Do Children Really Need a COVID Vaccine?
Recent recommendations by an advisory group to the World Health Organization have been misinterpreted by the public.
I’m an attending physician in the Division of Infectious Diseases at the Children’s Hospital of Philadelphia. In 2020, I watched as children came into our hospital with COVID, struggling to breathe. I watched them progress from receiving oxygen by face mask to requiring mechanical ventilation. I watched parents crying as their children were taken up to the intensive care unit. These scenes became even harder to watch in late 2021, when vaccines were available for young children. Invariably, children who suffered were unvaccinated, as were their families.
This experience has made it hard for me to watch how recent guidelines by an advisory group to the World Health Organization (WHO) have been misinterpreted by the media and the public.
On March 28, 2023, a working group of the WHO called SAGE (Strategic Advisory Group of Experts on Immunization) issued guidelines for the continued use of COVID vaccines. Noting a high level of population immunity following natural infection or immunization, SAGE argued that countries should now prioritize vaccines based on risk of severe disease. Those at highest risk included the elderly, people with multiple health problems—such as heart disease and diabetes—people who are immune compromised, and pregnant women. Those at lowest risk of severe disease were healthy young children.
SAGE stated, “The low priority group includes healthy children and adolescents aged 6 months to 17 years…SAGE urges countries considering vaccination of this age group to base their decisions on contextual factors, such as the disease burden, cost effectiveness, and other health or programmatic priorities and opportunity costs.”
Some have interpreted these guidelines to mean that children don’t need to get a COVID vaccine. For example, Governor Ron DeSantis of Florida said, “I would say we are affirmatively against the COVID vaccine for young kids. These are the people who have zero risk of getting anything.” Also, a recent segment on Fox Business News, referring to the SAGE announcement, featured a public health expert from Baltimore who claimed that young children don’t need to be vaccinated because all had already been naturally infected, ignoring the fact that most children hospitalized today are less than 4 years old.
But SAGE was only arguing that countries with limited resources should prioritize vaccination for those most likely to suffer a serious COVID infection, not that children in countries that can afford vaccines for all groups shouldn’t vaccinate those at lowest risk. While it is true that elderly adults have a risk of dying from COVID that is 1,000-fold greater than that of healthy young children; that doesn’t mean that children are at no risk, only that they are at lesser risk. And the United States is not a resource poor country. We can afford to protect everyone at risk. Indeed, one-third of children hospitalized with COVID have no other risk factors for severe disease.
Parents trying to decide whether to vaccinate their healthy children should consider the following:
1) Children can die from COVID; by April 2023, more than 1,700 children had succumbed to the disease.
2) Children between 5-13 years of age are the group most likely to suffer from a post-infectious inflammatory syndrome (MIS-C) that causes severe heart, lung, liver, and kidney disease. More than 9,300 children in the United States have been hospitalized with MIS-C and 76 have died.
3) mRNA vaccines, which are highly effective at preventing severe disease, have now been given safely to more than 10 million young children.
4) Children, like adults, can suffer from COVID for months (long COVID).
5) Although COVID vaccines are a rare cause of myocarditis (inflammation of the heart), the problem appears to be short-lived and self-resolving. Myocarditis following COVID infection, on the other hand, is far more common and far more severe than that following vaccination.
6) 3-4 million children are born in the United States every year who, by the time they are six months old, will be fully susceptible to COVID.
7) The virus that causes COVID is likely to circulate for decades if not longer. Children are currently the least vaccinated group.
Vaccination affords children the best chance to stay healthy. For these reasons, the choice of whether to vaccinate children should be an easy one
This is so so so disappointing Dr Offit. You were so correct last fall when you argued against bi valent boosters for the young and healthy. and now this dreck. Who got to you ?? there are so many mistruths and out right lies stated here. Just a couple examples : 1. "Children can die from COVID; by April 2023, more than 1,700 children had succumbed to the disease." the number is actually closer to 1300 and the vast vast majority of those were children with significant medical issues . any Childs death is sad but to not be honest about this - that the risk of death for a heathy child is literally statistically almost zero is at best disingenuous - at worst purposefully misleading 2. "Although COVID vaccines are a rare cause of myocarditis (inflammation of the heart), the problem appears to be short-lived and self-resolving. Myocarditis following COVID infection, on the other hand, is far more common and far more severe than that following vaccination." first , how about I give YOUR child some MILD AND SELF LIMITING myocarditis. You good with that ??? of course not because there is no such thing as MILD myocarditis - and you KNOW this. It puts anyone suffering from it in danger of future cardiac issues - again you KNOW this . secondly, MULTIPLE good studies have shown that myocarditis post covid infection is actually quite RARE - especially in children . 3. "Children, like adults, can suffer from COVID for months (long COVID)." The latest studies - including a recent one from Finland - show absolutely ZERO correlation between having covid and getting long covid ! think about that ??? in addition there are ZERO lab markers - a study from 2021 showed as only significant correlation for long covid - Middle aged women ! 4. "mRNA vaccines, which are highly effective at preventing severe disease, have now been given safely to more than 10 million young children." how many have been given UN safely ???? I mean most European nations do not even offer the mRNA vaccines to healthy children. esp under 12. but here you are shilling. As I stated. - I am so so disappointed in you.
Dr. Offit, as a pediatrician, who has followed your advice for years, I am greatly disappointed with this assessment. I think you are out of touch with what is happening in the primary care pediatricians office. The debate about Covid vaccines is a debate, and it is not settled science. Your comparison with Covid myocarditis versus myocarditis from the vaccine, is shortsighted. Myocarditis from Covid, included a much broader age group, and seriously ill patients who had a bump in their troponins levels, and not a true myocarditis. The myocarditis with the vaccine, on the other hand, showed a Signal in the young male ages 16 to 30. It also demonstrates a high propensity for scarring six months later. You know that this is a risk factor for sudden, cardiac death, and it dumbfounds me that you were comparing apples to oranges. The other destructive part of this discussion is the vaccine hesitancy that is happening in my patients with routine, tested vaccines. I have never seen this amount of vaccine hesitancy for a routine vaccines in my 23 years of practice. Another point that I’d like to bring up, is that the Covid vaccines were not tested for efficacy in those who already had Covid. You should know this. You should also know about the strength of natural immunity versus vaccine immunity. Omicron became the ultimate vaccine with the majority of children being infected. You also mentioned in MISC however, we only saw that with the first three strains and have not seen it since omicron came on the scene. Finally, your number for the number of Pediatric deaths is over a three year timeframe. It also is likely exaggerated considering the amount of testing that was done as well as studies that have shown hospitalizations for children were estimated to be 60% with Covid and not from Covid. Hospitalizations now are likely more attributable to “coinfections“ in conjunction with another illness like RSV or metapneumovirus. Hospitalizations use PCR. PCR can detect viruses present as far as six weeks prior. You know this. Please use critical thinking in evaluating patients that are testing positive in the hospital and happen to test positive for Covid. This article makes me sad for you and your future opinions that I previously valued so much.