Last Monday, Florida became the only US state to recommend against healthy children receiving the COVID vaccine. Our team continues to endorse vaccination for all children who are eligible, so we wanted to clear up a few misconceptions.
First, the people who advise Gov. Ron DeSantis believe children are at almost no risk from COVID.
This is false.
Since August 2020, 116,461 kids have been hospitalized with COVID. 14% of them, or about 1 in 7, had a severe outcome such as requiring mechanical ventilation or dying. When the vaccine was approved for children 5-11 years old (the lowest risk age group), 33% of those who were hospitalized had no underlying conditions. And 20%+ of all pediatric COVID deaths occur in children without health conditions. Vaccination is an important tool to prevent significant illness in any child.
Of course, we do not want to minimize the very real risk of myocarditis after vaccination. But we have to compare it to wild virus infection which can be much worse. “They aren’t equal,” Dr. Paul Offit told me. “Myocarditis following vaccination is generally transient, self-resolving, and without consequence. This is not true for wild-type virus infection.”
One outcome of wild virus infection can be a multisystem inflammatory syndrome (MIS-C). This unique, severe condition often involves 5 or more organs and sends most kids to the ICU, where their median stay is four days. It requires multiple, sometimes serious drugs to treat. On the other hand, a child with vaccine-induced myocarditis might stay at a hospital for 1-3 days (often just to watch how they recover) and will usually be treated with ibuprofen or rest. Both conditions can be more severe and have lasting effects, but the odds for a better outcome are not equal. Providers who observe COVID illness and vaccination side effects firsthand recommend vaccination.
The data strongly support those providers. We know that 1,451 kids have died from COVID, roughly 3 times the number of recorded myocarditis cases in those under age 18 from December 2020 to August 2021 (pericarditis appears to be even rarer). And during all but one month of 2021, COVID-19 was among the top 10 causes of death for every American over the age of 5.
None of this even touches on long COVID. Although it impacts only a minority of children, and almost all of them recover within 2 months, being sick for such a long time is not worth the risk. We know that other viral infections can have rare but serious long-term impacts, and we do not know everything about COVID’s long-term effects. Why risk it?
Now for the second misconception: Gov. DeSantis’ advisors falsely believe protection from the vaccine either wanes too quickly to be of use or doesn’t protect against new variants. This just isn’t true. We know now how hundreds of thousands of kids from 11 states fared during Omicron. While the vaccine seems to provide only limited protection against getting sick with mild COVID, it does protect against severe COVID at a level of about 40-50%. And, of course, making sure our children don’t get severely sick is what matters most. We also know for sure that 12-17 year olds are protected because they’ve been getting vaccinated for long enough for us to gather that information.
Are there enough hospitalizations to draw these conclusions? When you look at the data, you see that the protection is consistently positive and high every single week (strongly suggesting it’s not random). And while protection against hospitalization ultimately does wane to about half, it is probably long-lasting since it involves memory cells that stick around rather than antibodies that completely prevent infection.
Also keep in mind that COVID is here to stay. Few people predicted Delta, and almost no one predicted Omicron which caused a wave of reinfections. We have every reason to expect future variants. If your child comes across a variant, it’s best to face them with some vaccine protection.
But DeSantis’ Surgeon General emphasizes that transmission is now low and natural immunity is high. Why vaccinate?
For one, making predictions about COVID has proven difficult. Omicron, which was called a cold and nature’s vaccine, ended up accounting for 1/3 of all pediatric COVID deaths in the span of just two months. While it seems now to be on its way out, Europe has already begun to see a uniform uptick in cases. And whether that lasts or burns out, COVID as a disease isn’t going away. Your child’s best option is to be vaccinated when they get it.
As for vaccination after infection, consider this: most people are willing to get two shots and then face the virus. What’s the logic behind getting infected and then fearing the vaccine? If you get vaccinated after natural infection, you will reach hybrid immunity, meaning that your immune system knows how to handle a variant and the vaccine-made spike protein. The thinking is that it will almost certainly be lower risk than getting COVID again. This is why Dr. Ashish Jha notes: “If we want to do a risk-benefit calculation of the vaccine, we need to think long-term.” And long-term thinking means getting vaccinated for greater immunity.
All in all, the recommendation against COVID vaccination in kids is a poor one. It’s no surprise that Florida’s own chapter of the American Academy of Pediatrics, made up of 2,500 pediatricians, roundly condemned the action. It’s also no surprise that the panel which informed Florida’s recommendation was mostly made up of non-pediatric doctors, several of whom have advised not to vaccinate kids in the past. Everyone else, on the other hand, encourages you to vaccinate your children.