On Tuesday, after months of delays, the Centers for Disease Control and Prevention finally authorized Pfizer’s COVID-19 vaccine for children ages 5 to 11, citing clinical trials that found it both safe and more than 90 percent effective in preventing symptomatic infection in kids.
Earlier reports greeted the trial results as “a ray of hope” for “weary parents” who have endured months of uncertainty about when their long-ineligible children might finally get inoculated — and who recently had no choice but to send them back to school unvaccinated while the hypercontagious Delta variant was hospitalizing a record 30,000 of their peers each month.
But what if opening up vaccination to younger kids represents something more than just peace of mind for parents? What if it’s actually the pandemic off-ramp that all vaccinated Americans have been waiting for — the dividing line between 19 endless months in crisis mode and whatever kind of less disruptive coexistence with COVID comes next?
“There are huge implications here on how we view COVID and live with COVID,” says Dr. Leana Wen, an emergency physician and public health professor who previously served as Baltimore’s health commissioner. “Having the vaccine available for children isn’t just critical for parents. It’s critical for everybody.”
One could argue that many Americans — especially unvaccinated Americans — are already living like the pandemic is over. But we aren’t back to normal yet. Millions are still working remotely. Masks are still commonplace in public and in school; many areas still require them indoors. And individual Americans are still limiting their own lives because of COVID, nearly a year after vaccines first became available.
The reason? Some of it comes down to the trajectory of the virus, which is still killing an average of more than 1,200 Americans each day, nearly all of them unvaccinated, and is threatening to trigger yet another winter surge. When a deadly pathogen is causing that much damage, public health (and basic decency) requires everyone to help protect the unprotected.
Our present situation is also driven by vaccinated Americans, who tend to be a lot more cautious than their unvaccinated counterparts, protecting themselves from the unprotected — the likeliest vector for breakthrough infections, which Delta can trigger.
But a lot of it is kids — even though they remain much less likely than adults to get really sick from the virus.
Consider the numbers. The U.S. is fast approaching the point where pretty much every adult in the country who’s willing to be vaccinated has already gotten a shot. Right now, 80 percent of Americans 18 and older have received at least one dose. With about 20 percent of U.S adults consistently telling pollsters they’ll “never” get vaccinated, that number has likely maxed out. Indeed, the average daily number of first doses administered nationwide — which inched up during the Delta surge — has bottomed out at around 200,000. It hasn’t been that low since the very start of the U.S. vaccination campaign.
That leaves Americans under 18. There are 73 million of them in all, and about 21 million of them (ages 12 to 17) are already eligible for shots. But kids ages 5 to 11 actually outnumber older minors, making them the single largest bloc of Americans — at 28 million strong — who until now hadn’t been authorized by the CDC to receive the vaccine.
Likewise, kids ages 5 to 11 are also the most important remaining cohort, because unlike the 24 million toddlers and infants under 5, the vast majority of them are required by law to be inside with dozens of their peers all day long at school. No one in America except school-age children has to do that.
Which means that vaccinating as many kids ages 5 to 11 as possible could have an outsize impact — again, not just for their parents but for everyone.
Part of the equation is epidemiological. Any time you open vaccine eligibility to a new group of people, you get one step closer to reaching the sort of population-wide immunity threshold that makes it hard for the virus to find new hosts. Right now, 78 percent of all eligible Americans have received at least one vaccine dose, but among all Americans that figure is 11 points lower. To push it closer to 80 percent, younger kids need to get vaccinated en masse.
“We know that children can be vectors for spreading COVID to other individuals,” Wen explains. “This is something that very much affects people in their families as well as in the surrounding community — being able to contain or to prevent children from further spreading to others. It would be very difficult for us to reach herd immunity without children also getting vaccinated.”
The other part of the equation is ethical. At some point — perhaps after any winter wave has passed — the vast, vaccinated majority of U.S. adults will have to accept that their unvaccinated counterparts have decided to acquire immunity the hard way (and risk suffering or even death in the process).
So vaccinated (and, increasingly, boosted) Americans won’t continue to limit their own lives indefinitely in order to protect the willfully unprotected. The U.S. doesn’t mandate masks during flu season, and even the most cautious leaders are eager to stop requiring them for people who’ve chosen, through vaccination, to reduce their personal risk from COVID to something like the flu or a cold.
