Comment: Parents of unvaccinated kids need better guidance

Public health officials, not parents, should be summarizing the research on how to protect kids under 5.

By Nita Farahany / Special To The Washington Post

We parents of young children still waiting for a covid-19 vaccine feel abandoned at this late stage of the pandemic. Federal officials, it seems, have decided to leave it up to us to figure how to navigate coronavirus risks for our children. This lack of information has bred distrust in parents while putting public health agencies in an unenviable Catch-22 as they prepare to — finally, hopefully — vaccinate children under 5.

Either the risks to this age group are minimal, which potentially weakens the imminent message to vaccinate children younger than 5 years old, or they are more substantial, and public officials have failed to adequately advise parents about how to protect children in the absence of a vaccine. It’s not too late for public health agencies to correct course and to issue targeted guidance for what we should be doing (and not doing) to protect our young unvaccinated children from covid’s short-term and long-term risks.

Moderna recently requested emergency use authorization of its coronavirus vaccine for babies and the youngest children, but the Food and Drug Administration has delayed a decision until June, apparently to review it alongside a candidate vaccine from Pfizer-BioNTech.

This follows an earlier about-face on approval of the Pfizer and BioNTech vaccine for children under 5. (The FDA planned to evaluate a two-dose regimen in February, then, after disappointing data, pushed off the review to see how three shots fared.) Meanwhile, parents have received maddeningly little information about the reasons for delay, and little information about what they should do in the interim.

The mixed messaging is frustrating. Public health agencies stress the importance of vaccinating older children and adults who interact with unvaccinated children; like my 2-year-old daughter. And they stress keeping them distanced from others in public. And yet, the CDC has relaxed its public masking guidance, leading cities and counties to abandon mandates, thereby making it nearly impossible for parents to act on that advice.

I’m a bioethicist who, stuck in parental limbo, has become a fervent amateur epidemiology researcher, devouring information to better decipher the risks to our youngest child. But like other parents, I’m exhausted from the effort and confused by the data that’s out there, and believe public health agencies, not me, should be doing the work of summarizing the most salient findings, and explaining how to act on them.

I’ve been comforted that the short-term risks of death and other severe outcomes for the youngest has remained quite low, relative to older populations, even though their hospitalization and death rates rose during the omicron variant wave. If the risk I were taking when I brought my child out in public were limited to a short-term bout with the disease, I would not be overly concerned; at the youngest ages, comparisons with the flu are not unfounded. (The flu, after all, can be deadly, too.) But I would like federal health officials to affirm that my judgment on this question is correct.

It’s the known and unknown risks about long covid that worry me more, and that exacerbate my frustration at the lack of public health guidance. One concern, for instance, is the risk of multisystem inflammatory syndrome in children (MIS-C), a rare condition that has been linked to covid.

Granted, some of the data on long covid in children is ambiguous: One study, from Britain, suggested that tens of thousands of children there (11 to 17) could be suffering from long-term symptoms. Another, based on an American population, found only a very small difference in the prevalence of long covid symptoms experienced by people diagnosed with covid-19 and those who had never been infected. But it shouldn’t be up to parents to reconcile conflicting medical studies and make a judgment about risk; it’s the job of public health officials.

As studies accumulate on the long-term impact of covid on adults, we parents are wondering whether the risks for children are similar. Do children similarly suffer an increased risk of stroke, heart failure and other cardiovascular problems? What should we make of the data that says even mild cases in older adults increase brain matter loss? (Evidence of cognitive decline in that study was slight.) Given that children’s brains are developing rapidly, should we be taking even greater precautions to make sure our youngest aren’t infected; or are there reasons not to worry? Either way, parents want to know.

What is my family doing, day-to-day? We lost a child to an infection with respiratory syncytial virus (RSV), so we are more conservative than many, but I don’t think we are being unreasonably cautious. We balance maintaining the mental health and well-being of our 7-year-old — who needs to interact with other children and teachers, we’ve decided — with the risk to our 2-year old, and we reevaluate risk frequently.

Everyone else in our household is vaccinated, and we are only spending time indoors with other vaccinated friends and family. We also ask everyone to take a rapid antigen test before spending time unmasked with us. We do let our 7-year-old have indoor playdates with other vaccinated children, although we encourage them to play outdoors whenever possible. She also attends school in person (where the indoor masking requirement was recently lifted).

When the case counts came crashing down, we took our children out to breakfast a couple of times in a restaurant with widely spaced tables, indoors, but as cases climbed, we went back to avoiding indoor dining with strangers. We delayed a plane trip to visit in-laws when the mask mandate was dropped. I have delayed weaning her to give her antibodies to the coronavirus through breast milk, one of the only ways I can actively protect her.

Everyone has their own risk calculus, but we shouldn’t be forced to wing it in this way. My family’s approach seems reasonable, but there’s just no way to know. All of us need timely information to make choices to best protect our children, and parents of young children especially need this information, given that we are still waiting for vaccines. Unfortunately, federal health officials are letting us down; still.

Nita Farahany, a bioethicist, is the Robinson O. Everett professor of law and philosophy and the founding director of the Initiative for Science & Society at Duke University.

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