Do kids need COVID vaccines?

Let's talk about it.

It’s been daunting to think about writing about COVID-19 vaccines amidst the current upheaval in vaccine recommendations in the US. But that confusion means it’s all the more important for us to discuss openly and get the facts out there.

While the current debates about official recommendations are important for many reasons (including implications for insurance coverage), take-up of COVID-19 vaccines among US children is already low.

In 2024-25, only 13% of children aged 6 months to 17 years were estimated to be up-to-date on their COVID vaccination, similar to 2023-2024 rates. In comparison, 49.2% of this age group got the flu vaccine in 2024-2025 (although this has sadly fallen from 62.4% in 2019-2020 so we need to do better there too).

Some argue that this low uptake shows that Americans aren’t interested in COVID vaccines or convinced they work. Perhaps. Call me crazy, but it also seems possible that deliberate efforts to undermine vaccine confidence over the past few years are working. Regardless…

We need to better communicate the benefits and importance of COVID-19 vaccination in kids.

My three kids were teens at the start of the pandemic. Getting them the protection of that first shot in the summer of 2021 felt like such a relief. As they’ve left the house for college, I’ve encouraged them all to continue to get annual COVID (and flu) shots, which they often (but not always) do.

You never forget your first COVID shot

Here are my top reasons, as a scientist and a parent, why I believe regular COVID vaccines are important for kids:

Kids *will* be exposed to lots of COVID

COVID remains a highly transmissible virus, circulating year round. While it may settle down to lower levels eventually (here’s hoping), an estimated 30-60% of Americans were infected with COVID each of the last couple of years. In contrast, an estimated 8% of the population is infected during a typical flu season. This means it’s almost a sure bet that your child will be exposed to COVID regularly. So the choice is not vaccine vs no vaccine for your child; it’s facing COVID protected vs facing COVID not protected.

Kids can get very sick from COVID, and even die

Over 2100 children have died from COVID in the US since January 2020, including 184 in 2024. Please think about that number if someone says that COVID in kids is “no big deal.”

Data from CDC Wonder

But deaths are just the tip of the iceberg for disease burden. In addition to these tragic deaths, over 234,000 children in the US were hospitalized due to COVID between September 2020 and April 2024, rising to more than 734,000 considering both suspected and confirmed COVID admissions. Children aged 0-4 accounted the highest proportion of pediatric COVID-19 hospital admissions, with youngest babies at highest risk. From October 2022 to April 2024, young infants had the highest hospitalization rate of any age group, except for adults 75 and older. And lest you think these hundreds of thousands of hospitalizations were not serious, 1 in 5 children hospitalized with COVID are admitted to the Intensive Care Unit (ICU).

Besides hospitalization and death from acute COVID, kids are at risk of another rare but serious condition that can happen 2-6 weeks after a COVID infection, multisystem inflammatory syndrome in children (MIS-C), characterized by fever and dangerous inflammation of multiple organs. Fortunately rates of MISC-C have declined significantly with fewer immune naive children, but they still happen and are quite serious. Among the 117 MIS-C cases reported in 2023, 58% had no underlying medical conditions and 50% required intensive care. In the intensive care unit (ICU), 34% experienced shock, 27% experienced cardiac dysfunction. Most cases were unvaccinated, and cases with prior vaccination were all more than one year out from their last vaccine.

And of course below the hospitalization layer of the iceberg are many millions of outpatient visits and nasty illnesses that make kids miserable. So besides protection from severe disease-which is a real concern-reducing acute illness in kids means less suffering and fewer days of missed school for kids and work for parents.

While Long COVID and other post-acute sequeale of COVID deserves a longer treatment (please see this post by

From the Science Classroom by Science Whiz Liz

), there is growing evidence that children can face longer term health consequences of SARS-CoV-2 infections and vaccines likely reduce this risk.

It’s not obvious who is high risk.

Despite what a certain HHS secretary might tell you, these sick kids were not already on the brink of death waiting to be pushed over the cliff (frankly the cruelty of even thinking this is chilling). While no child deserves to be written off, no matter how medically complex, nearly 50% of children hospitalized with COVID were otherwise healthy, and “pre-existing conditions” in others included common illnesses like asthma.

So both things can be true 1) kids with health conditions like diabetes are at higher risk for severe COVID (and so vaccines are even more important for them) AND 2) plenty of “otherwise healthy” kids still get severe COVID.

Going unprotected from COVID because you assume you are not high risk is like not wearing your seatbelt because you think you are a safe driver.

Fewer infections mean less transmission.

Less transmission means fewer cases.

Fewer cases means fewer serious cases and deaths.

