Why Florida’s New COVID-19 Vaccination Guidance Could Hurt Kids

Florida Surgeon General Dr. Joseph Ladapo sparked controversy this week by recommending against COVID-19 vaccination for healthy children—contrary to the advice of health organizations and plenty of data that suggest the shots are safe and effective.

Florida “is going to be the first state to officially recommend against the COVID-19 vaccines for healthy children,” Ladapo said at a roundtable on March 7.

Official guidance released the next day softened that stance somewhat, saying that “healthy children aged 5 to 17 may not benefit from receiving the currently available COVID-19 vaccine” due to their low risk of severe disease and the possibility of rare side effects. According to the guidance, parents of children with chronic medical conditions or other health issues should speak to their pediatricians.
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Although the Florida guidance doesn’t prevent parents from giving their children vaccines, doctors worry that it might have an adverse effect on a campaign for pediatric vaccinations which has been moving slower than expected.

“The Florida Surgeon General’s decision to recommend against COVID-19 vaccination for healthy children flies in the face of the best medical guidance and only serves to further sow distrust in vaccines that have proven to be the safest, most effective defense against severe COVID-19 disease, hospitalization, and death,” said Dr. Daniel McQuillen, president of the Infectious Diseases Society of America, in a statement.

Dr. Mobeen Rathore, past president of the Florida Chapter of the American Academy of Pediatrics and associate chair of the University of Florida Health Jacksonville’s department of pediatrics, calls Ladapo’s remarks dangerous. “Any time people in power…make a statement, some people will believe that,” he says. “This could result in some children dying.”

He suggests that all eligible children be vaccinated by Florida pediatricians. “All children should be vaccinated,” he says. “This is the only way we’re going to get out of this morass of the pandemic.”

Continue reading: My Kids Can’t Get Vaccinated Yet, and I’m Barely Keeping It Together

Following the U.S. Food and Drug Administration (FDA)’s authorization of Pfizer-BioNTech’s COVID-19 vaccine for 5- to 11-year-old children last fall, the CDC recommended COVID-19 vaccination for everyone in the U.S. ages 5 and older, as did the American Academy of Pediatrics. Just 26% are currently fully vaccinated for children between 5 and 11. The vaccination rate for 12- to 17-year-old children is higher, at 58%, but that’s still well below the adult rate of 75%.

According to the Kaiser Family Foundation, which tracked vaccination attitudes throughout the pandemic period, many parents are concerned about side effects or unknown harms that COVID-19 vaccines might cause. However, there have been numerous scientific studies showing that both boosters and two-dose series of COVID-19 shots were safe and effective. “The younger the age group, the more cautious [parents] are in terms of proceeding with vaccination,” says Liz Hamel, KFF’s vice president and director for public opinion and survey research.

KFF polled parents in the United States to find out if they believed they knew enough about COVID-19’s safety and effectiveness. Parents with children between 12 and 17 years old said 66%, while 61% answered with kids 5-11 years of age. 43% were with younger kids.

The hesitation is understandable among parents of very young children, given that vaccines have not yet been authorized for kids under 5 and the FDA recently delayed its review of Pfizer’s shot while waiting for more data. Although early indications indicate that it’s safe for children under 5, there remain questions regarding its effectiveness. Among older age groups, though, COVID-19 shots have proven safe “not only in research, but also in the real world,” Rathore says.

Dr. Paul Offit, director of the Vaccine Education Center at Children’s Hospital of Philadelphia and a member of the FDA’s vaccine advisory committee, says that much of the reluctance among parents stems from the belief that children—especially those without preexisting medical conditions—do not need to be inoculated because they are very unlikely to get severely ill or die from COVID-19.

This reasoning was brought up at the roundtable where Ladapo advocated against COVID-19 vaccinations for healthy children. Ladapo also mentioned a recent preprint study from New York, which found that, during the Omicron wave, vaccine protection waned more quickly among 5- to 11-year-old children than it did among older kids—perhaps because of the smaller dose given to the younger age group.

A CDC report based upon data from 10 states, published just after the New York study, concluded that age differences could be explained through timing. Omicron is an extra-contagious variant of Omicron that has outperformed previous vaccines. Omicron was developed shortly after the vaccines for children between 5 and 11 years old became available. Both papers showed that vaccines become less effective over time at blocking infection, especially Omicron, but the CDC report found they are between 73% to 94% effective in preventing COVID-19 hospitalization.

Offit states that this alone is enough to make vaccination worth it. It’s true that kids develop severe disease much less often than adults, but exceptions happen. According to CDC data, more than 100,000 children were hospitalized for COVID-19 during the epidemic. Other complications include Long COVID, MIS-C, and pulmonary inflammatory disorder MIS.

“When I was working in the hospital in the middle of December, we admitted 18 children that week,” Offit says. “Five of them went to the intensive care unit. It’s safer to avoid it. [through vaccination], then avoid it.”

Offit, however, doubts that Florida’s guidance will have a major effect on pediatric vaccination rates in the state or more broadly. It’s “a political statement” more than a public-health policy, he says, and most people have by now made up their minds about whether they plan to vaccinate their children. “I don’t know what people are waiting for, at this point,” he says.

Data shows that some parents remain undecided. As of February, 10% of parents with 5- to 11-year-old kids said they were going to “wait and see” about vaccination, according to a recent KFF report. That suggests there is still some wiggle room—and anything that further confuses or concerns parents could sway them against vaccination, Rathore says.

One-on-one conversations with loved ones and trusted sources—which, for parents, often means their child’s pediatrician—can make the biggest difference in vaccine intentions, Hamel says. “One big question is, how do pediatricians interpret [Florida’s] advice and filter that to their patients?” she says.

On Twitter, many Florida pediatricians expressed support for vaccination. “As a Florida pediatrician I could not recommend the covid vaccine for eligible children more,” tweetedDr. Chelsea Torres. “I am beyond myself as a pediatrician in Florida,” tweetedLindsay Thompson. “This will have ripple effects on all vaccines and children will end up suffering and dying.”

Rathore stated that he hopes colleagues will ignore his advice. “Anyone who cares for children, advocates for them, and stands for them,” he says, “would want them to get vaccinated and get protected.”


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