Hanna Riva Goldberg, 16, of Great Neck, receives her COVID-19...

Hanna Riva Goldberg, 16, of Great Neck, receives her COVID-19 vaccination at Cohen Children's Medical Center in New Hyde Park on April 6, while her mother Allegra Goldberg looks on. Credit: Debbie Egan-Chin

As rituals of summer return to America, the national goal of herd immunity against the coronavirus has been largely abandoned. States are instead focusing on at least partially immunizing at least 70% of adults. There's a problem with this strategy, though: It leaves out children. In fact, some parents and doctors have recently suggested there should be no urgency to vaccinate U.S. children at all, given the risk of rare heart complications, the fact that COVID-19 is typically mild in young people and the concern that vulnerable people still lack the vaccine worldwide.

But teens and even young children, if the vaccine is approved for them, must remain part of our approach if we are to end this pandemic, for many reasons — not just because all individuals irrespective of age can be infected with and can transmit the SARS-CoV-2 virus. Sustainable control of COVID-19 will certainly require vaccinating children. And kids have the right to live free of the threat of the virus, too.

The Food and Drug Administration has approved the vaccine for adolescents 12 and older, and manufacturers are testing lower doses of the vaccine to use on even younger kids, possibly as early as this fall. Although COVID-19 tends to be milder or asymptomatic in children, new variants of concern continue to emerge, including the delta variant, which is substantially more infectious than the original virus and many other variants.

So far, vaccines used in the United States seem to be holding up against these variants, but the risk of the virus to unvaccinated individuals remains significant. At this point, most COVID-19 deaths and hospitalizations are among the unvaccinated.

Barely 47% of the U.S. population has been fully vaccinated. While many states have reached the goal of 70% of adults receiving at least one dose of a coronavirus vaccine, more states (particularly in the South) are well below this target. County-level variability in immunization rates is even starker. It is hard to imagine gaining sufficient ground against the virus without vaccinating a large swath of teens and children.

Vaccinating children would eliminate the need to choose between keeping them safe and restoring a sense of normalcy for them. After all, it's children who will be going back to indoor classrooms this fall; children who are subject to testing every time they get the sniffles; children who have to wear masks, even in hot weather; and children who are missing out on the swim lessons and birthday parties that still haven't resumed in parts of the United States. Even when children engage in these activities, parents continue to worry about the looming risk of the variant du jour.

The Centers for Disease Control and Prevention issued guidance Friday that vaccinated children and teachers can have the option of going maskless in school buildings this fall — recommendations that could open new risks to young children if there is no mechanism to ensure that those shedding their masks have truly had their shots.

Given the substantially higher risk of COVID deaths and hospitalizations in older people, it was appropriate to prioritize adults — particularly older adults — in the early part of the outbreak. The World Health Organization continues to appropriately recommend prioritizing various adult groups for the first 50% of the vaccine supply. However, for the past several months, the United States has had sufficient supply on hand for vaccinating its population.

What about global vaccine equity? Should young people in the United States be considered for vaccination when many older individuals in low- and middle income countries remain unvaccinated? This view treats vaccine equity as a zero-sum game — which it is not.

Increasing global vaccine access will require ramping up production and distribution manyfold both in the United States and through global technology transfer, with the donation of doses from high-income countries as a short-term strategy. The United States must redouble the efforts to increase global access to vaccines and do so with fierce urgency.

But taking away vaccines from young people in America would yield only a small fraction of the additional doses the rest of the world needs. And if there is a substantial increase in cases and hospitalizations in the United States — already a country with one of the highest death tolls of this pandemic — domestic pressure on the government is likely to decrease willingness to prioritize global vaccine access.

Like many policy choices in this pandemic, vaccinating young people is a challenging one. Even though young people have a lower risk of severe COVID-19 outcomes, vaccination is the rational choice for their own individual and societal benefit. A return to greater normalcy and the resumption of schools, sports and social interaction without fear of the virus are the least we can do for those responsible for our future.

Saad B. Omer is director of the Yale Institute for Global Health and a professor at the Yale University schools of medicine and public health.

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