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The case for vaccinating kids against COVID-19

As COVID-19 vaccines become more accessible, the next big question will soon take center stage: Should kids be vaccinated?

The answer is probably yes, assuming the virus will circulate for years to come and that vaccine trials for kids prove safe and effective. To understand why, here are some important data points to consider.

Skeptics of vaccinating children are likely to point out that COVID-19 deaths among children are rare. This is true: The Centers for Disease Control and Prevention report that 226 children under age 18 have died from the disease. Most had some type of medical condition that put them at risk. Approximately 23 percent were obese and 12 percent had diabetes, according to the Coronavirus in Kids Tracking and Education Project, and a study from FAIR Health, to which one of us (Marty Makary) contributed, of approximately half the nation's private insurance data found that children without chronic conditions had a covid-19 mortality rate of zero.

But this is only part of the story. The severe illness and intensive care associated with some pediatric covid-19 infections could lead to significant long-term problems. Thousands of American kids have developed multisystem inflammatory syndrome in children (MIS-C) due to covid-19, which is estimated to occur in 0.09 percent of confirmed cases in children. Nearly all kids survive MIS-C, but in some cases, it can be terribly painful and have lifelong consequence, such as heart weakness and neurological damage.

Preventing covid-19 in kids could also mean preventing disability from long covid, a condition in which children have lingering symptoms of fatigue, muscle pain or neurologic symptoms months after infection. Only recently have cases of this condition been recognized. Though it appears to be less common in children than in people in their 30s and 40s, there's still a lot we don't know.

There is also the concern of kids transmitting the virus to more vulnerable people. A large meta-analysis in the journal Clinical Infectious Diseases found kids are less likely to be the source of household outbreaks. However, there are documented cases of children passing covid-19 to adults. Although there was not a single reported case of viral transmission from child to teacher in a study of 90,000 school children in North Carolina during the pandemic, that may be due to precautions such as masking and distancing.

Every child's life matters, and even though covid-19 complications are rare in kids, that does not mean we should not try to prevent them.

Of course, the risks of covid-19 should be weighed against potential risks of vaccinating children, if any. Data on this should be coming soon. Pfizer and Moderna, whose vaccines are authorized for people over age 16 and 18, respectively, have each recruited approximately 3,000 to participate in adolescent vaccine trials. The Moderna study focuses on children ages 12 to 17 while Pfizer is looking at 12- to 15-year-olds. Studies for younger kids are likely to follow as safety is demonstrated.

Based on the impeccable safety profile of the vaccines currently available to U.S. adults, we expect that child vaccine trials will demonstrate a similar safety profile. We know of no vaccines for other diseases that were found to be safe for adults that have not also been found to be safe for children.

A final consideration should be needle anxiety, which affects a small proportion of kids. Saving lives and preventing illness and disability supersedes the problem of needle anxiety, but we should invest in approaches that reduce the discomfort of injection. Cold therapy and vibrating devices, such as the "Buzzy" device, can confuse nerves to numb an injection site and result in little to no pain.

One possible alternative to a universal vaccination approach is a targeted vaccination approach for kids based on risk factors for COVID-19 complications, such as obesity. But such an approach would not prevent most cases of MIS-C, which can affect children without risk factors. It could also stigmatize millions of children with obesity, asthma and other conditions. It could also be difficult to implement.

None of this is to say that vaccinations should be required for kids to attend school. The suggestion by some teachers unions and others that child vaccinations could be a prerequisite to in-person learning is ignorant of the plethora of data on the harm to children being shut out of school.

To be clear, deciding whether to vaccinate children will take patience. We should not rush to any universal policy until the vaccine evaluation process is complete, the data are compelling and we are sure COVID-19 remains a threat. Nevertheless, we are strong believers that pediatric vaccinations save lives. The same may be true for the COVID-19 vaccine, too.

Marty Makary is a professor at the Johns Hopkins School of Medicine, Bloomberg School of Public Health and Carey School of Business, and author of "The Price We Pay." Nicole Saphier is a physician at Memorial Sloan Kettering Cancer Center, an assistant professor at Weill Cornell Medical College and author of "Panic Attack."

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