ABI HAMMOND HARDLY FITS THE profile of an anti-vaxxer. The 30-something gym owner and strength and fitness coach considers herself “middle of the road politically,” lives in blue state Connecticut and has not only kept her two children, ages 7 and 11, up to date on their vaccinations but also makes sure they get flu shots every year.
But she won’t be first in line if, as expected, the U.S. Food and Drug Administration (FDA) approves COVID-19 vaccines for children under 12 early next month. She’s not sure if she’ll get in line at all.
“I’m really conflicted,” she says. “Is the level of illness that significant in children? I don’t know what the answer to that is. Initially, you hear, ‘This is not serious for kids at all.’ And then it came time for the vaccine to be rolled out for kids. And it was like, ‘It’s actually very serious for kids, too.’ And I’m like, ‘Wait a second…’ The dialogue keeps changing. It’s confusing. And it’s become so political.”
On October 20, the White House, in anticipation of FDA approval, released details of its plans to have kids vaccinated through pediatricians’ offices, hospitals and other locations. Previously, the White House had told governors to start preparing to vaccinate children as young as 5 by early November. Administration officials said they had purchased 65 million pediatric doses of the Pfizer/BioNTech vaccine, enough to vaccinate all 28 million children who would become eligible if the FDA approves the shots for children between the ages of 5 and 11 when it meets to consider the issue. An advisory committee is slated to offer a recommendation on October 26, and is widely expected to be all for it.
Parents? Not so much. According to a Kaiser Family Foundation poll, four in 10 parents with children between 5 and 11 plan to “wait a while to see how it is working” before vaccinating their kids. Their reservations run the gamut: Some worry the vaccine is not safe. Others believe the government has exaggerated the threat COVID-19 poses to kids. A small percentage are opposed to all vaccines. But many, like Hammond, who says she plans to “wait until the dialogue settles a bit,” are simply confused by all the noise.
From the beginning of the pandemic there has been plenty of noise, ranging from honest scientific uncertainty about how to deal with the pandemic to conflicting statements by public health officials to misinformation and lies from conspiracy theorists and political opportunists. Two years into the pandemic, medical understanding of the virus has made enormous leaps, but public understanding has lagged. Cutting through the confusion may mean the difference between a return to something like normal or a continuation of periodic waves of emergency and lockdown.
For vaccinating kids, a lot of confusion stems from the fact that there are two medical arguments in favor of it. Both of them involve the slippery question of risk.
The first, which has been made by public health experts for some time, is that vaccinating kids would reduce the overall spread of the virus. Children are at much lower risk of serious illness or death than adults from the virus, but they appear to be just as likely to spread it. To many parents with doubts, however, that rationale sounds like experts asking them to risk their kids in order to protect somebody else.
The dialogue keeps changing. ‘You need one shot. You need two shots. Now you need a third booster.’ It’s confusing. And it’s become so POLITICAL.”
The second argument, which has gained strength with the spread of the Delta variant and may prove more compelling to hesitant parents, is that, amid a recent sharp rise in cases, the risks to kids are higher than had first been thought. How high? To put it into some context, in a typical year the disease that kills the most children in the U.S. is cancer (about 1,800 deaths), followed by heart disease (about 600 deaths). The Centers for Disease Control (CDC) estimates that over the last two years, COVID-19 has killed roughly 570 American kids. and hospitalized about 22,000.
“Even though this doesn’t represent the same degree of death and hospitalization as you’re seeing in adults, it still represents a major cause of death and hospitalization in children,” says Yvonne Maldonado, an expert in pediatric infectious diseases at Stanford University who chairs the infectious disease committee of the American Academy of Pediatrics (AAP), which has taken a leadership role in urging parents to get eligible children vaccinated. “The question is do we want to prevent deaths in children?”
That question may have an easy answer for doctors and public health experts. But it is not so clear to parents like Hammond, and they are the ones that are going to need to be convinced—or compelled—to get their kids vaccinated.
We’ve often reduced the quantification of risk to a simple ‘have to,’ ‘must’ or ‘need to’ get a vaccine. But what is the ACTUAL RISK for a healthy child?”
LAST YEAR, LOCKDOWNS, HOME-SCHOOLING AND other mitigation measures may have masked the vulnerability of kids and helped create the false impression that children were protected. Pediatric cases, however, ticked up dramatically in the late summer and early fall, driven by Delta and a return to classrooms. The number of children and adolescents hospitalized with confirmed COVID-19 had already risen in August, largely due to Delta. When schools opened in September, new cases soared to more than 250,000 a week, reaching levels exceeding even those seen during the spike last winter.
In August and September, COVID-19 was the leading cause of death for Americans ages 35 to 54, and the sixth or seventh leading cause of death for children, according to recent numbers released by the Kaiser Family Foundation. And at one point, the situation was so dire, the Children’s Hospital Association, which represents 220 hospitals, sent a letter to President Joe Biden warning that many hospitals were nearing capacity, experiencing “unprecedented strain” and pleading for help.
In recent weeks, those numbers—in both children and adults—have begun to wane significantly, thanks in part to rising natural immunity from those who have already been infected, new restrictions and growing vaccination levels in the hardest- hit areas. But many frontline medical providers say what they have seen in their hospitals only highlights the importance of vaccinations.
“One thing we have clearly learned in 2021, which may not have been as clear in 2020, is that pediatric COVID must be taken seriously,” says James Versalovic, pathologist-in-chief at Texas Children’s Hospital in Houston, which has hospitalized 1,400 children for COVID-19 since the start of the pandemic. “I have seen too many children here walking through our ICU, in our emergency centers or on ventilators. These are serious setbacks for children.”
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