As California looks for ways to get students back in the classrooms quickly, teachers and school employee unions say vaccines for adults will be a major component of safely reopening schools.
But what about the students?
It could be months before federal health officials approve the vaccine for younger cohorts. If schools are to reopen as quickly as Gov. Gavin Newsom and others want them to, before the end of the spring semester, they’re unlikely to wait to vaccinate children.
Newsom has said he wants to reopen schools quickly and safely, and the Centers for Disease Control say it is possible to reopen schools for in-person activity safely as vaccine distribution continues, as long as districts take the the proper safety measures.
The CDC says children, age 0 to 17 years old, have reported fewer cases of COVID-19 than adults, but the true incidence of infection in children is not known due to the lack of widespread testing and the prioritization of testing for adults. Children in general are less symptomatic when infected and less likely to develop severe illness from the coronavirus, the CDC says.
But even if the effects in children tend to be more mild than adults, recent evidence suggests that compared to adults, children likely have similar viral loads in their nasal cavity and can spread the virus to others.
“Eventually, we want to get kids vaccinated,” said Bradley Pollock, a professor of epidemiology and chairman of the Department of Public Health Sciences at the University of California Davis School of Medicine.
“The problem is that it’s going to take some time to get to the point where we can do that, because you have to have the efficacy and the safety data generated to be able to do that.”
The authorization of two coronavirus vaccines, from Moderna and Pfizer, marked a huge turning point in the pandemic. But under emergency authorization from the U.S. Food and Drug Administration, the vaccines are only approved for adults and older teens. Pfizer’s vaccine is authorized for ages 16 and up, while Moderna’s is authorized for those 18 and older.
Under California’s vaccine rollout plan, healthcare workers and long-term care residents were first in line to get the shot. The state has now moved on to the next tier, which includes people 65 and older, education and childcare workers, emergency services, and food and agriculture.
It could be months before California moves onto Phase 1C, which gives some allowance to younger people. Under that phase, people 16 to 49 will be able to receive the vaccine, but only if they have an underlying health condition or disability which increases their risk of severe COVID-19.
Pfizer said late last month it has finished recruiting kids age 12 to 15 for participation in its youth clinical trail of the COVID-19 vaccine. Moderna, on the other hand, reports having trouble finding young people 12 to 17 to participate in a similar trial.
To squash the virus, communities need to develop something called herd immunity, where enough people are immune to the virus either from previous infections or vaccines. The CDC says experts do not yet know what percentage of people would need to get vaccinated to achieve herd immunity to COVID-19, but it is likely that inoculating minors will be an important part of achieving that goal. In California, people under 18 represent nearly 23% of the population, according to the U.S. Census Bureau.
California, like most states, requires students to receive certain kinds of vaccines in order to attend school, like the MMR vaccine that protects against measles, mumps and rubella and is required to enter day care and kindergarten. But compared to COVID-19, measles is much more contagious, Pollock said. And more research needs to be done to determine how long the coronavirus vaccine lasts. If it provides long-term protection like the MMR vaccine, a case could be made for vaccinating children on a large scale.
“If we find that there really is long-term conferred immunity, I think that would change…. when we would introduce this into the vaccination schedule for kids,” Pollock said.
The concern around reopening schools isn’t necessarily related to children getting sick, though there have been some incidents of severe cases and COVID-19 deaths among young people. The bigger concern is that children may be able to transmit it to older adults who could become severely ill.
But some studies suggest that children aren’t very good at transmitting the virus.
Last fall, researchers at Duke University and the University of North Carolina Chapel Hill studied nearly 100,000 students and staff in North Carolina and found that they were able to keep transmission relatively low, thanks to hybrid in-person and online learning, and social distancing and masking guidelines. Over a nine-week period, the schools in North Carolina reported only 32 in-school transmissions. None of the cases involved a child infecting an adult.
“And that’s something that we’ve seen in other studies as well,” said Dr. Annabelle De St. Maurice, an assistant professor of pediatrics at UCLA Health. “Children really aren’t transmitting to adults as efficiently as adults are transmitting to adults, or adults are transmitting to children, particularly in children who are under age 10.”
It’s unclear whether California lawmakers have any interest in mandating COVID-19 vaccines the same way the state mandates vaccines for diseases like measles. State leaders are currently focused on funneling more doses to California and distributing them to high-priority populations like those in long-term care facilities and front line healthcare workers.
State Sen. Richard Pan, D-Sacramento, has worked on vaccine legislation in the past, and said it is premature to discuss mandatory vaccines for children, especially when there isn’t yet a vaccine approved for anyone under 16.
In the meantime, the state should focus on educating the population about the safety of the vaccine and its effectiveness.
“This is not the time for a mandate for school kids,” Pan said. “But this is a time to educate parents and families about the importance of COVID vaccines and also to be sure people can get answers to legitimate questions they have.”
The majority of Californians surveyed by the Public Policy Institute of California last month said they would get a coronavirus vaccine, an increase from last fall. More than two-thirds of respondents said they would definitely or probably get the vaccine when it is available to them, an increase from about 57% in October.
Although vaccine hesitancy is on the decline, about one in four surveyed Californians still said they would probably not or definitely not get the vaccine, PPIC reported.
De St. Maurice at UCLA pointed out that the California’s measles vaccination rates went up significantly when the state got rid of personal belief exemptions. A similar strategy could speed up the process in fighting this pandemic.
“From looking at our experience with the measles vaccine, if we do have a vaccine that’s demonstrated to be safe and effective in children, if we want to achieve herd immunity more quickly, that may be one strategy toward achieving that,” she said.
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