Experts weigh in on why the U.S. departs from its peers in recommending
COVID-19 boosters for young children.
JOSEPH PREZIOSO|GETTY IMAGES
A young child receives a Moderna COVID-19 vaccination at Temple Beth Shalom, June 21, 2022, in Needham, Mass.
When it comes to vaccinations for COVID-19, the U.S. stands apart in recommending booster shots for children.
Centers for Disease Control and Prevention guidelines call for children 6 months and older to get an “updated” COVID-19 vaccine – a tweak in terminology from a “booster” to reflect a new formula for the shots. In contrast, England last year called for boosters for children as young as 6 months if they were in a clinical risk group, while the U.S. stance also has differed from recommendations of European Union members like Germany and France. The World Health Organization additionally considers healthy children between 6 months and 17 years old to be a “low priority” for COVID-19 vaccination.
Among U.S. public health experts, opinions on COVID-19 boosters for young children are somewhat mixed. For insight on the issue, U.S. News & World Report spoke separately with Dr. Aaron Glatt, chair of the Department of Medicine at Mount Sinai South Nassau Hospital in New York and a spokesman for the Infectious Diseases Society of America, and Dr. Paul Offit, director of the Vaccine Education Center at Children’s Hospital of Philadelphia and author of the new book, “Tell Me When It's Over: An Insider's Guide to Deciphering Covid Myths and Navigating Our Post-Pandemic World.”
The following interview excerpts have been edited for length and clarity.
Why do you think other countries have not made similar recommendations when it comes to COVID-19 booster shots for children?
Glatt: I think there are different opinions as to the overall public health benefit for vaccinating very young children. While I think we all can agree they would benefit in general from the vaccine, that benefit is not a mortality benefit, and it’s not clear it would be a significant benefit. Is it worth the time, effort and the possible minimizing of public health advice when there isn’t as clear cut a case for it as you would have, for example, in an elderly patient?
I strongly recommend people to get vaccinated if they are at high risk from COVID – whether they have underlying medical problems, whether it’s based upon age, or both. But it’s hard to make a strong “you must do this'' recommendation for a COVID-19 vaccine in a 5-year-old kid, especially if they have previously gotten the vaccine or previously had COVID. I think the rest of the world said they were not going to make their stand here.
Offit: The goal of this vaccine is to prevent serious illness. That’s the goal. So the question then becomes: Who is getting seriously ill? That generally falls into four groups: the elderly, those who have high-risk medical conditions, people who are pregnant or people who are immunocompromised, and that’s why those countries make those recommendations.
I think that the reason the U.S. broadly recommends boosters for children is because we think that a nuanced recommendation – meaning targeting high-risk groups – is a garbled recommendation, and the best way to get those high-risk groups vaccinated is to recommend the vaccine for everyone.
Are there concerns that having broader COVID-19 recommendations for children might exacerbate some parents’ anxieties about vaccines in general?
Offit: Only if they were mandated. If the vaccine was mandated as a booster, I think that would do it. We saw that happening as the pandemic came winding down and there were some universities that still mandated a vaccine for college students – that created a pushback, and frankly, an understandable pushback.
Glatt: I want parents to get their children their measles, mumps and rubella vaccine, their diphtheria, pertussis and tetanus vaccine. I want them to get the stuff that I think is essential.
In the scheme of things, the COVID vaccine is not as essential as those other vaccinations, so I’m going to spend my time and effort recommending those over the COVID vaccine, though not to the exclusion of the COVID vaccine. But when they’re hesitant already, let’s get in the ones that are much more important from a public health point of view.
Has the public’s view of public health agencies eroded since the beginning of the pandemic? If so, do you think it’s forced leaders to be more judicious about how they spend their remaining credibility when making recommendations?
Glatt: Unfortunately, we’re in an era where people just don’t listen to what their doctor says automatically. Today, patients question, and patients Google. We have to get around the idea that there is an absolute right and an absolute wrong. In the European countries where they have chosen not to recommend the vaccine boosters to all children, I think they’re basically saying that they have chosen not to go that route because it’s just not worth the amount of time, effort and credibility by saying, ‘This is essential,’ when it may not be essential.
Offit: I think we’re living in an unusual time. What you’re seeing is a large percentage of this country that doesn’t trust the government and doesn’t want the federal government in their life. The Food and Drug Administration and the CDC suffer from that, and I feel that the pandemic has made things much worse in that regard. The anti-vaccine movement has been emboldened and is much better funded than ever before, and I would argue that they have more funding than those groups that are trying to put good information out there.
Measles is a good example. We eliminated measles in this country in the year 2000, and the reason we did it was because of one thing: school mandates. But now you have an erosion, where somewhere around 35% of parents are questioning whether school mandates are necessary. You have a paper that was published by the CDC in November of last year showing that more kindergartners are opting out of school vaccines for nonmedical reasons.
I think it’s just a sort of zeitgeist that the CDC is suffering from right now. I do think, though, the CDC should be out there every other day explaining why they are doing what they’re doing, and explaining the science for why they’re doing what they’re doing.
How does public health contend with vaccine misinformation and the diminishing trust in public health agencies to effectively promote its recommendations?
Offit: We all want the same thing: We want to keep people from dying and being hospitalized from COVID-19. That’s what we want. The question is how best to do it. It’s the CDC’s belief that the best way to do it is to have a universal recommendation for everyone 6 months of age. That’s fine – then get out there and make that case and show why that’s true.
The goal of this vaccine is to keep people out of the hospital, so are people who are boosted much less likely to be hospitalized who are not in those high-risk groups? If that’s the case, they can prove that. But I think the solution is to be out there on the record in a very strong, clear, definitive way as to explain why you are making the decisions you are making.
Glatt: I think it’s possible to have a nuanced approach. A 5-year-old kid that has never had COVID and never got any vaccine might be a different priority than a 5-year-old kid who got two doses of vaccine and had COVID. There certainly are circumstances that the recommendations do not take into account.
I do think that as a clinician, when I advocate for public health, it’s much easier for me to take those kinds of factors into account. The CDC is limited to a certain extent, and I don’t think they’re wrong, but that’s just not the place where I as a physician would want to go and make my do-or-die stand
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