As of Wednesday, the Moderna and Johnson & Johnson vaccines have a minimum age of 18 years. The Pfizer vaccine is available only for those 12 and older, under an Emergency Use Authorization, and fully approved for those 16 and over. That means that 48 million American children currently have no protection when it comes to fighting COVID-19—including in states like Florida and Texas where Republican governors have done everything possible to prevent school districts from requiring masks or social distancing.

But that could change in the next few days. After turning over data from its Phase 2/3 trials on younger patients last month, Pfizer officially asked the FDA last week to issue an Emergency Use Authorization (EUA) for use in children ages 5 through 11. 

That request is likely to be considered at an FDA meeting currently scheduled for October 26. On that date, the FDA is likely to consider both whether it should extend the use of Pfizer’s vaccine to those under 12, as well as expanding approval of more boosters—including approving the use of “mix and match” boosters. Decisions on those issues could help the nation tamp down the wave that began when the delta variant became dominant, and help schools stay open without placing kids at unnecessary risk. Should the FDA approve the EUA for Pfizer’s vaccine on that date, it’s likely the CDC will follow up with guidelines at a meeting scheduled for November 2.

On Wednesday, in anticipation of FDA and CDC rulings, the White House announced its plans for distributing vaccines to kids under 12. That includes enough doses to cover every child in the age group. “Should the FDA and CDC authorize the vaccine, we will be ready to get shots in arms,” said White House COVID-19 response director Jeff Zients.

Those plans include providing children with vaccination at schools and other public sites that may not have previously hosted vaccination events. “Kids have different needs than adults.” said  Zients. “Our operational planning is geared to meet those specific needs, including by offering vaccinations in settings that parents and kids are familiar with and trust.” Those sites include over 100 hospitals associated with the Children’s Hospital Association, which will act as vaccination sites starting as soon as the vaccines are authorized.

In addition to rolling out the vaccine, the government will also roll out a new effort at outreach and education, with the Department of Health and Human Services heading up a program to provide parents and guardians with the information needed to get children vaccinated, as well as the facts to push back against anti-vaccine propaganda.

At the beginning of the month, California became the first state to require vaccination for educational staff and students over 12. In that announcement, Governor Gavin Newsom made it clear this requirement would be extended to students as young as five when the FDA made the vaccine available to younger students.

Should the FDA and CDC approve the vaccine as expected, other states are anticipated to add COVID-19 to the list of required vaccinations that all primary and secondary education students much have before attending school. Students in most states are required to be vaccinated against seven or more diseases—including mumps, whooping cough, measles, and chickenpox—before beginning classes, with many states requiring additional vaccinations for older students. Moving the age limit down to five would avoid the confusion of having some students in middle schools vaccinated and some not vaccinated by making vaccines available to every student from kindergarten through high school.

In New York, Governor Kathy Hochul has announced 25 new “Vax to School” pop-up vaccination sites. Hochul is recommending that parents of students under 12 plan now for vaccination as soon as they become available.

Also on Wednesday, New York City Mayor Bill de Blasio announced that he was mandating vaccination for all municipal employees, and providing a reward for those who act quickly. “Starting today, City employees will receive an extra $500 in their paycheck for receiving their first shot at a City-run vaccination site,” said de Blasio. “This benefit will end at 5 p.m. on Friday, October 29th, by which point City employees are required to have proof of at least one dose. Unvaccinated employees will be placed on unpaid leave until they show proof of vaccination to their supervisor.”

The CDC currently reports that 77.2% of Americans 12 or older have received at least one dose of vaccine. When younger children are added to that number, the current totals drop to 66%, but that number could rise rapidly if there is broad adoption of vaccination by schools. Both mumps and measles have a transmission rate significantly higher than COVID-19—even the delta variant—but are kept in check by roughly 91% vaccination rates due to mandated vaccinations at schools.

As NPR reports, the unreasoning hostility to COVID-19 vaccines has led Republicans to increasingly fight against not just vaccines for COVID-19, but all vaccine mandates—leading the U.S. back to the days when over one in five children died from diseases we now control with vaccines. 

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