For much of the COVID-19 pandemic, life-saving vaccines were not available for children and adolescents. But now children five and older are receiving vaccinations, and starting this week, those as young as six months will be eligible. At minimum, expanding vaccine eligibility means that vaccinated children will face a much lower risk of infection, hospitalization, and death. But to be most effective, national efforts to vaccinate children against COVID-19 must be combined with other efforts to expand health equity and reduce the impact of systemic racism so that children of all races, ethnicities, and income levels stay healthy during the pandemic and throughout their lives.
To fully understand how racial and ethnic inequities related to the pandemic and vaccine rollout have likely affected children, it is important to first understand these inequities in adults. The most recent data from the Centers for Disease Control and Prevention (CDC) show that American Indian and Alaskan Native adults have been more than three times as likely, and Black and Hispanic adults more than twice as likely, than non-Hispanic whites to be hospitalized with COVID-19 infections. Furthermore, American Indian, Alaskan Native, Black, and Hispanic adults have been nearly twice as likely to die from COVID-19 than non-Hispanic white adults.
The inequities do not stop there. At earlier stages of the pandemic, Black and Hispanic adults in the United States were less likely to be vaccinated against COVID-19 than their non-Hispanic white counterparts and at greater risk of infection. Contributing factors included barriers to vaccine access, such as lack of transportation to vaccination sites; inability to schedule appointments at convenient times; and issues related to language barriers.
Still, if adults faced these inequities during the vaccine rollout, how do we expect children to fare?
Research suggests that racial and ethnic inequities at the center of the pandemic will spill over into our ability to vaccinate children. Findings from an investigation published in the Journal of the American Medical Association Pediatrics revealed that Black, Hispanic, and Asian children have been tested for COVID-19 at lower rates than non-Hispanic whites, but are significantly more likely to be infected. In addition, Black, Hispanic, American Indian, and Alaskan Native children were two to three times more likely to be hospitalized with COVID-19 than non-Hispanic white children. Even though death from COVID-19 is rare among children, Black children were 3.5 times and Alaskan Native children were 2.7 times more likely to die from a COVID-19 infection than non-Hispanic white children.
The pandemic threatens child well-being beyond vaccine access and illness. Cases of anxiety and depression, for example, among youth have skyrocketed during the pandemic. In addition, the CDC found that mental health-related emergency department visits increased by 31% for adolescents ages 12 to 17 from 2019 to 2020, and that emergency department visits for suspected suicide attempts for 12 to 17 year olds were 22.3% higher in summer of 2020 and 39.1% higher in winter of 2021 compared to corresponding periods of 2019. The reality is most stark for children of color, as American Indian and Alaskan Native children continue to report the highest depression rates of any racial or ethnic group in the United States; and the rate of suicide among Black youth is growing faster than any other racial group. In addition, the impact of the pandemic on children of color and children from under-resourced communities is further complicated by the fact that they historically face systemic barriers to affordable mental healthcare and make up the largest proportion of children who are under-insured or uninsured.
Perhaps the most devastating fact of all is that the global pandemic forced children to watch as their caregivers died because of COVID-19. Researchers estimate that more than 203,000 U.S. children lost a caregiver during the pandemic. Julie Kaplow, Executive Director of the Trauma and Grief (TAG) Centers at The Hackett Center for Mental Health and Children’s Hospital (New Orleans); CEO of the Lucine Center; and Executive Vice President, Meadows Mental Health Policy Institute notes, “We have failed to prioritize children throughout the pandemic. Let’s not fail them again by abandoning them to their grief.” Simply put, we must ensure that all children have affordable access to insurance, mental health services, and other resources associated with their health-related social needs.
Earlier stages of the pandemic were defined by racial inequities in vaccine access and in health outcomes, but the picture is beginning to change. Extensive outreach efforts within both Black and Hispanic communities have resulted in increases in vaccination and declining death rates from COVID-19 amongst Black and Hispanic adults. Racial inequities can be narrowed with continued investments in the health of people of color, and the same investments must be made during the child vaccine rollout to ensure that children can be as healthy as possible.
On this Juneteenth, the nation must think about the ways in which systemic racism has defined the pandemic. In order to truly reckon with our histories of oppression, the vaccine rollout must be combined with greater efforts to make healthcare and related resources affordable and easily accessible for children and families from underinvested communities.