• John Lantos

So? Gonna immunize your kids?

Parents in the US make up their own minds about immunizations. Almost all consent to some vaccines for their kids. Over 99% of US children have received at least one dose of one vaccine. But immunization rates vary for different vaccines. The highest rates (>90%) are for the routine childhood vaccines - DTaP, MMR, Polio, Hib, and Hepatitis B. Hep A lags with only 57% of kids getting 2 doses. HPV is even worse - only 51% of females and 30% of males have gotten two doses of HPV. Influenza is tougher to measure, since it must be given every year. Some years are better than others. On average, though, about two-thirds of US children get flu vaccine each year.

With these stats in mind, how are we doing with COVID-19 vaccine? The uptake of COVID-19 vaccine seems to follow trends for other vaccines. About two-thirds of older adolescents have gotten the COVID-19 vaccine. But rates are much lower, so far, in younger children.

All the experts recommend the vaccines for kids over 6 months of age. But many parents are not following the experts recommendations. The data on uptake are complicated because the vaccines were approved for different age groups at different times. Still, for each age group, there seems to be a trend. In the first months after approval, many kids are vaccinated. Then the number of new vaccinations tails off. So, about 70% of kids age 12-17 have gotten at least one dose of a vaccine, 37% of kids 5-12, and only 4% of kids under 5. In each age group, the numbers peaked soon after approval, then started to fall Will those numbers change? Or will many parents remain opposed to the recommendations of the experts?

Debates persist because the data about COVID in kids and about the vaccine are complex and complexity leads to uncertainty and indecision. We speculate that there are at least five sources of uncertainty.

First, there are concerns about safety is the vaccine safe. There are, clearly, adverse events associated with the various vaccines. Still, they are remarkably safe. But safety is relative. So the second concern relates to the relative risk and severity of disease. The risk changes as the prevalence changes and as new variants emerge. Third, there are questions about how to measure the efficacy of the vaccine. Is the goal to prevent all infections? For that the vaccines aren’t very effective. But they do prevent serious infection with hospitalization or mortality. Fourth, studies are done in specific populations. The age categories have no biological basis. So why study children 5-11 separately from those 12-15? Even within age categories, we find variation between the youngest and oldest children. Finally, there are questions about the regulation of vaccine administration – vaccines can be approves under an Emergency Use Authorization or receive full regulatory approval. Once approved, they can be recommended or mandated. They can then be reevaluated and perhaps redesigned each year to respond to changing epidemiology and new variants.

Given all these uncertainties, some lingering doubt in the minds of parents and doctors is inevitable. Current policies of recommending but not requiring vaccines make sense. That is, perhaps why even states that once considered mandating vaccines for schoolchildren have opted instead to back away and, instead, make vaccines available and optional. It makes sense to immunize children against COVID-19. It doesn’t yet make sense to mandate it.

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