As COVID vaccines roll out, where do kids fit in?

New vaccines against COVID-19 promise a return to normal in the not-so-distant future, but for many children, . the next school year may still look much the same as this one, with social distancing in classrooms, masks on faces and some number of students remaining online. Testing of a vaccine for teenagers could be complete by midyear, but most of them will likely remain unvaccinated for the fall semester. Vaccine studies for elementary school-aged children have not started in the United States yet, making widespread immunization for that group a distant prospect. When child vaccines do become available, it is unclear when doses will be widely circulated and how many parents will let their children be immunized. A Department of Public Health spokeswoman said there would be no mandate discussion until the U.S. Food and Drug Administration gives full approval to a vaccine

This story has been updated with the latest child death in Georgia from COVID-19 and additional information from a parent.

New vaccines against COVID-19 promise a return to normal in the not-so-distant future, but for many children, the next school year may still look much the same as this one, with social distancing in classrooms, masks on faces and some number of students remaining online.

Testing of a vaccine for teenagers could be complete by midyear, but the timing is so tight that most of them will likely remain unvaccinated when the first-period bells ring in Georgia for the fall semester. Vaccine studies for elementary school-aged children have not started in the United States yet, making widespread immunization for that group a distant prospect.

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When child vaccines do become available, it is unclear when doses will be widely circulated and how many parents will let their children be immunized.

Elizabeth Karen, a DeKalb mother of a 3-year-old, has a master’s in public health, had a fellowship at the Centers for Disease Control and Prevention and works for a medical device company. She will have her daughter vaccinated once the federal government authorizes one for emergency use in children. She believes the vaccine should be required to attend school at that point, and worries about the mistrust she sees on social media. “I’m seeing a lot of people who say ‘I believe in science, but,’” she said.

Experts estimate that about 70% of the population would have to be vaccinated to achieve herd immunity, the point at which enough people are immune that they indirectly protect those who are not. Yet many of those surveyed recently don’t plan to get immunized.

In November, Gallup released a poll in which 42% rejected vaccination. Many objected to a “rushed” development timeline or expressed a wait-and-see approach. Some were simply anti-vaccination. A significant number fell into an “other reason” category.

ExploreComplete coverage of COVID-19 in Georgia

People sometimes express religious or medical reasons for rejecting vaccination.

An Oconee County teacher who complained to The Atlanta Journal-Constitution about large numbers of students eschewing masks doubts their parents will accept the science behind the vaccines.

“The mentality here, it’s just such an anti-mask ‘you can’t tell me what to do’ county,” the teacher said, asking for anonymity for fear of reprisals. “You’re not going to put a mask on your face but you’re going to try to get someone to inject something in their arm?”

Even parents who support other efforts to fight the virus, like wearing masks and social distancing, are wary of the new vaccines, at least for now.

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“I don’t want my kids to be guinea pigs,” said Cleo Gladden, a Gwinnett County mom. She heeds the warnings from public health experts, getting her groceries delivered and rarely leaving the house. Despite that, she lacks enough confidence in the vaccine vetting process to put her four sons, schooling at home and online, at the front of the vaccination line. Her son in college and her two in high school may get vaccinated someday. Her 3-year-old? Not until a vaccine is thoroughly tested and proven safe.

Nicole Hedgemon in Fulton County lacks confidence in the vetting process.

“It’s just some big, unknown bureaucracy saying we know what to put in your body,” the East Point mother of two teenagers in private school said. “Sometimes they get it right but not all the time.”

Mandates not on table yet

It is unlikely anyone will be forcing their compliance anytime soon. Mandating immunization for students appears to be a political non-starter.

Policy experts say it is too early to contemplate that anyway, given unanswered questions about the safety and efficacy — and availability — of child vaccines. Current mandates, for measles, for instance, cover vaccines that have a long history of both safety and long-term protection for the vaccinated. COVID-19 vaccination, meanwhile, is authorized only for emergency use, noted Polly J. Price, a professor of public health law at Emory University.

“I can’t see schools, even high schools, moving right away to any kind of mandate,” Price said.

In Georgia, the Department of Public Health determines which vaccines are required for school attendance, and some religious and medical exemptions are allowed.

A DPH spokeswoman said there would be no mandate discussion until the U.S. Food and Drug Administration gives full approval to a vaccine.

