From the earliest days of the pandemic, doctors and public health officials have seen widespread vaccination as the most effective way to stop COVID-19 in its tracks. But a growing contingent of medical experts is now questioning whether that conventional wisdom ought to apply to children.
Their doubts are not borne of conspiracy beliefs, but couched in the carefully calibrated language of risk and benefit. And they’re expected to get a public airing next week as advisers to the Centers for Disease Control and Prevention ponder a spate of post-vaccine heart problems in adolescents and young adults.
No one is arguing that COVID-19 immunizations for kids should stop altogether. Rather, a debate has erupted over the need to inoculate healthy children as soon as possible and according to the two-dose regimen authorized by the Food and Drug Administration.
The vaccines made by Pfizer-BioNTech and Moderna have been administered safely to millions of adults and been vetted in several thousand adolescents. But neither has been subjected to exhaustive testing in diverse pediatric populations, as is typically required for a vaccine intended for universal use in kids.
The FDA authorized the Pfizer-BioNTech vaccine for emergency use in adolescents as young as 12 on May 10. In the weeks that have followed, the safety monitoring systems managed by the FDA and CDC detected dozens of cases of a possible side effect in newly vaccinated teens: an inflammation of the heart muscle known as myocarditis.
The cases typically developed in older adolescents, most of them boys, three to four days after they got a second dose. Virtually all were considered mild, presenting as chest pain and tightness that resolved after treatment with over-the-counter medications. None of the patients appear to have died or suffered serious cardiac malfunction, though it’s too early to know whether they will suffer long-term effects.
More investigation is needed to determine whether the vaccine caused these heart problems or if the timing was merely a coincidence, he said.
As the pandemic appears to be winding down across the United States and its limited toll on children has been tallied, it’s no longer clear that immunizing children will bring the outbreak to a faster close, said Dr. Martin Makary, a public health expert at Johns Hopkins University.
Makary is urging his colleagues to “think twice” before recommending universal COVID-19 vaccination of healthy kids. Given the data in hand, “there’s no compelling case for it right now,” he wrote this month in MedPage, a website widely read by physicians.
From the moment that the first COVID-19 vaccine started going into Americans’ arms, one certainty has seemed almost beyond questioning: As soon as enough doses were available, the nation’s children would roll up their sleeves.
There are strong arguments for that position too.
Although it’s clear COVID-19 has largely spared children from severe illness, the CDC says 456 American kids have died of the disease, though that is considered a conservative estimate.
At least 20,000 — and as many as 100,000 — kids have been hospitalized with COVID-19. Indeed, the CDC reports that even as adult hospitalizations declined in March and April, the rate at which adolescents were admitted ticked upward. Nearly one-third were treated in intensive care units, undercutting the argument that severe illness rarely happens in this age group.
At Children’s Hospital Los Angeles, pediatric cardiologist Dr. Jodie Votava-Smith has seen the wreckage of COVID-19 firsthand, and she has no doubts about the value of vaccinating kids.
The mother of two children who are 5 and 7, Votava-Smith said she “can’t wait” to get them vaccinated. “They know they’ll be getting their shot when it’s their turn,” she said.
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