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Comment by wyxuan | Hacker News Reader

Would like to add that the adcom meeting that happened yesterday wasn't unanimous even though efficacy data was strong because of they were asked to approve it for 17 and 16 year olds as well even though the data for these age groups was lackluster.

This likely didn't matter much to FDA because 16 and 17 year olds aren't likely to receive any doses before the full throated approval because they by and large aren't in the people first in line for the vax (1st line workers, vulnerable groups, old people).

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Interestingly, this seems to also be the case with pregnant women (unless I’m missing something). I’m guessing they’ll be ahead of teens but still low enough in the priority scheme to mostly not receive it?

Pregnancy is a "generic" risk factor for any medical intervention, as is young age. There is no reason to believe the vaccine is particular harmful in these groups. But since it's eminently possible to avoid the risk by vaccinating most people around them, that option is (slightly) more attractive.

The Society for Maternal-Fetal Medicine advocates for the inclusion of pregnant women in vaccine trials and just released a statement applauding FDA’s decision to allow pregnant women access to the vaccine. [1] [2] US FDA’s decision deviates from UK MHRA’s decision to hold off on finalizing their advice for women who are pregnant. [3]

[1]: https://www.smfm.org/covidclinical

[2]: https://s3.amazonaws.com/cdn.smfm.org/media/2632/FDA_final.p...

[3]: https://www.gov.uk/government/publications/covid-19-vaccinat...

And the concerns about 16-17 weren't that it wasn't effective or safe, but that given that age group has a very low incidence of serious symptoms or death that the bar for risks needed to be much higher since they compromised a relatively small part of the study group.

Considering this going to be the strategy all over the world,

I think children should get the vaccines ASAP provided the vaccine is proven safe as missing a year of school is going to have profound impact on their life and society. Many students from marginalized society, especially from poor countries might never go to school again as they have been employed by their parents for meager sum.

But I think definition of who's 'vulnerable' is what going to be contentious, apart from obvious front-line workers and elderly whom would you decide are vulnerable? Immunity compromised individuals? I'm myself house ridden for over 2 years now due to spine surgery and so likely immunity compromised but there's no way that could be informed to the Govt. I just hope my elderly parents get their vaccine.

Children are low on the priority list because they get severe symptoms at a much, much lower rate than adults and especially older adults.

And the schools are not closed right now because of the fear that younger children are going to get the virus. Schools are closed because teachers are (rightly) concerned about getting the virus, and families are (rightly) concerned that their children might pick up the virus at school and bring it home with them and infect more at-risk individuals. If the teachers and family members are vaccinated, then I think it is pretty clear the risk/benefit analysis would highly suggest sending children back to school, even if they aren't vaccinated yet.

Schools in the US have already opened in many places before there is a vaccine, so I don't doubt schools are going to be opening ASAP, and that is almost certainly before most children are vaccinated.

I'd be worried creating a viral reservoir in schools even if the adult population were completely vaccinated. It'd be an excellent environment for the virus to mutate and become endemic.

As far as we know young children don’t spread COVID. There aren’t any confirmed cases of children under ten spreading it to other people. It’s super odd, but that’s what the evidence suggests at this point.

The latest evidence indicates that young children are about half as likely to get infected and half as likely to spread the virus. That's great, but the Covid-19 is incredibly contagious, so it can still spread like wildfire in children.

https://www.nationalgeographic.com/science/2020/12/we-now-kn...

That article states that the risk starts to increase between 10-12 tears of age and between the ages 10 and 15 children are half as infectious as adults. I doesn't really dig into details about children under 10.

I'm not a virus expert, but my understanding is this type of virus is very unlikely to mutate in a way where the vaccine will not work against it, and it is going to become endemic regardless of what we do. So I don't think either of those concerns would merit not opening schools.

Covid-19 is a new disease that requires continued study before we can make definitive statements about its evolutionary possibility frontier. Having said that, we currently have extremely effective vaccines (far more effective than our flu vaccines), so we have an excellent chance of nipping this thing in the bud before it becomes endemic if we act swiftly.

