Lingering vaccine hesitancy is complicating the Biden administration’s goal to keep kids in classrooms, even with clearance of Pfizer Inc.’s booster shot for 12- to 15-year-olds, health policy analysts say.
The Food and Drug Administration kicked off 2022 by authorizing Pfizer’s Covid-19 boosters for young teens, widening access to additional doses as parents seek to protect their children from the omicron variant. Boosters have been shown to be effective against severe illness from omicron, but their ability to help scale back infections in schools may be restricted if only half of U.S. parents are getting their children vaccinated.
“I’m excited for parents and kids to have this option of a booster, but I’m not certain it will make much of a difference in achieving safe, Covid-free schools in many areas of our country right now,” said Katharine Head, chair of the Indiana Immunization Coalition’s advisory committee.
While parents who were eager to get their children immunized may line them up for a third shot, 53% of 12- to 17-year-olds have received the initial two-dose regimen, according to CDC data through Dec. 30. Health policy experts say that increased masking, testing availability, and other measures will be key to ensuring Covid-19 safety in schools.
“The first two years of the pandemic have shown us that children need to be in school,” Head said. “But we cannot safely keep kids in school in the midst of a raging pandemic surge when we don’t have the tools we need.”
A Centers for Disease Control and Prevention panel of advisers is expected to meet Wednesday to provide additional recommendations on dispensing booster doses to younger adolescents.
Roughly 98.9% of school districts were operating fully in-person as of late December, according to data collected by the Department of Health and Human Services.
Boosters for Some
Public officials are urging for schools to remain open despite the spread of omicron. Secretary of Education Miguel Cardona said this week that in-person education should be the default, citing its benefits over virtual learning.
In-person learning is “critical” to mental health, Thomas Russo, chief of the infectious diseases division at the University of Buffalo’s Department of Medicine, said. “Our children lost almost a year of education. Some just don’t do well with remote learning or have access.”
Head, a communications professor at Indiana University-Purdue University, Indianapolis, said her students were challenged both by the “abrupt move” to fully remote learning in 2020 and the more recent return to in-person classes.
Booster shots, from a scientific point of view, provide a promising bulwark against infection for teens, safely increasing antibody levels for a stronger response to various forms of the coronavirus.
“It should make vaccinated children much less likely to be infected or have severe disease so it will make schools safer from serving as Covid-19-spreading events,” said Andrew Pekosz, vice chair of Johns Hopkins University’s W. Harry Feinstone Department of Molecular Microbiology and Immunology.
But while boosters should quickly cut down on severe disease for teens, hesitancy remains relatively high among younger people. “It appears we are seeing even more reservations than we see in the adult population,” Pekosz said.
“For parents, it’s all about safety,” and some “were a little bit spooked” by reports of myocarditis—heart inflammation—as a rare side effect of vaccination in young males, Russo said.
Yet myocarditis from vaccination is rare, mild, and usually resolves within 24 to 48 hours. The condition is more likely to result from Covid-19 rather than Pfizer vaccination and is more severe in those cases, he said.
Preventing Serious Outcomes
The administration is already banking on boosters to curb omicron’s spread among teens.
Peter Marks, director of the FDA Center for Biologics Evaluation and Research, said in a Jan. 3 media call that third doses for 12- to 15-year-olds will “hopefully prevent Covid-19 in its various forms” and “prevent serious outcomes such as hospitalization and death which, granted though uncommon in 12- to 15-year-olds, can occur.”
Yet Head warned that schools are still lacking needed tools, such as Covid-19 tests, to bolster safe on-site learning.
“The Biden administration has its heart in the right place, but unfortunately, their missteps in promoting widespread vaccination and the failure to provide widespread accessible Covid-19 testing means that we are still facing a public health crisis that puts many kids at risk,” she said.
Timing also isn’t on the administration’s side when it comes to using boosters to fuel in-person learning.
Already,"there are a lot of children out of school in January for whom this will not have a major impact” as people return from holiday gatherings, said Julie Swann, a North Carolina State University professor who led a government-backed team for supporting public health decision-making in the pandemic.
Since the holidays, both of her children—10- and 13-year-olds who are both vaccinated but were ineligible for boosters until the FDA’s recent authorization—contracted mild cases of Covid.
“In the longer term, boosters can contribute to more in-school learning. It just won’t have much impact this month,” Swann said. Boosters take a few weeks to be fully effective, and “omicron’s out there.”
Child safety during in-person learning may also be compromised by school districts’ responses to the pandemic, health experts say.
While staff vaccinations, ramped up testing, masking and improvements to air ventilation could help make classrooms safer, many districts lack “a comprehensive strategy taking all those things into account,” Pekosz said.
“Whatever variant is circulating, the secret is to have a high-quality mitigation plan in place and execute it,” Russo said.
Health experts say testing is crucial to reducing the spread, even for those who aren’t showing symptoms of Covid.
Testing would “do a lot more to reduce the spread in classrooms than just doing boosters for teenagers,” Swann said, though noting that additional doses “could help keep some teachers and staff of the schools out of the hospital.”
“The goal ultimately should be more about preventing severe outcomes,” she said.