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The president of the American Academy of Pediatrics on kids’ vaccines, the FDA’s process, and masks in schools

September 16, 2021, 11:00 PM UTC

American children are contracting COVID-19 at alarming rates.

Nearly half a million COVID-19 cases were documented in children in the U.S. in the two weeks leading up to Sept. 9—representing almost 10% of the total number of children who have tested positive since the beginning of the pandemic—according to the American Academy of Pediatrics. And though it’s well documented that children are considerably less likely to suffer from a severe COVID-19 case than adults, hospitalizations have trended upwards, adding to the pressure to get a vaccine for those under 12 years old authorized and distributed.

Pfizer expects that the Food and Drug Administration could authorize COVID-19 vaccines for the use of children between 5 and 11 years old by Halloween, while the sign-off on its use for kids as young as 6 months old may not be far behind. But to understand why it’s taken longer to do so, and how parents should be thinking about vaccinating their children once one is authorized, Fortune‘s Ross Kohan spoke with Dr. Lee Savio Beers, the president of the American Academy of Pediatrics.

This edited Q&A has been condensed for space and clarity.

What are we seeing in terms of infection rate among children, specifically in those under 12 who don’t yet have the option of getting vaccinated?

Beers: Across the country, in children and adults, we’re seeing big increases in infection rates, largely due to the Delta variant, which we all know is much more transmissible.

Thankfully, children by and large do very well with COVID-19 infection. They’re not as at risk for severe infection as adults are, but they can get very sick. A small percentage of a lot of kids is a whole lot of kids. In our pediatrician’s offices and our children’s hospitals, we’re seeing a lot of children who are who are very, very ill with COVID.

Fully vaccinated children and adults do still face the possibility of a breakthrough case. How are vaccinated children who do contract COVID-19 reacting?

Vaccination is one of the most important things tools in our toolbox to help prevent the COVID-19 infection. We do know that there are are small numbers of breakthrough infections. This is normal. This happens with every vaccine. But in adolescents and adults, what we’re seeing is that those breakthrough infections are much less severe. When we look at hospitalizations, over 95% of hospitalizations for COVID are in unvaccinated patients. So bottom line is that even if you do get a breakthrough infection, it’s highly likely to be much more mild and prevent hospitalization and severe illness, which is what we’re all looking for in the first place.

What would you say to those parents who aren’t getting their eligible children vaccinated?

For parents who have questions about the COVID-19 vaccine, I think the first thing I want to say is that’s normal. You’re a parent. Your job is to make sure that you understand the health decisions that you’re making for your child, so I would first encourage parents to talk to their pediatrician, to talk to a trusted health professional, to ask their questions, to ask their concerns.

In addition to being a pediatrician, I’m a parent of two teenagers, and my teenagers are both fully vaccinated. I made sure I had the answers to my questions. I asked people when there were things I wasn’t sure about, and I felt 100% comfortable getting my children vaccinated. So I think that’s another important thing, is just to remember that this is a safe and effective vaccine and COVID infection, while less severe in children and adolescents, can be very severe and sometimes we can see long term impacts from COVID infection.

Why has it taken so much longer to develop a vaccine for children?

We know children are younger, that they’re still growing and developing, and so we’re always going to have an extra layer of caution when we’re developing vaccines, or really any medication, for children.

We’re going through all the steps that we always do with vaccine development. You start with adults, determine that the vaccine is safe and effective, and then you start to work backwards and figure out, is the vaccine effective in younger kids [and] what’s the right dose. You have to take that step-by-step to make sure you have a safe and effective vaccine.

In August, you wrote to the FDA asking it to be “aggressive” when it comes to authorizing a vaccine for kids. What does “working aggressively” look like? What are some of the steps you feel need to be sped up?

Just as a general statement, this is not specific to the FDA, but children are too often an afterthought, and it’s really important to us as pediatricians to make sure that we’re really thinking about the needs of children in the context of the pandemic.

[With any vaccine authorization] there’s the safety review and looking at the data and making sure that we’re really following a careful and cautious vaccine development process. And we don’t want to rush that at all. What we do want to do is make sure that we’re not getting held up in administrative things—that we’re moving on the data that we have as quickly as we can.

How should parents who get their children vaccinated weigh social interactions with others kids who have not been inoculated, especially for those who are too young to wear masks?

As a parent, there’s a couple of things I would think about. First is what are the simple, safe, effective precautions that you can take to try to minimize risks? That includes things like wearing a mask when you’re around people who who aren’t vaccinated, or if you yourself are not vaccinated, like the younger kids, taking your playdates outside as much as you can. Also, as a parent, your child needs to be interacting with other people, they need to be playing with their friends, they need to be doing those things that help promote healthy child development. And so doing those things, but doing them safely, doing them in a way that you can decrease the risk of spread of COVID.

Should children be wearing masks in school, even once they are vaccinated?

The American Academy of Pediatrics really recommends that in-person school is the best place for kids to be. We want to make sure that all children have access to in-person school. And part of how we can make that happen is by implementing safe and effective and layered mitigation precautions. One of those things is wearing a mask in school.

We know there are still lots of kids who aren’t eligible to be vaccinated, so we want to make sure that we’re keeping them safe, and that we’re also helping to prevent the spread of COVID to others, because we know masks protect us as individuals, but they also protect our friends and those around us.

I’m really sympathetic to teachers. They have a lot that they’re managing right now, and to be asking them to figure out and remember who’s vaccinated, who’s not vaccinated, you can wear a mask, you don’t have to wear a mask—that’s not terribly practical or pragmatic. So the safest and most efficient and effective thing is to just require universal mask wearing in schools. It also just helps decrease the stigma of it. It helps make it a normal thing, and it’s a simple, safe and effective intervention that we know can decrease the spread of COVID in schools so that our kids can get there and stay there.

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