But that’s unlikely to happen before 28 million younger Americans who are required to spend all day indoors with one another have had an opportunity to get vaccinated.
Wen cites office reopenings as an example. “Right now, it’s just not fair to parents who can work from home to require them to engage in in-person work when that could pose a risk to their unvaccinated children,” she explains. Vaccination essentially eliminates that last major risk — which makes it equitable for the office to reopen for everyone.
These wider ripple effects are key, and they apply to everything from masks to travel. “That’s why having the vaccine available for children is critical for us to reach any hope of an off-ramp from the pandemic,” says Wen.
To be sure, there are challenges ahead. Pediatric vaccination rates are likely to trail adult rates by a significant margin, at least initially. So far, just 50 to 60 percent of adolescents have received one or more doses, and polls indicate that roughly a third of U.S. parents plan to leave their elementary-school-age children unvaccinated.
Such hesitation will create awkward situations in the coming months: classrooms where some kids are vaccinated and others are not, so no one is sure if it’s safe to stop requiring masks; disruptive school quarantines that could have been avoided if everyone were vaccinated; school districts in some places — like Los Angeles and other California cities — that require student vaccinations, side by side with districts that don’t; birthday parties with vaccine requirements.
Meanwhile, an estimated 7 million to 10 million immunocompromised Americans will face an elevated risk of infection no matter how many kids are vaccinated. So the road ahead won’t be smooth.
“There’s going to be an initial group of parents who are really eager for their kids to be vaccinated,” Wen predicts. “Others will wait and see, or only be motivated once it’s required for various purposes. And then there’s going to be a group of holdouts.”
Some degree of initial trepidation is understandable, given how few children have died of COVID so far. But Wen says focusing on the lower risk of COVID in kids relative to adults is backward. Instead, parents should be focusing on how the risk of COVID in kids compares to other risks children face — and the benefits of minimizing that risk.
For instance, COVID was the sixth-leading cause of death among children ages 5 to 11 in 2020. Overall, the virus led to nearly 700 pediatric deaths — more than three times the number of kids who die during a typical flu season. And according to CDC estimates, every million doses of the COVID vaccine will prevent more than 56,000 infections, 190 hospitalizations and 60 ICU admissions among younger children.
“There has not been a case of polio in the U.S. since the 1970s, but we still get our children vaccinated so that we don’t have polio here in the U.S.,” Wen says. “We really need to start looking at the COVID vaccine the way that we look at other immunizations.”
Wen says the same logic applies on a personal level. “I’m the mom of two little kids, a 1-year-old and a 4-year-old,” she continues. “So yes, the risk of them getting COVID, getting hospitalized and dying is very low. But if I could change that risk from very low to zero, why wouldn’t I do that?”
Ultimately, the goal for the U.S. may be to look something like Denmark, where 76 percent of the total population is fully vaccinated and all restrictions were removed months ago — and where COVID deaths remain flat even as Delta drives a winter surge in cases. Or Spain, where 80 percent of the total population is fully vaccinated and “experts are beginning to believe the country is on the cusp of reaching something that barely seemed possible even weeks ago — herd immunity,” according to a recent article in the Lancet.
The problem is that with so many adults who refuse to get inoculated, the U.S. can’t reach that threshold until most nonadults are eligible too — and transitioning out of emergency mode and into endemic mode won’t be equitable or practical until then, either.
In September, Moderna chief executive Stéphane Bancel gave three reasons why he thinks the global pandemic will be over “in a year.” First, “enough doses should be available ... so that everyone ... can be vaccinated.” Second, “boosters should also be possible to the extent required” by waning immunity or new variants. And third, we “should also be able to vaccinate children aged five to eleven.”
As for “those who do not get vaccinated,” they “will immunize themselves naturally, because the Delta variant is so contagious,” Bancel explained.
The U.S. already has more than enough doses for its entire population. An estimated 89 percent of vaccinated adults already qualify for boosters. And now younger kids will be vaccinated here before anywhere else. So while it may take the entire world another year to “return to normal,” the U.S. could get there a lot faster.
“In this way,” Bancel concluded, “we will end up in a situation similar to that of the flu.”
This is an updated version of a story originally published on Sept. 25, 2021.
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