It'll probably be at least a year before enough vaccine is produced that low-risk groups like children become eligible, so modified education in one form or another will have to continue till that point. This doesn't mean they can't go to school, but things like pods, wearing of PPE, social distancing, and other such things will need to continue till herd immunity can be achieved through vaccination.

You'd need to vaccinate most of 7B people, and this sickness is low priority in most places due to more pressing concerns, once vulnerable groups are protected.

> especially older adults

Someone at the CDC disagreed with the strategy of vaccinating people in long-term care facilities first because their weaker immune systems might not have an effective response to the vaccine. I'm not even sure if vaccinating front-line heathcare workers first makes sense because they've probably been exposed already (or not; this is easily checked with antibody tests).

You want to vaccinate people most likely to spread it. Who that is, I'm not sure.

The trouble with vaccinating people most likely to spread it, at least as I've seen it explained, is that you have to vaccinate a lot of people in order to have an impact compared to vaccinating the most at risk groups and there's only a limited supply of vaccine and limited capacity to administer it right now. (Also, technically there's probably more evidence of it working to protect at-risk people from severe disease and death than for it stopping anyone spreading it, but that's mostly just an artifact of what's been tested so far.)

We don't test health care workers in America.

https://www.npr.org/2020/12/07/943945361/think-health-care-w...

Untrue and off topic.

> 42% of RNs in hospitals said they had ever been tested for the virus.

and anyways that's different from a one-time pre-vacccination test.

Only 42% of RNs having ever been tested is pretty solidly "We don't test health care workers in America". I would expect close to 100% of them to be tested on a regular basis.

> You want to vaccinate people most likely to spread it. Who that is, I'm not sure.

Not when your vaccine isn't proven to stop spread.

I think along the lines you're thinking, you would actually want to come up with an expected cost of an infection of an individual ("cost" being in a misery-illness-utility sense, not financial). This would presumably include the average expected illness severity of the person infected but also the average illness burden in others indirectly attributable to that person being infected.

So you'd want to give it first to people who are very likely to become severely ill themselves, and whose infection would cause others to become severely ill, directly or indirectly (eg through disease spread or through lost resources, as if an ER doc in an understaffed area became severely ill).

> And the schools are not closed right now because of the fear that younger children are going to get the virus. Schools are closed because teachers are (rightly) concerned about getting the virus

Schools in the UK have been open since September. Typically if there's a positive case then they isolate and typically their closest contacts isolate, if there's more than one then the entire class isolates.

There's no evidence that teachers are any more likely to die from covid than many other essential workers who aren't working from home.

There's no evidence that these vaccines stop spread, so there's little point in prioritising vaccination of children who - even if they did catch covid - are practically immune. Same with the majority of teachers. Makes far more sense to vaccinate older people who are at serious risk (with IFR in the 5, 10, 15% range) - then they don't need to worry about the kids bringing the virus home.

>There's no evidence that teachers are any more likely to die from covid than many other essential workers who aren't working from home.

What's the death rate for teachers been since September compared to other occupations like nurses? Is there "no evidence" because the evidence shows they're less likely to die, or is there no evidence because no one is bothering to keep track?

>There's no evidence that these vaccines stop spread

Nothing is 100%, but my understanding is that the AstraZeneca has results showing that it significantly reduces the chance that someone who has the vaccine will spread the disease

The virus goes after the ace2 receptor, which is activated by puberty. Children under 14 can get it, but they get a very mild case because they don't have the receptors.

I'm not telling children are getting COVID-19, but schools haven't opened in several countries due to COVID-19 unfortunately replies have glossed over that.

"Children have increased concentration of ACE2 receptors in lung pneumocytes that may have a protective effect on severe clinical manifestations due to SARS-CoV-2 infection."

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7113798/

Why did 4 people vote against recommending approval?

It was likely due to disapproval over the inclusion of people age 16 and 17. At least two of the four dissenting votes have confirmed that this was their reason and they would otherwise have given their wholehearted approval. [1] As GP points out few in that age group will be in line to get the vaccine early anyway.

[1]: https://www.statnews.com/2020/12/11/podcast-pfizer-covid-19-...

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