White House's Jha Spreads Misinformation about COVID & Kids
The real question is FUTURE RISK and do vaccines lower it
Recently someone wrote a bad blog post arguing that COVID was worse than flu for kids. The post contained elementary errors, which are detailed here. It would not have made the news had it not been for the fact that Ashish Jha, the White House COVID czar, and somebody who should know better, retweeted it. This lead outlets like Bloomberg to uncritically cover it.
But talking about a bad blog has moved us away from the real truth about kids, covid, vaccination, etc. Here are the facts, as far as I can tell
Most healthy kids already have had covid19. The CDC's estimate prior to recent infections was that over 75% had antibodies to COVID-19 from infection. These antibodies are not present in everyone who recovered from COVID-19, as demonstrated by a recent NIH paper, so 75% is the floor. Top this off with more infections. We are likely nearing 90% plus who have been exposed to COVID-19.
It should be obvious: Once you have had COVID-19, the likelihood you will get it again and suffer a severe outcome is super low.
The key question going forward is what is the risk to kids from COVID19 in the future? To some degree, it depends on variants, but all available evidence would suggest the risk to healthy children was already very low, and it is only lower with widespread natural immunity.
Now, let's consider vaccination. In a properly functioning society, you would run a randomized control trial of vaccines and kids powered for severe diseases as the endpoint. This is not unreasonable, as the polio vaccine was studied in randomized trials that included over 400,000. That was also a long time ago. As time goes on, evidence gets better, typically. It's not impossible to run a randomized control trial of a quarter million children powered for severe disease. But the FDA didn't demand that. They failed. Two people who work there resigned. The primary endpoint of the study we got is non-inferior antibodies. That's pretty worthless. So no one can say we have randomized control trial data showing a reduction in severe disease. That is sad.
Observational studies are often used to justify vaccinating kids. But these are hopelessly flawed. The parents who rushed out to vaccinate their five to 11-year-olds are fundamentally different than those who did not. Their kids are very different. You can't trust any of these studies. But that said, does anyone have a study that actually shows even in observational cohorts that there's a reduction in severe disease or hospitalization in healthy five to 11-year-olds? I haven't seen it.
The vaccine targets the old Wuhan strain. It's not targeting the actual circulating strain. Which by the way most kids have already had. So what evidence do we have that the vaccine will further lower the risk of severe disease or death in these kids? The answer is we have no such evidence.
Vaccine effectiveness against symptomatic disease fades fast with time. This has been shown in many observational cohorts, and particularly for Omicron.
Putting these together. The conclusion is inescapable. It is entirely reasonable to wait for more data before vaccinating children. It is super reasonable for a healthy child who already had COVID-19 to wait. Mandates would be mistaken, and an abuse of power. And people who promote fear-mongering statistics to try to scare people into vaccinating are doing a grave disservice. Their irresponsible actions will harm faith in public health and science going forward. I truly doubt their ability to think about data.
Going forward everyone should remember that the people who failed are the employees of the US food and drug administration because they did not compel the manufacturer of multi-billion dollar products to run clinical trials capable of adjudicating the efficacy of those products in low-risk populations. Running large randomized control trials is actually more necessary in the population at lowest risk than the population at highest risk.
These are just the facts about where we are. It's actually pretty sad from an evidence-based medicine point of view.