Dr Adam Ratner says most parents he speaks to are excited about the idea of getting their children vaccinated against COVID-19. More than a year into the deadly pandemic in the United States, the jab is seen as key to getting regular life back.
But one question keeps coming up: Will it be safe?
“It’s important to make sure that these vaccines are safe and that they are OK in kids in the same way that they are in adults,” said Ratner, the director of pediatric infectious diseases at Hassenfeld Children’s Hospital at New York University.
There is no reason to think coronavirus vaccines, which have been proven very safe, will work differently in children but because children’s immune systems are different to those of adults, they must be tested before they are distributed.
“But once we know that [it’s safe],” he said, pointing to research trials that have shown promising results so far, “I think it’s going to be very important to vaccinate large numbers of children.”
Children make up about a quarter of the US population – and Ratner and other health experts say vaccinating them, both for their own defence against COVID-19 and to protect the wider community, will be critical to overcoming the pandemic.
Already, the US has authorised Pfizer-BioNTech’s jab for children aged 16 and 17.
Pfizer announced last month that its vaccine was 100 percent effective in a trial in 2,260 children aged 12 to 15 and on Friday, the company submitted data to the US Food & Drug Administration (FDA) to extend its emergency use authorisation to that age group. It said it planned to file similar requests with other regulatory bodies in the coming days.
“While the FDA cannot predict how long our evaluation of the data and information will take, we will review the request as expeditiously as possible using our thorough and science-based approach,” Janet Woodcock, the FDA commissioner, tweeted.
“The vaccines so far have been shown to be very safe in children,” said Dr Yvonne Maldonado, a professor of global health and infectious diseases at Stanford University.
She said emergency use approvals for 12 to 15 year olds would come first, while approvals for children under age 12 could happen in late 2021 or next year because those vaccine trials are staggered and take more time. The trials are staggered “because you have to start with safety settings first and then you move to younger and younger ages”, Maldonado added.
But vaccine hesitancy among the population has raised questions about whether parents will allow their kids to get jabs when they are available – and about the best ways to encourage inoculations.
According to a recent survey by the Kaiser Family Foundation (KFF) nonprofit, around 13 percent of Americans said they would “definitely not” get a vaccine, while 7 percent would get the vaccine “only if required to do so for work, school or other activities”. The share of those taking a “wait-and-see” approach to vaccination was 17 percent. The survey found that around three in 10 Republicans and White evangelicals said they will “definitely not” get a vaccine.
Some parents have raised concerns about the safety of the vaccines for children, despite the assurances from health experts, while others have longstanding opposition to vaccines for kids generally – based in large part on misinformation. For any vaccine to be approved, the FDA says a vaccine must be safe and effective and its benefits must outweigh any potential risks.
Strong public health messaging will be key to getting the highest number of children vaccinated, Maldonado told Al Jazeera, adding that it is “really important for paediatric providers to make sure that they speak to the parents of their patients and make sure that the parents feel comfortable”.
Another way to get children vaccinated is through school-based mandates; ordered at the state and local levels, these could require children to be inoculated against the coronavirus to attend public or private schools or even day-care centres.
But some parents have already made clear they oppose school-based coronavirus vaccine mandates. According to a recent Indiana University survey of more than 2,000 parents with kids under age 18, about a third of mothers said they were very or somewhat unlikely to vaccinate their children while a third also opposed requiring vaccines in schools.
The most strongly opposed were white Republican mothers, 47 percent of whom said they were very or somewhat unlikely to vaccinate their kids. Fifty-four percent said they opposed school vaccine requirements.
“Especially in the context of the pandemic and the misinformation that we see around vaccines, these moms in particular … feel like they are more able to control the risks of COVID than they are to control the risks of the vaccine,” said Jessica Calarco, an associate professor of sociology at Indiana University and one of the report’s co-authors.
Calarco told Al Jazeera that some of the mothers, who generally feel pressure to account for the health of their children, raised concerns about the long-term health effects of the vaccines. Instead of dismissing those concerns out of hand, she suggested health authorities acknowledge them – but provide accurate information.
“My hope is that by understanding some of the underlying reasons for this reluctance, by addressing some of the misinformation … that potentially gives us room and space to change course,” said Calarco.
History of mandates
Currently, all 50 US states have laws requiring specific vaccines for students, such as measles or rubella but 45 states as well as Washington, DC, allow religious exemptions, according to the National Conference on State Legislatures. Some states grant philosophical or medical exemptions, the US Centers for Disease Control and Prevention explains, while attendance rules for exempted students can change during an outbreak.
A few US colleges, including Rutgers University and Cornell University, have said they will require vaccinations for students when classes resume next fall. The head of the Los Angeles Unified School District also said in January that once COVID-19 vaccines are available for children, they will be required, “no different than students being vaccinated for measles and mumps”.
But so far, there is no statewide order requiring children to get a COVID-19 vaccine to go to school.
Vaccine mandates are not a novel concept. A 1905 US Supreme Court ruling set out that state and local authorities had the power to mandate vaccines in the interests of public welfare, explained Juliet Sorensen, a professor of health and human rights at Northwestern Law School.
The case, Jacobson v Massachusetts, involved “an early anti-vaxxer”, said Sorensen, who was fined for refusing to get vaccinated during a smallpox outbreak.
The decision came up as recently as last year when religious groups sued New York state for imposing limits on religious gatherings during the pandemic. The Supreme Court ruled in November that Governor Andrew Cuomo’s order was an unconstitutional breach of freedom of religion.
While that ruling did not overturn Jacobson, Sorensen said it will be interesting to see its effect going forward. She added that it is “highly plausible, given how infectious and serious COVID-19 can be”, that school boards already requiring children to get specific vaccines to attend school, will add coronavirus jabs to their requirements.
‘Carrot not a stick’
While it ultimately will be up to state and local authorities to set the rules around possible vaccine mandates, Maldonado warned that generally “it tends to polarise people when you make them do something”.
That was echoed by Sorensen who said “while a vaccine mandate more broadly, beyond the context of school attendance, may well be legal, it historically is politically very unpopular” and few policymakers are calling for vaccine mandates.
“Their approach rather is to persuade the public to get vaccinated because it’s good for our collective health – to use a carrot – not a stick.”
Meanwhile, Ratner stressed that it is important to remember that while children generally fare better than adults if they contract COVID-19, it can still be serious and require hospitalisation, and kids also can spread the virus to other people, including high-risk adults.
“If there is still widespread COVID and the vaccines are safe and effective in kids, I think you will probably see a lot of school districts going to the idea of mandating these vaccines. I think that would be reasonable,” he said.
“We don’t get out of this pandemic without protecting kids from COVID.”