with Paige Winfield Cunningham

Experts say it’s a no-brainer for adults and adolescents to get vaccinated against the coronavirus.

But for younger kids, the case isn’t as clear cut.

The Centers for Disease Control and Prevention last week authorized the Pfizer BioNTech coronavirus vaccine for use in children ages 12 to 15, though it could be months before a vaccine is approved for use in children younger than 12. Pfizer has said it could apply for emergency use authorization for vaccines in this younger age group by early fall, and Moderna may be on a similar timeline.

Yet it’s unclear how big the benefit would be from getting them vaccinated, some experts say.

Children under 12 are rarely hospitalized with or die of covid-19, the disease caused by the coronavirus — and there’s evidence they don’t spread the virus as easily as adults.

“For adults, it’s obviously better that the first exposure is to a vaccine, not natural infection,” said Jennie Lavine, an infectious-disease researcher at Emory University in Atlanta. “Vaccinating children becomes pretty marginal. They’re not getting much of a direct benefit, and it’s not clear that the indirect benefit will be that large.”

That could change, though, she said, if a new variant becomes much more infectious or deadly in children.

One reason vaccines could be more complicated: Children are at very low risk from covid-19.

The CDC reports that 159 children under age 12 have died of covid-19 — that’s a little more than three in every 1 million kids. And it’s not that different from a bad flu year.

More children have been hospitalized: About 56 out of every 100,000 kids under 4 years old have been hospitalized. For children ages 5 to 17, it’s 35 out of 100,000. There’s some debate, too, over how often covid-19 infections can cause lingering effects in children.

Children, especially young children, also seem less likely to transmit the virus. A 40,000-person study in Iceland found that kids under the age of 15 are about half as likely as adults to transmit the coronavirus to others. 

Ashish Jha, dean of the Brown University School of Public Health, called it a “no-brainer” to get older kids vaccinated, but he’s not sure “we’ll be as certain and comfortable with young kids with the clinical trial.” He said he’s reserving judgment until we see more data and the rate of community spread come this fall.

It may be harder to evaluate benefits of a vaccine for younger children.

The Pfizer pediatric trial is enrolling 4,600 kids, and Moderna is enrolling 6,750. Although the trials test safety and immune response, those study sizes may not be big enough to catch the type of rare event that occurs 1 in 10,000 times. 

“Studies of that size will not be able to completely, 100 percent, rule out rare complications. Even much larger studies, such as those done in adults, would not,” said John Lantos, a bioethicist at Children’s Mercy Hospital in Kansas City, Mo.

But that doesn’t mean we shouldn’t move ahead with vaccines for children, Lantos said. Instead, it means parents will need to make their own risk-benefit calculation and scientists will need to monitor rare side effects after any emergency use authorization.

Ezekiel J. Emanuel, a bioethicist at the University of Pennsylvania, said serious side effects from vaccines, if any, are likely to emerge quickly. Even though we still need trials for children and to find the proper dosages, the evidence from more than a billion adult vaccinations should be reassuring.

“We have to do a risk-benefit calculation, but so far the risks of vaccines are incredibly low and the protection is incredibly high. If that’s the case for kids, we ought to go forward and vaccinate children,” Emanuel said.

Vaccinating kids could help protect adults.

The more people who are vaccinated, the harder it will be for the virus to spread. Cases have been declining, but about 590 people per day are still dying of covid-19 in the United States.

The vaccines could be particularly life-changing for kids who are high risk or who live with adults who are immunocompromised.

“There are also good reasons to immunize kids to protect the adults on whom the kids depend. It's not only good for the kids themselves, but will make their schools and homes safer,” Lantos said.

Anthony S. Fauci said on May 18 that safety and immunogenicity studies were on track for children to receive the vaccine in the first quarter of 2022. (The Washington Post)
Still, it may not be enough to stop the spread of the virus entirely. 

Lavine says that although vaccinating children can help reduce population transmission, it’s unlikely that the coronavirus will ever stop circulating in the United States. 

She argues that the coronavirus will probably look different than the measles, for which childhood shots can offer lifelong protection and where it’s possible to drive local transmission down to zero. When it comes to the coronavirus, the United States may have to learn to live with some level of natural infection, including eventual reinfection of people who have received vaccines. 

The U.S. will be vaccinating low-risk kids, while many elderly people in other countries can’t get shots.

While this strikes many experts as profoundly unfair, it is not clear that vaccines for children are a major obstacle to dose sharing. The United States is producing about 4 million doses a day. Even at the current rate, which is expected to increase, it would take less than two weeks to produce enough shots for the country’s 48 million kids under 12.

“We have more than enough vaccine immediately including for these kids,” said Emanuel.

Vaccinations could help kids return to school — or not.

Many public health experts have heralded vaccines for children as a way to make in-person schooling even safer and alleviate concerns among parents who might otherwise be wary about sending their children back to the classroom in the fall.

Others worry vaccines could paradoxically have the opposite effect if schools are reluctant to admit unvaccinated students or if parents don’t want to send their children back until they can get a vaccine.

“I’m concerned about the messaging that the only way for children to go back to school will be for them to be vaccinated. We need to be clear that we are helping adults, but it’s not an infection that disproportionately affects kids, like measles, mumps and rubella,” said Monica Gandhi, an expert in infectious diseases at the University of California at San Francisco.

Emily Oster, an economics professor at Brown University who writes about the coronavirus, said public health officials will have to “thread the needle” when it comes to messaging about vaccines for young children.

