlikely to implement COVID-19 vaccination mandates at all. We should therefore expect that the North-South vaccine divide could widen further when it comes to childhood vaccinations.
Perhaps the best hope for achieving adequate vaccination coverage for school-aged kids is the emerging Biden administration plan to work through our nation’s pediatricians and pediatric nurse practitioners. Pediatricians rank among the most trusted of all health professionals, with at least one KFF study finding that 78 percent of parents trust their family’s pediatrician for COVID-19 health information. The administration was wise to go down this path for COVID-19 vaccinations, rather than emphasizing the pharmacy chains and hospital systems that dominated the adult rollout.
With a virus pathogen such as the Delta variant—now accounting for 99 percent of COVID cases—the bar is high to halt COVID-19 transmission in America. Vaccination coverage as high as 85-90 percent might be required nationally. And that’s for the entire population.
While COVID-19 vaccination is essential to protect kids, it will also help to curb transmission from children to adults. It would also prevent further school closures, which have numbered in the thousands.
The bar is high, but it’s doable. Then again, given the absurd and ugly bile directed at safe and effective shots for teenagers—not to mention adults—I’m not holding my breath.