In previous articles, I discussed several fallacious arguments against vaccinating young children. These include:

  • The vaccine was not studied in an unethical, impossible randomized-controlled trial of a million children. (Discussed here.)
  • Preventing babies from getting COVID will somehow undermine confidence in vaccines for other “more significant” diseases, even though these other disease have impacted children much less than COVID. (Discussed here.)
  • Though it is rare and nearly always mild, the vaccine can cause myocarditis in adolescents, not younger children. (Discussed here.)

Another nugget of sophistry

However, the arguments in favor letting babies get COVID contain many other nuggets of sophistry. Here’s what I’ll be discussing today.

Dr. Marty Makary:

The CDC reported reported that, as of February 2022, 75% of children 0-17 years-old already had COVID-19. Given how rampant the Omicron strain has circulated since then, upwards of 80-90% of children have likely had COVID-19. There is absolutely zero clinical evidence to support vaccinating healthy children who already had COVID. Natural immunity, inexplicably ignored by public health officials, confers strong protection against severe disease.

Dr. Tracy Hoeg:

With rates of severe disease now much lower in children than at the start of the pandemic—due to higher levels of natural immunity and lower rates of severe disease caused by omicron—trials would have needed to enroll hundreds of thousands of children, if not over a million, in order to detect a significant impact of the pediatric vaccine against severe disease.

Dr. Vinay Prasad:

Most kids already had COVID-19. CDC estimates 75% as of February, but this number is an underestimate, as millions have been infected since.

These doctors are right that many children have contracted COVID. In an ideal world, they’d reflect on how their failed predictions of “herd immunity by April” and relentless vaccine fear-mongering helped create this widespread “natural immunity” with all its consequences.

However, instead of showing a trace of humility, they remain dedicated to their perverse mission of ensuring unvaccinated children contract COVID. Though they have every right to bask in their success, they’re not content that just 80-90% of children have had the virus. Seeking to get that number as close to 100% as possible, they now protest there’s no evidence the vaccine will benefit children who’ve already had the disease. They are right. They also think they are making a clever argument. They are wrong.

More methodolatry

I previously stressed that doctors are right to take reasonable actions in the absence of pristine evidence from massive randomized-controlled trials, especially in the middle of a raging pandemic (here and here). Decisions must be made, and time is not an unlimited luxury, even though contrarian doctors portray it as such.

Immediately after the results from the adult mRNA vaccination trials were announced, there was no evidence they saved lives. Only one person died in these trials. However the vaccine was very effective at stopping SARS-CoV-2 infections (it’s obviously not this effective now), and the vaccine was approved on this basis. Reasonable people surmised that since the vaccine prevented SARS-CoV-2 infections, it would also stop people from dying of COVID.

Their embrace of the extremely obvious paid off. Countless lives were saved because we didn’t wait until we had evidence the vaccine saved lives before we started to use the vaccine to save lives. The same is true for the pediatric vaccine. Some children are alive today because of the vaccine, and many more were spared hospitalization. This would not be the case had we demanded RCTs of a million children.

Image credit Kareem Carr

Doctors have to make choices with incomplete information all the time, and repeatedly exposing unvaccinated children to the virus is absolutely a choice. While it’s true we don’t know everything about the vaccine, we also don’t know everything about the virus. There have been zero randomized-controlled trials of the virus after all.

Nonetheless, I fully agree that a toddler who had the sniffles with Omicron, as nearly all do, has little to fear from a reinfection in the short-term. I’m not knocking viral-induced immunity. In one study from England of nearly 700,000 children from Jan. 27, 2020, to July, 31, 2021, only 1 in 300 suffered a reinfection. While 2.4% of children with reinfections were hospitalized, the same as a first infection, no children died.

Though this is generally encouraging, the study ended before Omicron arrived, and its relevance to variants circulating today is unclear. Meanwhile, there is evidence that vaccination after infection can limit reinfections, at least for adults (here and here). It’s reasonable to assume that hybrid immunity will also benefit some children. While viral-induced immunity shouldn’t be denigrated, responsible doctors shouldn’t plagiarize Melanie’s Marvelous Measles with statements such as “Natural Immunity wins again“, especially because the study that supposedly gave “natural immunity” its victory concluded “A single dose of vaccine after infection reinforced protection against reinfection”.

Currently, there’s no evidence that a child who had COVID-19 in March 2020 will have lifelong immunity to all future variants, nor is there evidence that repeated exposures to the virus are safe for developing children. We have to be humble about the possibility of long-term consequences, and we don’t know if worse variants may be circulating in a few months time. There’s uncertainty about both the vaccine and the virus. Honest brokers admit this instead of wielding the misleading phrase “natural immunity” as a magical talisman that perfectly wards off all future harms.

