Opinion: What we can learn from rows of small headstones

Editor’s note: Megan Ranney, MD, MPH, is a professor of emergency medicine and associate dean at Brown University School of Public Health. The opinions expressed in this commentary are his own. Read more reviews on CNN.


A few years ago I visited a cemetery in an old mining town in Utah. My husband and I were struck by the rows of small headstones. The date of death for each headstone was within weeks of each other in the early 1900s. They were all children who died of diphtheria. As a parent and doctor, it was an all too concrete reminder of the toll that infectious disease takes on American families and children.

Fortunately, we rarely see these kinds of small tombstones anymore. Thanks to pediatric vaccination, one of the greatest public health successes of the 20th century, we have virtually eliminated diphtheria – along with poliomyelitis, measles, Haemophilus influenzae type b and more – from the United States. .

It is no longer common for American children to die or be disabled by infections. Instead, injuries (especially gunshot wounds) are generally the leading causes of death among children in the United States.

New guidelines issued Tuesday by the Florida Surgeon General that “healthy children ages 5 to 17 may not benefit from receiving the currently available COVID-19 vaccine” are therefore upsetting to those of us in the public health and medical communities.

Covid-19 is certainly not as deadly as diphtheria. And it is true that death and hospitalization rates from Covid-19 are lower in children than in adults. Yet the fact that the absolute number of deaths among children is lower than that of adults does not mean that the deaths of these children do not matter.

Indeed, in 2021, Covid was among the top 10 causes of death for American children and young adults every month (except in June, for ages 5 to 14, where it drops to 11th place but remains in the top 10 teenagers). This month, nearly 40,000 Covid-19 hospitalizations were recorded in 25 states (data not available for other states). We are only just beginning to know the nature and frequency of the long-term consequences of Covid in children.

This is why the development, testing and eventual distribution of a pediatric Covid-19 vaccine – with the aim of preventing serious illness, long-term symptoms and death – has been so welcomed by parents. , physicians and public health professionals. It was an opportunity to give our children a return to normal. And that illustrates why Florida’s advice is so wrong.

Let me be clear on the facts. The Covid-19 vaccine currently under emergency use authorization in the United States for children 5 years and older – a two-dose Pfizer/BioNTech series – is effective in preventing the worst outcomes: severe illness, hospitalization and death .

Numerous studies show that children who are hospitalized with Covid-19 are, on the whole, those who are not vaccinated. Even during the Omicron wave, when vaccines became somewhat less effective at preventing a SARS-CoV-2 infection, preliminary analyzes supported that vaccinated children were still much less likely to have these most severe outcomes.

Equally important, these vaccines are safe for children. Nearly 20 million doses of the Pfizer Covid-19 vaccine have been administered to children aged 5 to 11 and 30 million people aged 12 to 17. Of these, only a handful had allergic reactions. Very few children between the ages of 12 and 17, and even fewer between the ages of 5 and 11, have been reported to suffer from the rare side effect of myocarditis; these cases were usually mild and resolved on their own.

Compare that to the known effects of Covid-19, which the vaccine can prevent: the tens of thousands of children hospitalized, the more than 1,000 children dead, the unknown numbers who will suffer from long-lasting Covid – and myocarditis severe, life-altering and other heart conditions. Some studies estimate that the risk of myocarditis in young people after Covid-19 infection is 100 times higher than the risk after vaccination.

Finally, the Florida Department of Health states that only “children with underlying illnesses are the best candidates for vaccination against COVID-19.” But, the ableism of this claim aside, it’s important to remember all the reasons why it’s silly. Nearly 20% of American children are obese – a major risk factor for poor outcomes after infection; not to mention the untold more with diabetes, cancer and myriad other risk factors. Moreover, even healthy children are getting sick: a study last summer reported that a third of pediatric hospitalizations related to Covid-19 were among young people without pre-existing high-risk conditions.

All these reasons explain why I enthusiastically vaccinated my own children against Covid-19. (PS They’re both fine.) It’s also why countries around the world – including the UK, which was initially reluctant to vaccinate children – are urging all children aged 5 or over to get vaccinated. against Covid-19.

Here in the United States, at a time when we are asking the public to take an increasingly individualistic role in controlling Covid-19, let us not undermine these effective protections available to our children. We should celebrate, not denigrate, vaccines. Let common sense, compassion and respect for data prevail.


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