Editor’s Note: Dr. Lawrence C. Kleinman, a pediatrician, is a professor and vice-chair of the Department of Pediatrics at Rutgers Robert Wood Johnson Medical School, where he is founding director of the Division of Population Health, Quality, and Implementation Sciences (PopQuIS). Kleinman is also a professor of global urban public health at the Rutgers School of Public Health. The views expressed here are his own. View more opinion articles on CNN.
Pfizer announced Monday that data from recent trials suggests that children 5-11 have a safe and effective response to its Covid-19 vaccine. The news holds the hope to herald a new phase in our battle to end the public health crisis caused by the coronavirus in the United States.
While all the usual caveats still apply (namely, Pfizer’s data has not yet been subject to peer review or public scrutiny; the primary endpoint reported today suggests immunity but does not prove it), a path toward that end certainly feels closer than it did before. Despite global distribution of vaccines remaining unsolved, Monday brings the essentially good news that it is possible, even likely, that a vaccine available to elementary school-age children is near.
From the beginning of this pandemic, the impact of Covid-19 on children – and of children on the spread of the pandemic – was underestimated. A quick search of the internet in early 2020 had countless statements that children were spared the wrath of Covid-19. These statements evolved into a misunderstanding that healthy children were safe. In fact, collaborative research to which I contributed had shown it to be false by spring and produced more evidence in the summer of 2020.
Our study of children in pediatric intensive care units early in the pandemic found that one in six of these children with severe acute Covid-19 had no underlying condition. By early summer we were describing MIS-C – the multisystem inflammatory syndrome in children – a potentially serious inflammatory condition that comes seemingly out of the blue, several weeks after even mild Covid-19 infections.
Informed by our research and along with other child health experts, I have been calling out the myth that children were spared from Covid since the spring of 2020. I believe this myth is a foundation for many of the errors in the public health response.
The approval of vaccines first in adults and later in adolescents 12 years and older offered hope. Earlier this year, federal leadership articulated an expectation for a return to normalcy by early summer. The Centers for Disease Control and Prevention and governors lifted mask mandates and restrictions. Anticipating the end of New Jersey’s mask mandate, a local businessman remarked to me, “This Friday the pandemic is over.” He was not alone in that perception.
Public confusion – and particularly in regards to how to protect children not eligible for the Covid-19 vaccine – was a direct result of the complexity of managing the Covid-19 pandemic combined with the unrealistic assumptions made by the CDC and others (for example, that those who were not vaccinated would be generous enough to wear masks), confusing messages – not helped by multiple clarifications – and, as always, that vision of us moving to a normalized summer.
Statements that Covid-19 was becoming a “pandemic of the unvaccinated” were supposed to convince the vaccine-hesitant to get their jabs and encourage maskless social interactions for those who were vaccinated. If not for the children, this might all have made sense – but the policy was neither child sensitive nor child protective.
Parents and children heard these statements differently than they were intended. Even I looked at my preschooler and wondered why policy wasn’t designed to protect her, and worse, why she was blamed as one of the “Unvaccinated!” It was not her choice. A series of policy decisions brought us here.
As a pediatrician and professor of pediatrics, a public health professional, and a researcher of Covid, I had a voice, but I was barely able to influence the conversation. My prior CNN opinion column (For the sake of children, keep wearing your mask May 16) drew praise online from pediatricians – but it did not change the policy discussions. It was not until the Delta variant that people in authority began to take a new, more sober look at Covid-19 and children.
There are a lot of children in the US: Census estimates confirm there are more than 20 million children less than 5 years old and nearly 30 million aged 5-11. Contrary to the popular narrative, the emergence of Delta variant in children was not shocking or even surprising. Instead, it was an inevitable consequence of our decision to open our society and loosen our approach to combatting Covid’s spread, despite a vast reservoir of nearly 50 million unvaccinated children in a divided society. And we experience the consequences of our leaders ignoring the well-known adage attributed to Wayne Gretzky: A good hockey player plays where the puck is. A great hockey player plays where the puck is going to be.
Each time we have started to catch up to this pandemic, we fall back again. A Herculean and bipartisan effort brought us safe and effective vaccines. The vaccine was tested in adults, then adolescents, now – finally – in school-aged children, and soon, hopefully very soon, younger children.
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The decision was made not to accelerate trials in children ahead of their usual place. The result, currently, is that as long as we cannot vaccinate children under 12, about one in six Americans is not eligible for the vaccine. Herd immunity, the elusive goal, cannot be achieved in the US without vaccinating children. This has always been true, even if it has only recently been acknowledged.
And so now perhaps we are nearing approval of a vaccine for 60% of the children who are not currently eligible for vaccination. If so, and if followed quickly by approval for preschool children – and if parents vaccinate their children as soon as they are eligible (as I will) – then soon we will be able to enter a period in which every school day, every work and each social interaction no longer threatens our children. Today is a good day. Soon it can be even better.