If You're Confused by the New COVID Vaccine Guidelines for Kids & Pregnant People, Read This
Confused about the new COVID-19 vaccine guidelines for children and pregnant people? Trust us, you're not alone. It all started on May 27, when Health Secretary Robert F. Kennedy Jr. announced that the U.S. would no longer recommend COVID-19 shots for healthy children over 6 months or healthy pregnant people — a move that shocked most healthcare providers. Not only did the announcement upend the typical vaccine recommendation process, it also targeted a vaccine with good safety and efficacy data.
Then, just a few days later, the CDC walked back part of RFK's statement regarding children's vaccines. The agency announced COVID shots would stay on the schedule for healthy children 6 months to 17 years old, as long as the children and their caregivers consulted with a doctor or provider — a caveat even doctors found confusing. 'My neck still hurts from the whiplash,' Dr. Molly O'Shea, MD, FAAP, an official spokesperson for the American Academy of Pediatrics (AAP) and a faculty at the Children's Hospital of Michigan General Pediatrics Continuity Clinic, said on a briefing hosted by the non-profit HealthyWomen this week.
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RFK is a known vaccine skeptic, but it's highly unusual for the Health Secretary to make such decisions unilaterally, as multiple experts pointed out during the briefing. So ultimately, what does this mean for children and pregnant people when it comes to getting vaccinated for COVID? Are these shots still necessary, and will insurance still foot the bill for them if without this government backing? Here's what we know so far, according to experts in the briefing.
The COVID vaccine is still considered very effective for children and pregnant people, with lower risks than the infection itself. Early in the pandemic, pregnant people and children often suffered significant outcomes from COVID, explained Dr. Margot Savoy, MD, MPH, FAAFP, senior vice president of education, inclusiveness and physician well-being at the American Academy of Family Physicians (AAFP). 'For pregnant people, in particular, the risk of ending up in the ICU, the risk of ending up on a ventilator, and the risk of death were just remarkably high, much more than you would expect,' she explained during the briefing. Once the vaccine became available, 'those rates declined,' Dr. Savoy said. In fact, the serious outcomes that many worried would be side effects from the vaccine — things like miscarriage, preeclampsia, blood clots, or premature delivery — were actually more likely to happen as side effects from COVID itself, not the vaccine. 'If you find yourself vaccinated, the rates of all of those things actually go down to almost none,' Dr. Savoy explained.
Plus, there's the fact that vaccinated pregnant people pass their immunity to their fetus. That means that the vaccine protects the pregnant person themselves; their fetus, against stillbirth and premature delivery; and the baby, once they're born, by conferring protection in their first six months, Dr. Savoy explained.
That's a good thing, because 'babies are very high risk' when it comes to respiratory infections like COVID, added Dr. Alice Sato, MD, PhD, an assistant professor at the University of Nebraska Medical Center and a member of the Infectious Diseases Society of America (IDSA) and the Advocacy Task Force at the Pediatric Infectious Diseases Society. 'Because they have such small airways… just a little bit of inflammation can make a baby get into trouble with their breathing a lot faster,' Dr. Sato explained. '[Babies] had very high hospitalizations, even with the last wave [of COVID-19.]'
Children of any age can also experience long COVID — Dr. Sato said the most recent estimate was that 6 million children in the US were suffering from it — leading to symptoms like fatigue and fussiness. COVID can also lead to missing crucial periods of time from school or preschool. Getting vaccinated can help shorten those periods and protect them from those kinds of complications. 'In my vaccinated patients who get COVID, they get mild COVID, if they get it at all — and they aren't as apt to get long COVID,' Dr. O'Shea said.
The vaccines are also still considered safe, the doctors agreed. In short, 'the recommendations have changed, but the science hasn't changed,' said Kate Connors, senior director of public affairs at the American College of Obstetricians and Gynecologists.
So what are those new recommendations? The CDC no longer recommends COVID vaccination during pregnancy, which 'seems to be following a unilateral decision from the HHS Secretary,' Connors noted, referencing RFK Jr. 'It was made without any of the input of the experts at the CDC, the members of ACIP [the Advisory Committee on Immunization Practices], certainly without feedback from organizations like ACOG, and so we're very concerned about this.' She noted that ACOG continues to recommend COVID vaccination for pregnant people.
For children, the new recommendations are less cut-and-dry. After initially saying the US no longer recommends COVID-19 vaccines for healthy children over 6 months (with exceptions for children with certain medical conditions), the CDC now says it recommends a 'collaborative decision-making [approach] with your pediatrician,' explained Dr. O'Shea. 'Healthy children with no underlying health conditions can, in collaboration with their pediatrician, make a decision about whether or not they want to have their child vaccinated this coming fall against COVID-19.' However, this unusual caveat leaves the door open for insurance companies to rescind coverage of the vaccine, possibly forcing parents to pay out of pocket to vaccinate their children (more on that below).
For Dr. Savoy, the 'really deeply troubling' part of these decisions is the lack of evidence to support them. 'I actually don't know what data was used to make the decisions that we're talking about today,' she said. 'The data that I have been able to see most recently continues to mark pregnant people as being incredibly high risk. There would be no situation in the data that I saw that would make me think that it makes sense to remove that recommendation.' The same goes for children, she added.
COVID-19 remains a threat, Dr. Savoy emphasized. 'We keep having new variants show up. We keep having people end up in the hospital. We keep running out of beds in the ER. There's things that are still happening, even though they don't show up on the news.'
This is one thorny question to come out of the changing guidelines. 'We don't know what's going to happen with insurance coverage, and we're very, very worried about it,' Connors said. That's because there's a direct connection between government vaccine recommendations and insurance coverage of those vaccines, Dr. Savoy explained. Insurance companies typically use government recommendations as a sign that a vaccine is safe and essential; when those recommendations are removed or weakened, the companies may see it as a sign (or an opportunity) to stop covering that vaccine.
Connors also pointed out that we're only a few months from flu and RSV season, when vaccines become all the more essential for public health. 'This is a really tough time for these conversations, for these unanswered questions,' she said.
All four experts continue to recommend COVID-19 vaccines for everyone, including pregnant people and children. Dr. Sato cited the 'incredible, robust' data that shows that the COVID-19 is safe, effective, and presents fewer risks of complications than an infection itself. 'The science has not changed,' added Connors. 'The COVID vaccine is safe and it is effective… [It's] the best tool that we have to prevent severe outcomes associated with COVID infection.'
Dr. Savoy agreed. 'I would still strongly recommend that if you're a pregnant person, that you get vaccinated, not just to protect yourself, but… to protect the fetus and to protect your newborn infant on the other side of that delivery,' she stressed. 'I'm still willing to stand on that hill… And if you were bringing your child in for their visit, I would still say that your child needs to have at least that primary series as a routine recommendation.'
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