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Opinion Why vaccinating kids for covid-19 makes sense — just like it did for polio

Seven-year-old Mimi Meade winces from the sting as Dr. Richard Mulvaney inoculates with the Salk polio vaccine on April 26, 1954. (HARVEY GEORGES/ASSOCIATED PRESS)

Ashish K. Jha is dean of the Brown University School of Public Health.

Seventy years ago, a virus terrorized Americans. Parents kept children indoors rather than risk exposure, and U.S. cities where cases were detected imposed severe curfews. What terrified Americans — especially parents — was that the disease could paralyze its victims. Many of these children could be kept alive only through immense artificial respirators known as “iron lungs.”

The virus in question was, of course, poliomyelitis, which the public rallied to defeat. It didn’t matter that only 0.1 percent of those infected develop serious complications. Americans embraced the highly effective vaccine developed by Jonas Salk. We continue to mandate the vaccines for children to this day.

This history may help parents make the decision about vaccinating their children against covid-19. Many parents and kids have eagerly filled up available appointments over the past week since shots first became widely available for 5- to 11-year-olds. But news reports also have highlighted considerable reluctance among other parents around shots for their kids in this age group — even including parents who have been vaccinated themselves.

This reluctance is understandable. Parents have repeatedly heard that covid-19 is no big deal for kids. This is true for most children, just as it was for polio. For both covid-19 and polio, three-quarters of those who become infected never develop symptoms, and most who have gotten sick made a full recovery after flu-like symptoms. Children are less vulnerable to covid-19 than adults, but to some extent, that was also true for polio. While polio primarily affected children, when it did infect adults, they often had worse outcomes.

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There are some important differences. Salk’s original polio vaccine used an inactivated virus. Given imperfections in the inactivation process, it would occasionally cause polio itself. Vaccines for covid-19 are different; they don’t use the coronavirus, so it is physically impossible to get the disease from the shot. In that way, coronavirus vaccines are far safer. And the coronavirus vaccines have been rapidly given to more than 4 billion people around the world, including to tens of millions of children, with a safety profile that far exceeds those of the original polio vaccine. In fact, it is greater than any vaccine in our nation’s history.

The comparison has other limits, of course. Polio was a devastating disease that in the 1950s caused as many as 3,000 deaths annually. There was no capacity to do screening testing — kids were tested for polio only after they showed symptoms and were likely already on the way to serious illness. It would be like waiting to test our children for covid-19 until the virus had already led to hospitalization.

Mercifully, covid-19 has led to only about 700 deaths among children in the United States, a tiny proportion of the overall death toll. Nonetheless, it has closed schools and canceled major public gatherings. And as with polio, thousands of children have been hospitalized with severe illness, and thousands have developed multisystem inflammatory syndrome, a life-threatening condition. Meanwhile, the number of infected children who suffer from long covid is unknown, as is their prognosis.

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There’s another difference between polio and covid-19: We eradicated polio, but given the highly infectious nature of the coronavirus, it will become endemic in the United States. Vaccines will likely become a regular part of our lives to keep the virus under control and the consequences of getting infected mild. Without the vaccines, children will remain vulnerable to potentially poor outcomes for years, if not decades.

Misinformation and anti-vaccine rhetoric make it easy to turn away from the impact of the coronavirus in children, particularly as we are still coming to understand the longer-term consequences of infection. Polio could not be ignored. In the 1950s, almost everyone knew someone paralyzed because of polio; their lives were shaped by wheelchairs and crutches. President Franklin D. Roosevelt was the most visible victim of the virus, leading the famous “March of Dimes” campaign to eliminate polio. When Salk’s vaccine became available, parents eagerly took the chance to protect their children from a disease whose impact was unmistakable.

If today’s misinformation, politicization and anti-vaccine sentiment existed in the United States in the 1950s, would the polio vaccine have received the same level of uptake? Would we have heard the same argument that most kids are not at risk? That a vast majority are asymptomatic? Or that only a tiny minority dies?

Fortunately, none of those arguments had much purchase back then. And we must not pay much attention to those arguments now. With holiday travel and family gatherings on the horizon, we need to vaccinate all eligible children as soon as possible so that both children and adults can start to put the pandemic behind us and look to a better future ahead.

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