With coronavirus vaccines finally available to the youngest Americans, the United States has reached an important turning point. Finally, children between 6 months and 4 years of age and their families can join the rest of the country in the new normal. And this campaign marks the beginning of treating covid-19 as an endemic infection handled through the routine health-care system.
Amid the pandemic in 2021, adults and older children thronged mass vaccination sites and trawled the internet for pharmacy appointments. By contrast, the White House envisions that most young children will be vaccinated at their pediatrician’s office.
There are logistical reasons for that shift, as well as emotional ones. Many states don’t allow pharmacies to provide any vaccinations to children under age 3. And even where pharmacists are technically permitted to give shots to very young children, not all have smaller needles on hand or staff who feel comfortable vaccinating babies and toddlers.
Even more important, though, are questions of comfort and trust.
While there are parents eager to get their young children vaccinated immediately, they are very much a minority: They represent just 18 percent of parents of children under 5, according to polling the Kaiser Family Foundation conducted in April. That figure has actually fallen from 31 percent earlier in the year. The parents who consistently say they would not vaccinate their young children for the coronavirus under any circumstances — between a quarter and a third of such parents in Kaiser’s surveys — are also a minority, and might not be reachable.
The largest pool of parents of young children consists of those who want to wait and see how they feel about the vaccination. But health-care providers have one major advantage in the vaccination campaign for these children: They see the doctor much more frequently than older children and adults, so their growth and development can be assessed. The Biden administration hopes that even for parents who don’t want to vaccinate their small children right away, frequent well-child visits will allow parents plenty of opportunities to ask questions, get updates on new data about vaccine safety and efficacy, and to build trust with their providers.
If the vaccination campaign for the youngest kids goes as planned, the result would be a difference that, while quiet, is significant. Rather than treating coronavirus vaccination as a wartime effort, administering the vaccines would become part of the primary-care regimen. The number of shots delivered to young children might start slowly at first but rise over time as babies advance through their six-, nine- and 12-month visits, and as slightly older kids go in for annual appointments to get their health certifications for school.
“This is going to be the group that leads that transition” toward treating covid as a more normal health risk, the physician and White House coronavirus response coordinator Ashish Jha told me on Friday. “There are still some real barriers to doing that. We’re not quite there yet. But that is certainly the aspiration, to get to a place where vaccinations, treatments, staying up to date with your immunity, are all part of how you take care of yourself with your physician, with your health-care provider.”
After more than two years of extreme precaution, treating covid the same way we assess other risks will inevitably be a major shift for a lot of Americans.
It’s true there’s a great deal we still don’t know about the prevalence, persistence and impact of long covid — or even about the numerous ways covid itself affects the body in people who don’t stay sick for months after their initial infection. The virus is still mutating. And certainly for people who are uniquely vulnerable to covid, prevention measures will stick around.
The opportunity to eliminate covid was probably lost long before many people even knew the disease existed. Given inadequate control measures and an uneven global vaccination campaign, the chance to stop its mutation is gone, too. Absent a master vaccine for all coronaviruses, moving toward primary-care treatment is the only sensible way to respond to a disease that is now a permanent part of the health landscape.
The lack of vaccines for young children meant they and their families lived with uncertainty and burdensome bureaucracy for longer than any other group of Americans. The youngest only know a world with masks and quarantines; for many, their first years have lacked the carefree attitudes and commonplace experiences that once helped define childhood. Given the relatively low risk covid poses to most children, kids were burdened for the good of their communities as much as for their own protection.
The vaccination campaign for young children should show us not just how to treat covid as part of routine health care but why to accept that it will be with us and to plan accordingly. It’s a big world out there. The time is long past for the youngest kids, and the rest of us, to get out there and explore it.