By Jeremy Samuel Faust, Katie Dickerson Mayes and Céline Gounder
Dr. Faust and Dr. Mayes are emergency medicine physicians at Brigham and Women’s Hospital. Dr. Gounder is an epidemiologist who served on the Biden transition Covid advisory board.
The world got lucky: The toll of Covid-19 on young people and children has been much lower than it has been for adults.
But in part because of that lower toll, some parents are on the fence about getting their school-age children and teens vaccinated. As reports of side effects from vaccination emerge, the risks from vaccines can seem greater than those posed by the coronavirus. However, it still makes sense — indeed, it is crucial — to vaccinate young people against Covid-19. This remains true even when we consider the worst possible outcomes from vaccination.
For example, an advisory committee for the Centers for Disease Control and Prevention met on June 23 to review data showing a likely association between a rare condition called myocarditis, or inflammation of the heart muscle, and Covid-19 vaccination with mRNA vaccines among teenagers and young adults in the United States. They found that more than 1,200 cases have been reported, and that they are mostly mild. The C.D.C. continues to recommend all people age 12 and older get vaccinated. (Children younger than 12 may be able to get vaccinated as early as this fall.)
That’s the right call. To understand why, it’s important to realize the choice is not “vaccinate or do nothing.” It’s “vaccinate or eventually contract the coronavirus,” and the risks that come with it. Most experts now believe that the virus is destined to be endemic, meaning it will circulate among humans indefinitely.
The best analysis comes by way of a simple thought experiment: What would happen if every child were eventually naturally infected with the coronavirus compared with what would happen if every child were to be vaccinated instead? By gaming out those two scenarios we can help parents and young people make the right choice. The correct lens to encapsulate these risks, we believe, is hospitalizations.
In the demographic with the highest rates of vaccine-associated myocarditis, boys ages 12 to 17, the rate of myocarditis in the week following vaccination appears to be 14 to 155 times the background rate of their unvaccinated peers. The obvious question might seem to be, what are the outcomes of that? But the better question is, what are the outcomes for all adverse reactions in young people from vaccines combined?
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