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COVID-19 vaccine effectiveness is rapidly waning in children

The fundamental feature of President Biden’s National COVID-19 Preparedness Plan is to ensure there will be no future economic and educational shutdowns whatever the cost to the population. In this regard schools have been the primary focus for the Democrats and Republicans, who understand quite well that economic output is directly related to having children in the classrooms so their parents can work. Yet, there is little discussion in his plan on declining vaccine effectiveness, especially in school-aged children, nor the evolution of coronaviruses with more immune-evading capacities.

Arihana Macias, 7, gets a compress after reviving the Pfizer COVID-19 vaccine for children five to 12 years at a Dallas County Health and Human vaccination site in Mesquite, Texas, Thursday, Nov. 4, 2021. (AP Photo/LM Otero)

As the 94-page document notes, during last winter’s massive COVID wave, which killed more than 300,000 people in the US, only 46 percent of K-12 schools were open for in-person learning. The report then suggests a connection between school reopenings and economic performance: “Today, about 99 percent of K through 12 schools are open for in-person learning. And since President Biden took office, there has been historic job growth. The US economy created 6.6 million jobs in 2021—the strongest job growth of any year on record …”

The massive wave last winter was triggered by attempts to force schools back to in-person education, followed by record numbers of people traveling and gathering for the Thanksgiving and Christmas holidays. Naturally, with the virus still widely present throughout communities, a devastating surge was the foreseeable result.

At the peak of the wave in mid-January 2021, there were about 211,500 pediatric infections reported. During that wave, from the beginning of October 2020 to the end of March 2021, about 170 children died from COVID.

The COVID vaccines, which were rolled out in mid-December 2020 and proved effective, became the means by which the federal government, states, and local officials coerced schools to reopen in the fall of 2021. However, two additional waves of COVID infections followed, the first with Delta (peak in September 2021 with 251,781) and then soon after with Omicron (peak in late January 2022 with 1,150,543).

Between the beginning of August 2021 and end of February 2022, more than 8.4 million children were infected, accounting for two-thirds of all pediatric COVID cases in the entire first two years of the pandemic.

According to the CDC’s tracker, just over 400 children had died from COVID by the end of summer 2021. Since then, another 1,000 children have succumbed, a product of school and day care reopenings that have allowed more virulent and contagious variants to spread unchecked.

For those who continue to insist that COVID doesn’t harm children, the flu statistics in the figure below demonstrate the dramatic reduction in flu cases in 2021. It also demonstrates how much deadlier COVID has been for children as compared to the flu.

Figure 1: Influenza-Associated Pediatric Deaths by Week of Death [Source: CDC]

There is a very clear and direct line from the initiation of these policies to the deadly outcomes being witnessed. In applauding the Biden administration’s efforts to ensure economic activities are back at a record pace, the pandemic preparedness plans make no reference to these statistics.

By April 19, 2021, all US states had declared Americans ages 16 and over eligible for the vaccines. On May 10, the FDA approved Pfizer’s COVID vaccine for adolescents aged 12 to 15. Then in November 2021, using a reduced vaccine dose (10 microgram), the FDA cleared the vaccine for children five to 11.

Most recently, the FDA postponed its Advisory Committee Meeting last month to discuss emergency use authorization for Pfizer’s COVID vaccine for children aged six months through four years (dosed at three micrograms) to allow the pharmaceutical giant to trial a third dose two months after the second dose. The vaccines had proved ineffective against the predominant Omicron variant, causing Pfizer to delay attempting a rollout. That leaves this sub-group of children, who number 24.6 million in all, quite vulnerable as Omicron leads to more hospitalizations and deaths. The figure from the Economist provides visual context to these developments.

Figure 2: COVID infections and hospitalizations in the US by age groups [Source: The Economist]

As of the last week of February, 7.1 million US children ages five through 11 have completed a two-dose vaccination series, accounting for only 25 percent of this age group. For children 12 to 17, 14.2 million or 57 percent of this age group has been fully vaccinated. As a whole, the 72.8 million children in the US remain quite vulnerable.

Yet, recent data is demonstrating the situation is even more concerning. Vaccine effectiveness for children has waned considerably. Data based on the New York state pediatric population, for those five to 11, shows vaccine effectiveness has declined from 100 percent to 48 percent, while the infection rate for vaccinated children is on par with those who never received the vaccines. The figure for vaccine effectiveness against infection shows a dramatic decline for the Omicron variant.

Figure 3: Vaccine effectiveness against infection, by week and year of age

For children 12 to 17, for the week ending November 29, prior to Omicron being detected in the US, vaccine effectiveness against infection compared to the unvaccinated showed an 85 percent protection rate. By mid-December, when Omicron represent 19 percent of all sequences, the effectiveness dropped to 65 percent. By January 24, 2022, with Omicron dominant, the effectiveness had dropped to 50 percent, as noted in the figure below. Vaccine effectiveness for older teens remained higher at 73 percent, but this too was down from a high of 94 percent.

The Centers for Disease Control and Prevention’s (CDC) new guidelines and the repealing of all mask mandates in school by state officials will have a significant impact on the health of children. According to Education Week, a newly formed coalition called The Urgency of Equity, which include Yale University Epidemiology Professor Gregg Gonsalves, has called on schools to make high-quality masks available for all students and defended universal masking.

They wrote, “Healthy schools mean fewer children bringing the virus home to their families where it can spread to other vulnerable family members, including grandparents and younger siblings. Over 200,000 children have lost a caregiver during the pandemic, causing emotional stress, poor mental health, and severe disruptions to learning … Tragically, more than 400 teachers have died.”

Meanwhile, the Biden administration had promised $130 billion from his American Rescue Plan towards the improvement of school ventilation and also to allow schools to access tests and hire more teachers, nurses, and other staff. Such promises have yet to materialize, and may never.

“These improvements,” as Chalkbeat noted, “will take time, and some won’t be completed for years after the pandemic first disrupted schooling … With limited options for spending a big, one-time chunk of money, school districts are using part of it for expensive facilities projects, which may have only a tenuous connection to the pandemic and will take years to complete.”

By next week, only the District of Columbia and Hawaii will have mask mandates fully in place. California, New Jersey, Washington, Oregon, and possibly New York will end theirs soon. It remains to be seen how BA.2 will surface in the US. Last week it represented 8 percent of all sequenced variants and it continues to double weekly.

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