Thread by @MichaelSFuhrer

I'm pro-vax, I'm pro-science, I don't like covid (who does?), and I don't want kids getting covid (who does?)

But vaccinating 5-11s is not a simple issue.

Here's the summary of the FDA's risk/benefit analysis is support of the EUA request for Pfizer for 5-11s in USA:

Thread
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The FDA's risk-benefit analysis looked at different scenarios of covid incidence, from the lowest point in June 2021 (about 35 cases/Mpop/day) to the delta peak in September (about 500 cases/M/day).

(Report is here: fda.gov/media/153447/d…)
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For comparison, Vic cases are currently around 170/Mpop/day, and NSW around 28/Mpop/day, ACT about 25/Mpop/day.

NSW and ACT have lower cases than the low estimate in the analysis!

Of course, community cases in Qld, WA, NT, SA, Tas are near zero.

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The FDA assumed myocarditis/pericarditis risk equivalent to that in 12-17s. This may be an overestimate; the lower dose for 5-11s and a lower observed systemic reactogenicity in the trials suggest risk in 5-11s may be lower. But we don't know yet; the trials are too small.

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Here's the result of their model. Scenario 3 is the low-covid prevalence scenario (remember, higher than current in NSW and ACT).

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Now, ICU and deaths aren't the only serious outcomes of covid. And ICU admission for covid and myocarditis aren't the same. And, long covid!

But short term, in that scenario, we *might* see ICU admits from vax exceeding ICU from covid. By a lot.

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The FDA makes the case that even in this scenario, benefits "may" outweigh the risks.

And with more data the model is likely to be proved conservative, and the benefits likely to clearly outweigh the risks. (We'll have that data soon from the US!)

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To be clear: the risk of myocarditis/pericarditis from the vaccine is low - the conservative estimate is 34 ICU admissions per million vaccinated, and perhaps it will be much lower.

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The risk from covid to 5-11s is also low. In this age group around 3.8M cases have been reported in the US (actual cases higher), resulting in 146 deaths (38 per million).

And hospitalization risk per covid case far outweighs that of the vaccine.

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So if you're certain your kid will get covid, the vaccine is *vastly* preferable.

But there's another way to keep kids from getting covid, which is to keep adults from getting it.

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https://twitter.com/Fiona_M_Russell/status/1455762828623683584

And that might just happen in Australia. Cases are low, and have been decreasing.

We might see a resurgence after restrictions are lifted, but then again we might not.

Best solution: we keep cases low for everyone. (I don't think endemicity in Australia is inevitable.)

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I'm not arguing against the vaccine. I live in Melbourne, If I had a kid 5-11 (mine is older), I'd get him vaccinated if it became available. In Sydney, perhaps the same. But in Brisbane? I'd wait for sure.

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Which leads to an important point.

IF the vaccine is approved for 5-11s, how should the gov't communicate about it? How should we communicate about it?

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*Unqualified* recommendation of the vaccine to 5-11s is going to lead to hospitalizations of children in areas with zero covid (and zero hospitalizations of children for covid). ICU of kids for myocarditis may outnumber those for covid even in states with community txn.

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Are we ready for that? It could be very damaging to the credibility of vaccines, and public health in general.

But communicating that the vaccine has risks, is, well, risky too!

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I don't know the solution. It's obviously longer than 280 characters. But "Vax ALL the kids NOW!" is too simple a message - I'd think twice about this kind of advocacy, at least until we know more.

Best solution, let's just make sure no one gets covid.

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