There are obviously still vulnerable children out there

However, there’s a much bigger flaw in the argument that pediatric vaccines aren’t needed since most young children since have already had COVID. It overlooks something very obvious and very important things. You see, if 80-90% of children have had COVID already, that means 10-20% of children have not, and this translates to millions of children in the US. Doctors should embrace the opportunity protect all children from rare but severe outcomes with a simple vaccine.

According to the CDC, over 300 children are being hospitalized daily with COVID. Of course, contrarian doctors haven’t acknowledged such children before, and they’re not about to start now. Unwanted facts are unmentionable facts. However, that’s a lot of sick children, and it nearly matches the Delta peak of last year. While MIS-C has happily vanished with current variants, this may not be true in the future. Meanwhile, the CDC’s COVID Data Tracker keeps slowly increasing its grim pediatric death tally, which is now over 1,700 children. There are obviously still vulnerable children out there, no matter how many times sheltered doctors mindlessly repeat the mantra “natural immunity”.

Where are these vulnerable children coming from? In addition to rare reinfections and the millions of children who have not yet contracted COVID, it so happens that 8 million babies have been born in the US since the start of the pandemic. Newborns don’t arrive with “natural immunity”, and reasonable people want to keep it that way. Not only are there currently children who are still vulnerable to COVID, 10,000 more arrived today in the US alone. There were will always be vulnerable children. Allowing them to contract the virus to protect them from the virus makes as much sense as giving away all your money to protect yourself from thieves. It works, but…

Image credit xkcd.com

Though contrarian doctors seem unaware that 3.6 million children will be born this year in the US, regulators with skin in the game know where babies come from, and so they voted 21-0 to approve the vaccine for young children. As such, babies today will have an opportunity their older siblings lacked. If they can dodge the virus for 6-months and if their parents haven’t been fooled by anti-vaccine doctors, they can be vaccinated before they encounter the virus.

And here’s where it’s helpful to have some basic knowledge about vaccines and viruses. Prior to the vaccine, measles would rise and fall at predictable intervals as it infected a new crop of children. Given their interest in vaccines is both recent and shallow, I’d be shocked if contrarian doctors know this. I suspect – and hope – they’re entirely unaware their efforts could help recreate a similar situation for COVID, with all the suffering that entails. Given their complete lack of real-world responsibility for sick children, I am not optimistic about their potential for future enlightenment.

Measles | Vaccine Knowledge

We all know the COVID vaccine isn’t as effective as the measles vaccine, but it’s far from useless, and updated vaccines will hopefully provide better protection. So why not try to do to COVID what we did to measles in the 1960s? Why should we sit back and watch as millions of children get COVID every year? Should we just do this year after year? What would have to happen for these doctors to change their minds and enthusiastically embrace vaccinating kids?

For some sheltered doctors, the answer is simply “It really doesn’t matter“. This is false. It really does matter.

Again, it only requires basic knowledge of this virus to understand why. It turns out that babies have by far the highest risk of dying of all children, though you could read every article by every contrarian doctor and not learn this simple fact. Like I said, unwanted facts are unmentionable facts.

So far, COVID has killed over 500 children under 5 years. That’s a tragically large number, and it’s higher every time I check it. Given the abysmal vaccination rates for young children, COVID will likely continue to kill an unacceptable number of children for the foreseeable future. Normal people think this is sad and are eager to try to prevent it. While death is the most severe outcome, it is not the only bad one, and the vaccine has been shown to limit pediatric hospitalizations in older children, even with the Omicron variant. While most children do well, some hospitalized children are very sick.

It’s true there’s currently no evidence the vaccine will prevent these rare, but tragic outcomes in young children. But based on how the vaccine has helped every other age group, there’s every reason to think it will help some babies and toddlers too. The argument against vaccinating children is that since severe disease is rare, there’s not really a point. The argument boils down to “the vaccine won’t help that many children”. I think that’s a horrible argument. I think doctors should strive to have zero children suffer or die for lack of a vaccine. This shouldn’t be controversial.

Author

  • Dr. Jonathan Howard is a neurologist and psychiatrist based in New York City who has been interested in vaccines since long before COVID-19.

Posted by Jonathan Howard

Dr. Jonathan Howard is a neurologist and psychiatrist based in New York City who has been interested in vaccines since long before COVID-19.