Analysis: Do we vaccinate kids if pandemic’s end is near?

If this were December 2020 or August 2021, the case for vaccinating young children against COVID-19 would be easy to make.

With cases rising and hospitals stretched to capacity, vaccinating young children would help slow transmission of a virus that kills thousands of Americans every day. The risk that the vaccination could cause heart inflammation in young children appears to be negligible. The fight against the corona virus would clearly prevail.

But it’s the end of October 2021 and the virus seems to be in retreat. New infections and deaths have fallen by more than 45% since a surge in September. And after several waves of infection, more than one in four US citizens has probably battled the coronavirus and gained some immunity as a result.

All of that is good news, but it also means that widespread vaccination of the country’s primary school population is offering fewer benefits than before.

That makes it harder to say there’s enough gain from the shot to offset the theoretical possibility of heart risks — a downside that hasn’t been measured yet.

These are the calculations experts are trying to make when deciding whether Pfizer and BioNTech’s COVID-19 vaccine for children ages 5 to 11 should be made available to all 28 million U.S. children in that age group — and in particular, whether it should be recommended.

On Tuesday, the Food and Drug Administration’s panel of scientific advisers voted overwhelmingly to recommend expanding access to the vaccine to families who want it for their young children.

However, the panel also made it clear that it did not support the goal of vaccinating young children as quickly as possible. At this stage of the pandemic, there are simply too many unknowns to support blanket immunizations for everyone, several panel members said.

One uncertainty is whether prepubertal boys face the same risk of heart inflammation in response to vaccination that has been observed in teenagers and young men.

Another question is whether the Centers for Disease Control and Prevention is correct in its estimate that at least 40% of elementary school-age children have already been infected and are now protected to some degree.

But the most intriguing uncertainty is the state of the pandemic. Whether we’re nearing the end of the outbreak or just resting between waves is an unknown with far-reaching implications, FDA advisers said.

“If trends continue as they have been, this may not be the emergency it is now,” said immunologist Dr. James EK Hildreth at Tuesday’s meeting.

The reservations expressed by Hildreth and others came after an analysis by FDA staffers showed that under certain assumptions about a waning pandemic, vaccinating all children ages 5 to 11 might not be warranted.

For the record:

3:02 p.m. October 29, 2021An earlier version of this story incorrectly stated that the risks of vaccine-induced myocarditis would outweigh the benefits of vaccination in young children if the number of hospital admissions exceeded 11,500 per day.

In a scenario where new hospitalizations fell to 1,150 per day and new infections to 7,000, hospitalizations for vaccine-induced myocarditis could exceed those prevented by the vaccine.

We’re not there yet. But if current trends continue, we could be soon.

Even as it burns itself out, the pandemic continues to disproportionately affect black and brown families, said Hildreth, president of Meharry Medical College in Nashville. That’s reason enough to urge parents to have access to a COVID-19 vaccine for their young children if they so choose, he said.

dr Michael Nelson, a University of Virginia immunologist who is also a member of the FDA Advisory Board, agreed that “an option for a fully informed public is a pretty good way forward.”

He stressed that the panel’s support for the vaccine’s approval was “not a mandate” to vaccinate all children between the ages of 5 and 11.

The epidemiologist Dr. Echoing his colleagues’ flashing yellow signals, Arnold Monto of the University of Michigan acknowledged that he has “concerns” about “how groups that we have no control over will behave” when the pediatric COVID-19 vaccine is released approved for emergencies.

Chief among these groups are politicians and public health officials, who have called for immunization requirements for young children once the FDA makes the vaccines available.

President Biden has encouraged governors, health organizations and business owners to require COVID-19 vaccinations for adults as a condition of coming to work, attending public events and eating and drinking in bars and restaurants.

The resulting mandates have sparked an angry backlash across the country. Montana has banned vaccine mandates of any kind, and governors or legislatures in Texas, Georgia and several other states have taken action to severely limit enforcement of mandates implemented by local government or private entities.

Passing vaccination mandates for school children would be a little more complicated. While the full-strength Pfizer-BioNTech vaccine has received the FDA’s unqualified blessing for people over the age of 16, the agency won’t be issuing more than an emergency use authorization for use in young children any time soon. Until then, COVID vaccination requirements for schools could be on shaky legal foundations.

But those fighting to get schoolchildren vaccinated should be prepared to recognize that younger children are at lower risk of severe COVID-19 disease than adults, said Dr. Monica Gandhi, an infectious disease expert at UC San Francisco.

“The vote came in and it was like, ‘Woo-hoo, we’re going to be at the county fair next week and vaccinate all the kids,'” she said.

As adults crowd into sports arenas, bars and restaurants to eat, drink and cheer unmasked, they are urging children to get the vaccine before all safety concerns are resolved.

“We ask children to take one for the team,” Gandhi said.

dr Rochelle Walensky, director of the CDC, resisted the suggestion that the need to get children vaccinated was over.

“There is urgency because we’ve seen childhood illness, we’ve seen childhood deaths, we’ve seen ‘long COVID,'” Walensky said at a White House briefing on Wednesday, referring to an ongoing form of the disease. “Certainly we’ve seen cases before and the way to prevent a resurgence is to vaccinate more and more people.”

CDC data presented at the FDA Advisory Committee meeting showed that COVID-19 now ranks eighth on the list of leading causes of death for children ages 5 to 11. During the course of the pandemic, the disease has claimed the lives of at least 94 children in this age group.

And while these young children’s hospitalizations have declined over the past two weeks, they remain about as high as they were during the darkest days of the pandemic last winter.

The average daily death toll for Americans of all ages still exceeds 1,000, and a season of colder, drier weather could revive slowing transmission rates, Walensky noted.

“We must remain vigilant,” she said. Analysis: Do we vaccinate kids if pandemic’s end is near?

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