Now that FDA has authorized the Pfizer COVID-19 vaccine for children 5-11 years of age, we await the CDC/ACIP recommendations for use. And, somewhat hidden in all of this, what about the leading causes of death in children other than COVID?
Which 5-11 yo Children Should Receive COVID-19 Vaccine?
CDC didn't ask me, but my short answer is to recommend for all of them. The only scenario where this might not be true is if a child's risk of being infected with SARS-CoV-2 is extremely low for the next several months. Like for other respiratory viruses, science has difficulty predicting timing and intensity of infection surges, but most think it is unlikely we have seen the last of COVID-19 disease in this country. Also, even if a child was infected in the past, we have no idea how long any immunity might last nor how to use antibody testing to determine a specific child is immune. Yes, if vaccine is in short supply (which sounds like will not be the case), priority should be given to children living in areas with high infection rates, having underlying risk factors for COVID-19 infections, or having contact with others at high risk for complications.
FDA scientists presented 6 epidemiologic scenarios at last week's meeting, all leading to the conclusion that benefits outweigh risks for vaccination of children in this age group. Also, remember that these open public hearings involve a lot of thinking out loud by the members, not conducive to sound bites. These are experts with various backgrounds trying to think through the data in real time. Some of the press accounts failed to recognize this and reported concerns that in some cases overshadowed the vote of 17 in favor with 1 abstention and none against authorizing the vaccine for this age group.
COVID-19 is a Major Cause of Death in U.S. Children; What About the Other Causes?
The FDA/VRBPAC discussions mentioned the leading causes of death in children 5-11 years of age in the US. COVID-19 tied (with suicide) for 8th place in the past year, according to data in the CDC WONDER database. Let's not lose track of the others on the list. In order, they are accidents, cancer, congenital malformations, assault, heart disease, chronic lower respiratory disease, influenza and pneumonia, cerebrovascular disease, and septicemia. During the pandemic, regular medical care has understandably been overshadowed by COVID-19 concerns. Please encourage your families to continue to seek regular preventive care as well as illness care, rather than "putting it off" until SARS-CoV-2 calms down. We continue to see some children presenting relatively late in the course of their illnesses, sometimes resulting in an emergency situation that might have been avoided with earlier medical care.