“On the one hand, broadly in terms of public health dimensions, having kids vaccinated is good to protect other people. One way to encourage this is to say if you don’t get your kid vaccinated, they’ll get super sick,” said Oster. “But because, in fact the risk is very low, we don’t want to convey this. Instead, we want to convey that vaccines will protect your kid, but it’s fine for your kid to go to in-person school without them.”

Ahh, oof and ouch

AHH: A key task force says colorectal cancer screening should start at 45.

The new guidelines from the U.S. Preventive Services Task Force would push the screenings five years earlier than was previously recommended.

“The new guidelines fall in line with recommendations issued by the American Cancer Society three years ago. With the task forces added imprimatur, colonoscopies and other colon cancer screening tests for those aged 45 to 50 are far more likely to be covered by insurance companies,” NBC News’s Linda Carroll reports.

The group says that the change reflects a steady increase in rates of colorectal cancer in people between the ages of 45 and 50 and could save thousands of lives.

OOF: CDC Director Rochelle Walensky is shaking up the agency’s coronavirus response structure.

The changes will help consolidate Walensky’s oversight of the agency and reinforce its independence from the White House. They come amid criticism of the CDC’s guidance on mask-wearing and social distancing for vaccinated people.

“The changes in recent weeks include creating a clear reporting chain from the new director of the agency’s vaccine task force — which helped rewrite rules for mask-wearing — up to Walensky. The head of that task force had originally reported to both CDC and the White House. Walensky has also reshuffled the CDC’s pandemic modeling and data, analytics and visualization task forces,” Politico’s Erin Banco and Adam Cancryn report.

The overhaul in the pandemic response structure comes after Walensky decided that several pandemic task forces were no longer serving their original mission, a senior health official told Politico.

OUCH: The Post’s Fact Checker weighed in on a dispute over U.S. funding for a lab in Wuhan.

Sen. Rand Paul (R-Ky.) alleged in a recent Senate hearing that the National Institutes of Health had helped fund a controversial type of research, known as gain-of-function research, at the Wuhan Virology Institute in China. Anthony S. Fauci, director of the National Institute of Allergy and Infectious Diseases, said the senator was “entirely and completely incorrect.”

The disagreement hinges on different theories of how the coronavirus emerged, The Post’s Glenn Kessler writes.

While many experts say the virus probably emerged naturally from an animal origin, a prominent group of scientists last week made the case for continued investigation into the theory that it leaked from a lab. Some proponents of this idea say it could have emerged from a type of lab experiment gone awry — in this case, gain-of-function research where scientists create new genetic combinations in viruses. This can be done to try to predict and prepare for dangerous mutations that can occur in nature, but many scientists worry the risks outweigh the benefits.

In a May 11 hearing, Sen. Rand Paul (R-Ky.) asked top infectious-disease expert Anthony S. Fauci about NIH funding of research in China. (The Washington Post)

So did NIH help support gain-of-function research in Wuhan? There’s one published study from the virology institute that lists NIH as a sponsor, which some scientists say is a case of gain-of-function research. Other experts dispute whether the study meets that definition, and the nongovernmental organization EcoHealth Alliance that NIH funded denies being involved in any such research. It’s important to note that none of the viruses used in the experiments could have transformed into the coronavirus that causes covid-19.

Kessler’s ruling: “There is some smoke here, but we do not yet perceive the fire claimed by Paul. To some extent, all money is fungible. But the EcoHealth funding was not related to the experiments, but the collection of samples.” He gave Paul’s statement Two Pinocchios, suggesting exaggerations or major omissions.

More in coronavirus news

Italy celebrated Anthony S. Fauci. 

The U.S. governments top infectious-disease expert was feted Tuesday night at Villa Firenze, the Italian ambassadors residence, with the Knight of the Grand Cross, Order of Merit of the Italian Republic, that nations highest honor.

Italian Ambassador Armando Varricchio, who presented the honor, praised Fauci for “his role as a global leader in the fight against the most crucial health emergency of the century.” Fauci, who has spoken before about his Italian American heritage, joked that “I might actually be an Italian postdoc in somebodys laboratory somewhere” had his grandparents not emigrated from Italy to the United States around 1900.

  • Texas Gov. Greg Abbott said public schools are no longer allowed to mandate masks, the Texas Tribune’s Patrick Svitek reports. The Texas State Teachers Association has called the move premature and argued that the governor should have waited for updated CDC guidance on masks for the upcoming school year.
     
  • Coronavirus vaccines may not work fully for millions of immunocompromised Americans, about 3 to 4 percent of the U.S. population, The Post’s Ariana Eunjung Cha reports. “Emerging research shows that 15 to 80 percent of those with certain conditions, such as specific blood cancers or who have had organ transplants, are generating few antibodies,” she writes.

On the Hill

House Democrats accused AbbVie of inflating drug prices.

Lawmakers on the House Oversight and Reform Committee questioned AbbVie chief executive Richard Gonzalez over price hikes on the anti-inflammatory drug Humira and cancer drug Imbruvica. A committee staff report ahead of the hearing said the company had increased prices in the United States, while reducing them abroad, the Hill’s Justine Coleman reports

Rep. Katie Porter (D-Calif.):

Sugar rush

@washingtonpost

As demand for the coronavirus vaccine plateaus, Ohio Gov. Mike DeWine is giving state residents a shot to win $1 million. #vaccinehesitant

♬ original sound - We are a newspaper.