08/20/2020 - Cartersville, Georgia - Cartersville Middle School Technology teacher Michelle Cottingham (front of classroom) welcomes a group of socially distanced seventh graders to her classroom during their first day of hybrid classes at Cartersville Middle School in Cartersville, Thursday, August 20, 2020.  (ALYSSA POINTER / ALYSSA.POINTER@AJC.COM)
08/20/2020 - Cartersville, Georgia - Cartersville Middle School Technology teacher Michelle Cottingham (front of classroom) welcomes a group of socially distanced seventh graders to her classroom during their first day of hybrid classes at Cartersville Middle School in Cartersville, Thursday, August 20, 2020. (ALYSSA POINTER / ALYSSA.POINTER@AJC.COM)

Credit: ALYSSA.POINTER@AJC.COM

Credit: ALYSSA.POINTER@AJC.COM

State lawmakers delegate vaccine decision-making to DPH but could overrule the agency. A legislative mandate would be unlikely in this case, however, given the low risk of COVID-19 for children, said one key lawmaker.

“I would really think that mandating that they all be vaccinated would be very difficult to pass,” said Rep. Sharon Cooper, R-Marietta, chair of the state House’s Health and Human Services Committee.

Too many parents would see it as an infringement of their rights, said Cooper. “Unfortunately, the vaccine got politicized.”

Spokesmen for the University System of Georgia and Technical College System of Georgia said officials have not discussed whether students and employees would need to be vaccinated.

Calculating the impact on kids

It is hard to justify wholesale vaccination of a group that is not seriously threatened by the disease, argued an opinion piece in the Journal of the American Medical Association Pediatrics in September.

There is still much to learn about the role of children in spreading COVID-19, wrote the authors, three doctors who are experts in pediatric ethics. .

Children can catch COVID-19, and their infection rates have been rising.

As of Dec. 17, more than 47,000 children 17 and younger in Georgia had tested positive for the virus, according to Georgia Department of Public Health’s data. Of those, 581 of them landed in the hospital. The AJC reported on New Years Eve that an eighth child in Georgia, a 7-year-old Clayton County girl without pre-existing medical conditions, had died from the coronavirus.

Children rarely get seriously ill, though. As of mid-December, nearly 40,000 adults had been hospitalized and more than 9,000 had died due to the disease, DPH reported.

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Should youths remain unvaccinated, they could be an added vulnerability for communities in which many adults appear reluctant to take the vaccine themselves. Children are a fifth of the U.S. population, the Association of American Medical Colleges noted in a recent article on its website.

Dr. Jeffrey Stephens, who practices infectious disease medicine at Mercer Medicine in Macon and teaches at Mercer University, has had at least 20 patients die of COVID-19, including an otherwise healthy man in his 40s.

“It would be nice to be able to look forward to a return to some normalcy at some point in the latter half of 2021,” he said. For that to happen, people will have to get vaccinated even if they themselves are at low risk, he said.

He knows about the surveys indicating mistrust of the vaccines. “If a decent percentage of people have actually had somebody in their family or know someone that has had COVID,” he said, “they may feel differently.”

Clinical trials to include more kids

Dr. Evan Anderson, one of the doctors cited in the AAMC article, worries that pediatric vaccination trials have been too slow to get underway.

“It seems unlikely that a substantial rollout of a vaccine will occur in time for next school year,” Anderson, an associate pediatrics professor at Emory’s medical school, wrote in an email to The Atlanta Journal-Constitution. “A mandate is not going to be a serious consideration anytime soon.”

Clarkdale Elementary School students board their school bus at the end the school day in Austell, Monday, October 5, 2020. COVID-19 precautions for students are expected to continue into next school year. (Alyssa Pointer / Alyssa.Pointer@ajc.com)
Clarkdale Elementary School students board their school bus at the end the school day in Austell, Monday, October 5, 2020. COVID-19 precautions for students are expected to continue into next school year. (Alyssa Pointer / Alyssa.Pointer@ajc.com)

Credit: Alyssa Pointer / Alyssa.Pointer@ajc.com

Credit: Alyssa Pointer / Alyssa.Pointer@ajc.com

Many important questions about both the vaccines and the virus remain unanswered, and it is unclear how long it will take to answer them, said Dr. Rodger MacArthur, an infectious disease professor at Augusta University.

How often will children have to be revaccinated? Will they still be able to spread the virus after receiving the vaccine? When will enough of them get vaccinated to provide definitive answers?

MacArthur, who teaches at the Medical College of Georgia, said we cannot answer those questions yet. He is pretty sure we already know one thing, though:

“It’s likely that masks are going to be with us for quite some time.”

Staff writer Eric Stirgus contributed to this article.

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