Florida’s decision on Covid vaccines for healthy kids adds to confusion and distrust

Florida Surgeon General Joseph Ladapo announced Monday that the state will recommend that healthy children not be vaccinated against Covid-19, further muddying already roiling waters over Covid-19 vaccination for kids.

Ladapo’s decision is unlikely to interfere with the efforts of parents who want to have their children vaccinated, experts told STAT. But they added it will likely dissuade some parents who have been on the fence.

“There are obviously a lot of pediatricians and pediatric care providers in Florida who are very eager to vaccinate kids over 5. And hopefully that signal is loud — louder than this,” said Alison Buttenheim, an associate professor of nursing and health policy at the University of Pennsylvania who works on vaccine acceptance. “But if you’re looking for a reason to pass on this vaccine, this is a really good one to latch onto.”

Ladapo announced Florida’s recommendation against vaccination for healthy children after a roundtable discussion attended by Gov. Ron DeSantis, as well as by a number of people who have been vocal opponents of Covid containment efforts, including Stanford University health economist Jay Bhattacharya, sports medicine physician Tracy Høeg, and Robert Malone, a former researcher who was involved in the early development of mRNA technology but who has actively campaigned against use of the mRNA Covid vaccines.

“The Florida Department of Health is going to be the first state to officially recommend against the Covid-19 vaccines for healthy children,” Ladapo said.

The Centers for Disease Control and Prevention recommend Covid-19 vaccination for all children over the age of 5. (Covid vaccines have not yet been authorized for children under the age of 5 but studies are underway to determine the safety and efficacy of the vaccines in the younger children.) Uptake, however, has been modest; as of March 2, only 26% of kids aged 5 to 11 have had two doses of vaccine.

Andrew Pavia, chief of pediatric infectious diseases at the University of Utah, said Ladapo’s announcement made his “blood boil.” While it’s true that children are less likely to suffer from severe disease if they contract Covid, they can still get very sick, he said, noting that at the peak of the Omicron wave, about 40,000 children a week across the country were hospitalized with Covid infections.

Pavia dismissed Ladapo’s move as “political theater.”

“Anybody who takes care of children in a children’s hospital has seen very, very sick kids and tragic outcomes,” Pavia said. “It’s kind of unbelievable that this politically motivated surgeon general who’s taken every contrarian view on Covid from pushing ivermectin to using monoclonals for variants that are fully resistant to them is overriding the careful, transparent deliberations of dozens of real vaccine experts, public health experts, and pediatricians who have been caring for and caring about sick kids throughout this pandemic.”

According to CDC data, 1,567 children under the age of 18 have died from Covid. And children who contract Covid — even those who have mild symptoms — can also go on to suffer from a condition called multi-inflammatory syndrome in children, or MIS-C. Several weeks after their infection, some children develop an acute inflammation of various organs or body parts — the heart, lungs, kidneys, skin, the gastrointestinal system — that typically requires hospitalization for several days or longer. The CDC says to date there have been 7,459 cases of MIS-C triggered by Covid; 63 of those children have died.

Dorit Reiss, a law professor at UC Hastings who specializes in vaccine law and policy, agreed with Pavia about the motivation behind and the legal impact of Florida’s move.

“I would say this is performative and not legal in any way, shape, or form,” Reiss said, though she added that it might make it more difficult for the state college of medicine to discipline any doctors for spreading vaccine misinformation or for refusing to vaccinate children.

Health care providers and clinics that administer Covid vaccines get their supplies from the federal government, placing orders through the CDC. So Ladapo’s declaration should not impinge on the ability of doctors to vaccinate children. But Buttenheim noted the state could restrict funding available for vaccination clinics.

Wendy Parmet, director of the Center for Health Policy and Law at Northeastern University School of Law, said she couldn’t rule out the possibility that the state would try to tie the recommendation to some sort of legal enforcement measure. But she too felt the impact would mostly be to further undermine confidence among parents.

“It adds to the confusion and the distrust. And parents will understandably wonder what to do,” she said.

While Ladapo’s decision seems to suggest that children who don’t have underlying health conditions aren’t at risk from Covid, pediatricians do not agree.

“Healthy children are not immune to the consequences of Covid,” said Buddy Creech, director of the Vanderbilt Vaccine Research Program and a pediatric infectious diseases doctor at Vanderbilt Medical Center. (Creech is a principal investigator on a National Institute of Health-funded study of Moderna’s Covid vaccine for kids.)

“When I am taking care of kids in the hospital who have Covid, it is just as likely that I’m seeing a child who has an underlying medical condition as it is that I’m seeing a previously healthy child who has MIS,” he said.