Washington received its first batch of coronavirus vaccines this week, but vaccine makers have only just started testing the group that will likely be the last inoculated: children.
As a result, it could be as late as mid-2021 before most children are vaccinated, several experts say, although older high schoolers may be inoculated sooner because the recently authorized Pfizer vaccine is approved for people 16 and older.
Teachers, however, could be near the front of the line, potentially becoming eligible shortly after first-priority groups such as health care workers and long-term care residents are immunized, a federal advisory group has suggested. The group is meeting Dec. 19-20 to vote on who should be prioritized next.
So what does this mean for reopening school buildings? It's not entirely clear.
Some school districts have already opened schools without an available vaccine. And many more may choose to do so following Gov. Jay Inslee's announcement Wednesday that loosens disease metric benchmarks guiding when schools reopen.
But districts have followed past state guidance to varying degrees. What might make the real difference, some physicians and disease researchers say, is when a majority of teachers are vaccinated.
"That conversation should be happening now ... not the way we've always done it [during the pandemic], which is this totally 'wait and see,'" said Dimitri Christakis, director of the Center for Child Health, Behavior & Development at Seattle Children's Research Institute.
States will be faced with decisions about whether to mandate vaccines for students, school staff or both. In many states, including Washington, government officials require that children receive a slew of vaccines before enrolling in public schools, although there are some exemptions for religious, philosophical, medical or personal reasons. Teachers aren't required to get any vaccines at all.
But in the case of coronavirus, teachers are the ones who should get vaccinated to protect their pupils and their fellow educators, Christakis said.
Then there's the issue of timing. More than 153,000 people work in Washington public schools, roughly 40% of whom are over age 50. School employees could be eligible for vaccines in the next few months, but children and many of their parents likely won't be.
"If you bring a bunch of children all back to school and none of them are vaccinated, there's going to be some high risk child who is going to end up in the hospital," said Helen Chu, an infectious disease expert and associate professor at the University of Washington School of Medicine.
"At an individual level, it's going to be very hard, especially for parents of children who have underlying conditions that would put them at higher risk," she said. "But for society as a whole, it's got to be a question of what is the lesser of the two evils" — or, the risk of children getting infected versus continued isolation and academic backsliding.
Other unpredictable factors could affect the school reopening timeline, such as what we learn about adverse side effects as more people get vaccinated, and how public perception of available vaccines evolves.
"It's a bit murky, isn't it?" said Peter Hotez, dean of the National School of Tropical Medicine at Baylor College of Medicine in Texas. "The sense I'm getting is that the public perception around the new vaccines is going to very much reflect the news cycle."
The availability of a vaccine may not be necessary to bring the youngest learners back to the classroom. Research has suggested that it's possible but rare for elementary-age children to have serious complications if they are infected with the virus. And emerging research hints it's uncommon for children to seed outbreaks in schools.
'A good immune approach'
Vaccines are first tested in adults before being evaluated and approved for children, to both ensure they are safe and to protect against disease.
In the case of coronavirus, researchers from two leading pharmaceutical companies are now expanding their adult studies into younger age groups. Scientists studying Pfizer's two-dose coronavirus vaccine in a Phase 3 clinical trial say they are beginning tests in children ages 12 to 17; the company has future studies planned in children younger than 12. Moderna is also testing its coronavirus vaccine in children ages 12 and up.
Like those in adults, vaccine trials in children will also probe safety and efficacy.
"It's going to be harder [to test] in kids," said Benard Dreyer, professor of pediatrics at New York University's Grossman School of Medicine.
Parents may be hesitant to enroll their children in a vaccine trial, since the risk of possible side effects will have to be weighed against the low risk of contracting a serious case of coronavirus, some say. And children are less likely than adults to experience symptoms, which could make it difficult to find enough sick children in the control group to distinguish responses from the vaccine group, and determine if it works.
Ongoing studies in adults may make this easier. If researchers identify a particular immune response in vaccinated adults associated with protection against coronavirus, they could look for what proportion of children have the same response to predict if they're protected, said Walter Orenstein, associate director of the Emory Vaccine Center and former director of the United States Immunization Program.
Although coronavirus symptoms often manifest differently in children than adults, Orenstein says vaccines are expected to be effective in all age groups.
Both the Pfizer and Moderna vaccines rely on a new technology: They deliver messenger RNA, or instructions, that cells use to build a protein or piece of a protein that triggers an immune response. That response helps protect a person infected with the coronavirus.
"It makes sense in both children and adults that this would be a good immune approach," Orenstein said, but he added that it's "critical" to test the vaccines in children to make sure.
Even still, experts predict it could take six months to a year before makers market a pediatric coronavirus vaccine.
Poking the bear
A lot will happen in the meantime.
A Centers for Disease Control and Prevention advisory committee is expected to soon decide where educators fall in the vaccine priority line; the group already voted to prioritize front-line health care workers and long-term care residents and has indicated that teachers may be among other essential workers ranked next.
Washington officials may follow this guidance or set their own priorities; state Department of Health (DOH) officials said Friday that they intend to release their priority guidelines soon.
Unlike national teachers unions, such as the National Education Association, Washington Education Association (WEA) officials say they aren't lobbying for teachers to be prioritized.
The state union also isn't taking a position on whether educators should be required to be vaccinated before returning to school buildings, said Julie Popper, spokesperson for WEA. An unknown number of Washington teachers are currently teaching students in person in districts that have reopened buildings.
School vaccination mandates are set by the State Board of Health. So far, there's no indication that state officials are considering a coronavirus vaccine mandate for teachers, though there is some precedence for requiring adults to receive vaccines. In 2019, state lawmakers approved legislation requiring child care workers to receive the measles, mumps and rubella vaccine.
"People are talking a lot about vaccine mandates or paying people to get vaccinated. My argument is: These are very inflammatory issues right now, and why raise them when we don't even have enough vaccines to go around," Hotez said. "Why poke the bear if you don't need to."
Instead, Orenstein said, states should provide accurate information about vaccine safety, and encourage teachers to voluntarily get vaccinated. "And then, potentially consider mandates to pick up, in a sense, the stragglers."
Seattle Times staff reporter Manuel Villa contributed to this story.
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