While COVID vaccines don’t “block” transmission completely as we once hoped, they do reduce the likelihood of transmission. The voices downplaying the benefits of COVID vaccines are missing the spillover benefits for population health. If a vaccine protects your child from an infection, even in the short term, they can’t pass the virus to others. This means that their vaccine also protects other people, particularly those whose immune systems don’t respond as well to vaccines, like older people or young babies. No parent will be surprised to learn that the majority of the time, children are the source of household COVID transmission. Babies under 6 months old are not eligible for the vaccine but have the highest pediatric rates of Covid hospitalization and death, so reducing infections in older siblings protects them, too. I’m not sure how we got to the place where the answer to whether vaccines reduce transmission had to be “yes” or “no.” Clearly it is a continuum, and any reductions in transmission can have big population-level effects.

What are the downsides of COVID vaccination for kids?

The vaccines are extremely safe.

The main downside for kids is “reactogenicity,” or side effects like fever and fatigue after a vaccine. In the Moderna pediatric trial, 15-17% of kids had a mild fever after the vaccine, which was similar to other commonly used pediatric vaccines. Side effects are no fun, and you probably have a good sense of whether your kids are prone to reactions and can best weigh that trade-off. But it’s important to remember that the counterfactual is not comparing vaccine side effects to no vaccine side effects, but rather comparing vaccine side effects to an unprotected COVID infection. It’s also a shame that the COVID vaccine with milder side effects, Novavax (which was only approved down to 12 years of age), is now facing additional hurdles rather than wider dissemination.

What about myocarditis?

Myocarditis is inflammation of the cardiac muscle (myocardium). It’s not something to downplay, but it’s important to put into perspective given some dramatic rhetoric on this topic. An increased incidence of myocarditis in young males (ages 12-30) was observed after the primary series of mRNA COVID vaccines, raising investigation of this safety signal (vaccine safety surveillence working as it should). The myocarditis in this group was rare (<1 in 10000), and most of these cases were mild and self-limiting. In contrast, myocarditis caused by COVID infection is more common and severe. The risk of myocarditis for young adult males has been lower for subsequent vaccine doses, suggesting the risk may have been related to the short interval between the first two doses. No increased risk of myocarditis after vaccination was seen in kids aged 5 and under, and was very rare for kids ages 6-11. A recent study of kids looked at the impact of re-infections with COVID and found a big (4-fold) increase in the relative risk of myocarditis (as well as other post-acute conditions). For great in-depth coverage of the myocarditis data, see this post from

Unbiased Science

.

As a mom of two boys in the higher risk age range for vaccine-related myocarditis, to me the data clearly show that leaving kids unprotected from COVID is the much riskier choice than vaccinating.

But what about other countries that don’t vaccinate kids?

This also merits a deeper dive. But for now let me say that the vaccine policies of other countries (such as the UK where I live), are based on very different cost-benefit calculations within nationalized health systems and not necessarily the benefits to individuals and their families. In these systems there are lots of medical treatments rationed that might prompt outrage in America. These cost-benefit calculations are typically quite narrow (for example looking at the cost of hospitalizations prevented), and underestimate broader societal benefits of fewer missed school and work days, or longer term health effects of infection. For these reasons the policies are not universally popular, as described by

Christina Pagel

.

So while good faith discussions of the financial costs and benefits of COVID vaccines at the individual and population level are appropriate and welcomed, pointing to the policies of other countries as evidence that they don’t think the vaccines have sufficient health benefits is off the mark.

Let me sum up

Rates of COVID hospitalization and death for all ages have declined significantly over the last two years as our collective immune systems gained experience through infection and vaccination. This is great news, and we should continue to assess risks in their proper context.

What remains true is that the average child who gets infected with COVID has a low risk of severe disease or death. Kids also have a low chance of dying in a car crash any single time they get in a car. Still, the reason we wear seatbelts is because taking that risk is unnecessary and the stakes are so high. We know that the COVID vaccines are extremely safe. COVID-19 infection, on the other hand, is much risker.

To put it as clearly as I can, a decision to *not* vaccinate your child is still an active decision. It may feel like a more “natural” choice, but it’s a choice to leave your child in the path of a serious infection unprotected. Despite the current turmoil in US vaccine policy, as parents we should speak up for the value of these vaccines for our children now and in the future. Besides the kids we already have, around 3.6 million babies are born each year in the US each year who are immunologically “naïve” to COVID and will be most vulnerable to bad outcomes without vaccine protection (which miraculously they can get from their mothers for the first 6 months, as recently summarized by

Your Local Epidemiologist

).

This went WAY too long, so I am saving a deeper dive into how we know additional COVID shots are beneficial for a Part II. Stay tuned!

Stay well,

Jenn