Lessons from polio about vaccinating children against Covid-19

APediatricians, epidemiologists and public health professors – as well as mothers – are often asked if we recommend Covid vaccines for children. Those who ask are often skeptical about the benefits and point out that relatively few children have died from Covid-19.

There’s also institutional confusion: The American Academy of Pediatrics and the Centers for Disease Control and Prevention have urged families to get their children vaccinated, but some doctors now say the booster isn’t necessary. A new survey suggests that vaccine hesitancy, even among primary care doctors, may be higher than expected: About one in ten doctors who responded to the survey said they did not believe the vaccines were safe, and about 8% said they did not keep the Covid-19 vaccines were important.

We strongly recommend that children receive both the first series of Covid-19 vaccinations and any necessary boosters. We base it on the lessons we’ve learned in dealing with polio.

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In children who are not vaccinated against polio, 70% of polio infections cause no symptoms. The 25% who develop symptoms have nothing more than a low-grade fever and a sore throat, a minor illness indistinguishable from a cold. In this respect, polio is very similar to Covid-19, which mainly causes symptoms that go unrecognized or are mild.

But some children become very ill from the polio virus, and about 1% develop polio, which usually occurs one to three days after what appeared to be a minor illness has disappeared. Children who develop paralysis need long-term and intensive respiratory therapy just to survive. They may also suffer permanent disability or recover only to develop new muscle weakness or paralysis in adulthood.

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Thanks to pioneering vaccine research that began in the late 1940s, four doses of polio vaccine between the ages of two months and six years now prevent infection and transmission of the virus and provide lifelong protection.

There are certain parallels with Covid-19. Infection with SARS-CoV-2, the virus that causes Covid-19, is relatively benign for the vast majority of children who get it. A CDC survey indicated that by February 2022, 75% of individuals under the age of 18 had had Covid-19 at least once.

Less than 2% of youth who contract Covid-19 experience severe acute illness, although rates of severe illness are much higher among black and Hispanic children. Children with Covid have higher rates of several serious health problems after infection, including dangerous blood clots, inflammation of the heart muscle (myocarditis), acute kidney failure and type 1 diabetes.

In addition, the CDC has identified more than 9,000 cases and 74 deaths from the poorly understood multisystem inflammatory syndrome in children who have contracted Covid-19. Children can also develop prolonged Covid and associated fatigue, difficulty concentrating and other neurological problems, for which there are few if any treatments.

Meanwhile, current Covid-19 vaccines are nowhere near as protective as the polio vaccine. Currently licensed Covid-19 vaccines do not protect people against infection due to the ever-changing virus and declining immunity to current vaccines. However, they prevent Covid-19 from developing into a serious disease.

We are concerned about the potential for long-term neurological, cardiovascular and metabolic consequences of Covid-19, which are worrying enough to justify vaccinating children against the disease, especially given the safety and efficacy of the vaccines. Previous infection does not confer long-term immunity, so children must be vaccinated unless they have medical contraindications.

Current Covid-19 vaccines do not confer lifelong immunity; it takes motivation to maintain that shield.

Considering the benefits of vaccination, Covid-19 vaccination rates are generally low in children. As of mid-October, the CDC estimates that about 60% of 12- to 17-year-olds have received primary Covid vaccinations (meaning the first two doses of the Moderna or Pfizer mRNA vaccine or the initial dose of the J&J vaccine). The percentage is even lower among younger children: 31.6% of children aged 5 to 11 years, 3.2% of children aged 2 to 4 years and only 1.7% of children under 2 years of age. The frequency of stimulation shots in these age groups is much lower.

These statistics boil down to one thing: America’s children are becoming increasingly vulnerable to Covid.

As new variants of the virus continue to emerge, it becomes even more important for parents to follow the recommendations of the CDC and the American Academy of Pediatrics. For now, the latest information convinces us that childhood vaccination is safe and effective against severe acute Covid-19 disease and its complications, in children as well as adults.

It is too early to know what the long-term consequences of Covid-19 infections in children will be. But lessons from polio and the past teach us that many viruses can have lifelong effects on health. That’s why, in the case of Covid-19 as in so many others, we believe that an ounce of prevention is worth an ounce of cure.

Lynn R. Goldman is a pediatrician, epidemiologist, and dean of the Milken Institute School of Public Health at George Washington University, where Amanda D. Castel is a pediatrician and professor of epidemiology.

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