President Joe Biden has recovered from COVID-19, using his mild symptoms as an opportunity to reinforce the importance of immunization. Fully vaccinated and “double boosted,” the president ended isolation last week. I cautiously hoped the president’s short illness would spur COVID immunization rates, providing a high-profile case study of the mild disease experienced by those vaccinated to an under-immunized U.S. population.
Pediatricians provide the majority of vaccines nationwide, and low immunization rates can be devastating. Look no further than the return of polio, contracted by an unvaccinated adult in New York, or the rapid spread of monkeypox — there are now more than 3,500 U.S. cases, the highest level in the world.
To increase COVID immunization rates, reduce vaccine hesitancy and promote the importance of childhood COVID vaccination, pediatricians nationwide have led local efforts to address concerns about immunization. This is doubly important as the school year is about to begin across Tampa Bay.
After two years of surveys, public service videos, parent conversations, local information sessions, and clinics, here’s what we’ve learned about attitudes toward COVID vaccines, and what needs to change.
COVID Positivity Rates No Longer Influence Public Opinion
As the pandemic’s onset, the percentage of positive cases led the news. Hospitalizations soared, elective surgical cases were cancelled and hospital leaders openly speculated facilities wouldn’t have sufficient space for heart attack and stroke patients. Two years later, better COVID treatments and modest immunization rates have lowered adult hospitalizations, and the public has ceased to care about rates of circulating disease. Consequently, vaccination rates are stagnant.
According to the Centers for Disease Control and Prevention, the number of children 5-11 and 12-17 years old receiving their first COVID shot has been low and flat since March, meaning only 30% and 59% of kids in these age groups are fully vaccinated, a concerning level considering unmasked kids will resume normal school schedules this month. Only 4% of younger children, 6 months to 4 years, have received even one dose since the COVID vaccine was authorized for their age group last month. Yet, positivity rates, the former headline grabbers, have reached Mount Everest levels, led by the BA.5 variant, which infected the president. Nationally, 7-day positivity rates are about 17.8%, with 11 states higher than 25%. Contrast that with January 2021, when rates of 14% drove millions to mass vaccination clinics, clamoring for the newly available vaccine. Simply put, the public’s attention has turned elsewhere, and we are all at risk because of it. Remember, that more than 77,000 Floridians have died of COVID — and more than 1 million across the United States. Even now, more than 400 Americans are still dying each day from COVID. Imagine how we would react if a full jetliner crashed every day and killed all of its passengers. That’s what COVID is still doing.
Ignoring Long COVID
The BA.5 strain is less deadly than the original, omicron and delta variants, leading parents and families to perceive vaccination as less critical. This perception ignores the risks of long-COVID, which impacts about 1 in 4 adults up to a year after infection. Unimmunized patients are more vulnerable to disease and this complication, which can include difficulty breathing, problems with joints and muscles, heart conditions and “brain fog” up to a year after COVID. Sadly, and despite the efforts of thousands of my colleagues, the unvaccinated do not see this as cause for concern.
Underestimating the Impact of COVID on Children
COVID in children is underappreciated. 14 million children have been infected, representing almost one-fifth of all COVID cases, with hospitalization rates steadily increasing since April. Over 1300 children have now died, roughly one-third of them under 4 years old. Immunizing younger children is an uphill battle. Parents do not identify COVID as a serious health threat to their children. Parents are more likely to permit flu shots, though flu last year killed 24 children and, in an average, non-pandemic year, claims 600 children. Moreover, a recent study showed almost 6% of kids develop long-haul symptoms and a smaller percentage will develop the potentially fatal multisystem inflammatory syndrome in children.
Politicians Hijacked Medicine
The opportunism of politicians to use common-sense, well-researched and time-tested preventive health measures like vaccination as tools for demonizing public health officials will now be a long-standing impediment to protecting adults and children from vaccine-preventable diseases. Instead of reinforcing efforts to mitigate the spread of disease, leaders attacked science, immunization experts, the CDC and by extension, the pediatricians and other physicians who carry out their recommendations. Elected officials wore their refusal to be “jabbed,” as a merit badge — tying vaccination decisions to political party affiliation.
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In a bitterly partisan country, this made convincing parents to get vaccinated like encouraging them to root for a different sports team. Immunizing your child became an emotional decision, reinforced by widespread social media misinformation about magnetic arms and infertility — not a medical one. The conscious decision to manipulate vaccination into a political issue will hinder not only our ongoing fight against COVID but attempts at combatting future infections.
Monkey pox cases will increase. New COVID variants will emerge. Vaccine-preventable diseases like polio may return and we will face the first traditional flu season in 3 years this October. How we deal with these emerging threats will largely be determined by how quickly we unlearn these biases.
Shetal Shah is a pediatrician and chairperson of the national Pediatric Policy Council.