San Antonio Express-News (Sunday)
Parents anxious for vaccine; FDA cautious
Vaccines have changed the trajectory of childhood diseases. Most of us don’t worry about our children being hospitalized with measles, polio or “putrid throat” (diphtheria)
In the early days of COVID-19, many of us placed our hope on a vaccine to end the pandemic. Three vaccines came in less than a year, but not for everyone. If you’re younger than 12, you can’t be vaccinated against COVID.
As my 11-year-old recently raced off to school for the first time since March 2020, I had the same anxiety as many parents. My son’s San Antonio Independent School District campus had high vaccination coverage among staff and consistent mask-wearing among students and faculty, but I felt like I was playing Russian roulette. I kept saying, “The FDA should just do it already! Why are they taking so long to provide emergency use authorization for the Pfizer vaccine?”
As an infectious disease epidemiologist who has spent much of the past decade trying to improve immunization rates in Texas, I also understand the caution.
Early in the pandemic, older adults were most likely to suffer severe outcomes. Delta changed that. Along with RSV and flu, both occurring earlier in the season than usual, we now have a dangerous trifecta of childhood illnesses.
We know the COVID vaccines are safe and effective for children 12 and older, so why not 11? Or 10? While severe illness and death is still relatively uncommon in children, the families of 454 children in the United States who have died from COVID will beg to differ. COVID is not the flu. Last year the CDC reported one pediatric flu death. Children older than 6 months can get vaccinated against the flu.
Through July and August, more children were hospitalized for COVID than ever before. And that was before school started. Even the American Academy of Pediatrics has said the FDA must expedite emergency use authorization for 5- to 11-year-olds before delta spirals out of control.
So why the delay?
When we tell people to get a vaccine, we are saying: “Any effects of this vaccine are negligible
compared to infection with the virus.”
While severe complications from the vaccine are extremely rare, mild myocarditis, or heart problems, have occurred in boys aged 12 to 17 at a rate of 67 per 1 million (9 per 1 million in girls). The pre-delta risk of myocarditis from COVID infection is much higher (876 per 1 million cases in boys). There is no doubt the risk from COVID infection far outweighs any risks associated with the vaccine.
As adults, we are comfortable making these decisions for ourselves, but the stakes are higher when it comes to our kids. Every student of public health learns the history of our missteps and vows to not repeat them. Public health relies on public trust. If we get this wrong, even a little bit, we risk parents opposing not just the COVID vaccine but losing trust in all vaccines.
That would be a disaster.
The emergency use authorization for those 12 and younger isn’t just about COVID. It’s about public health leaders being able to tell parents in the next pandemic: “Trust us.” So the FDA has asked Pfizer and Moderna to increase the number of participants in the trials to identify the more rare events, just to be sure.
That’s small comfort to the parents sending their children back to crowded classrooms and receiving notices their child was exposed to COVID at school. As we wait, we rely on other mitigation measures, forming a protective cocoon around our kids by vaccinating all who can be vaccinated. We do it by requiring masks on every person on a school campus (with appropriate exceptions for medical conditions). We do it by creating physical distancing indoors and offering virtual options for those with higher risks.
Only, we’re not.
Just 44 percent of 12- to 15-yearolds and 56 percent of 16- to 49-year-olds in Bexar County are vaccinated. Our state leaders are trying to block schools from requiring one of the few tools we have: mask-wearing for all. They are suing school districts that have required vaccination for those eligible. Children younger than 12 don’t have a protective cocoon in their schools.
As a public health professional, I appreciate the FDA’s caution. We have to consider the long game of public health.
As a parent, I’m with the American Academy of Pediatrics: Hurry up already and approve the vaccine. My 11-year-old, whose fear of needles is legendary, said, “I’m ready!”