By Westyn Branch-Elliman and Shira Doron / Special To The Washington Post
The news that Pfizer and BioNTech are seeking authorization from the Food and Drug Administration to use their coronavirus vaccine in kids aged 5 to 11 has sparked hopes that a return to a version of normalcy in the classroom might be imminent.
It’s no wonder: For weeks this new school year, kids and families have been contending with mask requirements, outdoor lunches, unpredictable quarantines and Zoom PTA meetings.
But even if the FDA moves quickly to grant emergency-use authorization for the pediatric vaccine, we may still be many months away from the first normal-looking school year in a while. A lot depends on whether enough vaccine-hesitant parents allow their children to be given the shot; and at what point those who have embraced mitigation measures such as distancing and masks are willing to let down their guard against a virus that will continue to circulate and sicken people indefinitely.
Some of the hurdles that lie ahead are logistical. Pfizer and its German partner BioNTech announced positive early results in their vaccine trials for ages 5 to 11 on Sept. 20 (the vaccine is already available in the United States for those 12 and older). Assuming the FDA agrees with the results and quickly authorizes the vaccine — a meeting to discuss the application is scheduled for Oct. 26 — distributing the lower-dose version might take some time. And once the two-shot regimen is available, kids will still have to wait two weeks after the second dose before they are considered fully vaccinated. That likely puts us into December before we start seeing children reach maximum immunity.
The more significant hurdles, however, are behavioral. We know some parents intend to vaccinate their children, with plans to jump in line as soon as the vaccine is available. But data suggest that many parents are not so eager. The September Kaiser Family Foundation survey found about a third of parents with children ages 5 to 11 planned to get their child vaccinated right away, with another third preferring to “wait and see” how it works first.
Even in towns and school districts that are able to achieve high levels of vaccine buy-in, officials may not be quick to ease mitigation measures like mask mandates and regular testing. Just look at colleges, where virtually every student is already eligible for the vaccine: Many have decided to keep in place their covid-19 precautions despite mandatory vaccine policies for students and staff and near 100 percent compliance rates.
The highly immunized states of Massachusetts and Vermont have determined they can lift masking mandates in school buildings when 80 percent of occupants are vaccinated. This target is based on how contagious the delta variant is and the level of immunity required in a community to prevent an outbreak. But not everyone will be comfortable with an 80 percent vaccination rate, since the vaccines do not prevent 100 percent of infections. However, the vaccines do prevent severe disease, and, even with the delta variant, they reduce its spread. There’s also evidence that individuals with prior infection also have robust immunity, so an 80 percent threshold may ultimately prove to be overly cautious. For comparison, Denmark dropped all covid restrictions once 70 percent of its population was vaccinated, and Norway did away with its restrictions at 67 percent.
Another way to hasten normalcy in more cautious parts of the country will be transparency. The mitigation strategies that have become common in these places serve three purposes in schools: to limit spread of infection, to prevent learning loss due to classroom closures and quarantines, and to provide comfort to families and educators who may be anxious about the safety of in-person school. Parents will be more comfortable lifting the restrictions if we signal the benchmarks ahead of time and make clear they are based in science.
Ultimately, the vaccine for people as young as 5 — and likely soon after that, even younger — does signal that the pandemic is reaching its end point, and that’s good news. Although covid infections will likely be a part of our lives for years to come, they will stop being the source of so many hospitalizations and deaths. At some point, the risk posed to the community by this coronavirus will resemble that of the flu. We will eventually reach a point where the number of cases in a given place are no longer deemed relevant for determining risk and setting public policy. In August, Germany declared it would no longer be following case counts for this reason.
The pandemic has taught us all that we need to be humble about making predictions, and that we have to live with some degree of uncertainty. We will likely have a seasonal ebb and flow of covid-related hospitalizations for the coming years, and with it, fear and anxiety will rise and fall. But slowly, and with levels of comfort that differ by family, we will acknowledge that children deserve normalcy, and we’ll peel off mitigation measures one by one until they are gone. We will hold our collective breaths, and we will see that the kids are OK. We will eventually know that the nightmare is behind us.
Westyn Branch-Elliman is an infectious diseases specialist at the VA Boston Healthcare System and Beth Israel Deaconess Medical Center, assistant professor of medicine at Harvard Medical School and an investigator at the VA Boston Center for Healthcare Organization and Implementation Research.
Shira Doron is an infectious disease physician and the hospital epidemiologist at Tufts Medical Center. She is an associate professor of medicine at Tufts University School of Medicine.