Guidance from the Centers for Disease Control and Prevention (CDC) is clear: it recommends universal indoor masking in schools for all children ages two and up, as well as staff, teachers, and visitors, regardless of vaccination status. The American Academy of Pediatrics (AAP) is similarly clear in its recommendation that all children two and over engage in universal masking indoors at school.
Children At Risk Due to Lagging Vaccinations
Experts urge that widespread adult vaccination is key to protecting children while so many are still unable to be vaccinated. Since the end of April, one COVID-19 vaccine has been approved for use in teens and tweens ages 12 to 17. Vaccination rates by age group is in the graphic below:
Less than half of adolescents in both the 12-15 and 16-17 age groups have completed the vaccination series. The Centers for Disease Control (CDC) and other health officials stress that increasing the vaccination rate in this age group could be an important preventative measure as schools reopen, particularly with the spread of the more infectious Delta variant.
The situation is more complicated for young children. Clinical trials are currently underway for children ages 5 to 11, with the Food and Drug Administration (FDA) recently asking these companies to add additional children to their studies in order to ensure any rare side effects may be caught during the trial. The Academy of American Pediatrics (AAP) has now sent a letter to the FDA encouraging an expedited approval of the vaccine for these children, “based on data from the initial enrolled cohort, which are already available, while continuing to follow safety data from the expanded cohort in the post-market setting.” Trials have not yet begun for children under the age of 5, but the AAP writes that they believe a clinical trial can be safely completed for this age range with a 2-month safety follow-up based on “scientific data currently available on COVID-19 vaccines, as well as on 70 years of vaccinology knowledge in the pediatric population.”
Of course, the actual impact of a COVID vaccine when it is approved for children is dependent also on parents choosing to have their children vaccinated. Adolescent vaccination rates have already been shown to be lower than the adult population. Research and media coverage on this issue tends to identify key reasons as a belief that children/adolescents are likely to be seriously sickened by COVID; a concern about side effects; concern about the speed/process of vaccination approval; and/or a general skepticism about the value of this vaccine for anyone. The Larry A. Green Center recently dug into “vaccine hesitance” in a recent survey of primary care patients. Just 35 percent of all parents of children reported wanting to have their child vaccinated “as soon as possible,” with lower rates among low-income and rural respondents (29 percent and 23 percent, respectively). Thirty percent specifically said they do not intend to vaccinate their children. When asked about what would change the minds of this 30 percent, 14 percent reported they would do so if required by their children’s schools, while 11 percent would not vaccinate under any circumstances.
Between those wanting immediate vaccination and those intending to refuse vaccination for children, there exists a significant population who seem unsure about how to proceed. The key to reaching these families, per Green Center researcher, is engaging via pediatric primary care providers. Nearly 60 percent of parents reported that their child’s provider’s opinion on the vaccine is very important in their decision; this was much higher than those reporting government agencies or family/friends. Access to the vaccine will also be important to consider in a pediatric population; the mass vaccination sites that have been beneficial for widespread adult vaccination may not be as appealing. In fact, 64 percent of parents are most willing to vaccinate at their child’s doctor’s office. No other location even comes close to this–just 10 percent would feel most comfortable at a vaccination site and 8 percent at a pharmacy. As states and local communities begin developing vaccination outreach strategies in preparation for the next ages of vaccine approval, pediatric primary care providers–with whom children and families already have established, trust-based relationship–must be at the heart. Of parents who have discussed the vaccine with their pediatrician, 75 percent chosen to have their adolescent vaccinated.
Guidance from Pediatricians
While pediatricians and parents are discussing the value of the COVID vaccine, they should also discuss whether children need to catch up on any of the regular childhood vaccinations. As we have previously reported, these vaccines fell during the pandemic as families navigating fears of the virus and new operational rules at their doctor’s office. Nationally, the vaccination rate continues to lag behind pre-pandemic figures. While children under age 2 have generally “caught up” on these vaccines, older children are still behind, just as schools reopen.
As the current surge in summer cases of Respiratory Syncytial Virus (RSV) reminds us, while COVID dominates our headlines, children are vulnerable to all of the same illnesses as before; up-to-date vaccination helps save lives. Additionally, the AAP continues to encourage a “multi-layered” approach to preventing COVID in schools, including recommending vaccination for all who are eligible as well as masking for all those over the age of 2 regardless of vaccination status.