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Dr. David Pate, a leading voice on Idaho’s COVID-19 response, posed a hypothetical best-case scenario this week.

Assume 20% of people in the U.S. are under 16 years old, and that everyone else either contracts COVID-19 or is vaccinated against it.

“We would only get to 80% immunity,” Pate writes toward the end of a Feb. 22 blog post. That’s not likely. Some people will decline a COVID-19 vaccine and some people simply can’t take it because of allergies or conflicting medical conditions, he said in a Thursday interview with the Post Register.

Without vaccines for children, Pate said it’ll be tough for the nation to hit the 80 to 85% vaccination rates that experts now say is needed to reach herd immunity from more virulent coronavirus strains gaining hold. “You can’t consider herd immunity without including kids because when you talk about herd immunity, you have to include everyone who could be infected and who can transmit” the virus, Pate said.

Inoculating children is one of many hurdles the nation must clear as it seeks to return to some sense of normal. About 22% of the nation’s 328 million residents are under 18 years old. And for most of them, it’ll be a while until they can receive COVID-19 vaccines. Pfizer’s two-dose mRNA shot is approved for everyone age 16 and up. Trials testing the safety and effectiveness of COVID-19 vaccines on younger children likely won’t be complete for months.

Achieving herd immunity might be harder in Idaho, which has a hodgepodge of factors that make the hurdle higher: It has the third-highest proportion of children in the nation, one of the lowest flu vaccination rates and very permissive school vaccine rules that let anyone refuse a mandated vaccine for personal reasons.

“If we’re serious” about controlling the coronavirus, said Dr. Aaron Gardner, a pediatric intensive care unit doctor and a member of the state’s vaccine advisory panel, children need to get vaccinated. “Kids are out and about. Kids are cared for by adults.”

When could children get a COVID-19 vaccine?

Estimates vary for when vaccines for children will be available. With multiple trials ongoing, the best guesses are months after all adults who want vaccines can get them.

For children in high school, approval might come sooner.

“Somewhere between late summer and the end of the year (is) when we’ll find out if vaccines could be approved for children,” state health Director Dave Jeppesen said during a presentation Friday, referring to talks with state epidemiologist Dr. Christine Hahn.

Dr. Anthony Fauci said at a Feb. 19 coronavirus press briefing it’s “likely” to take one year to get data relating to COVID-19 vaccines for elementary-school-aged children. “However, we anticipate data on high school age individuals … by the beginning of the fall,” he said.

Hahn said in a media briefing Tuesday that “it’s tricky” to know when trials will be complete. They rely on people being naturally exposed to the virus to test how effectively vaccines prevent infections. The decline in new cases makes it more challenging to complete trials quickly.

“If cases keep disappearing, there’s a paradoxical effect … on these studies,” Hahn said, “because no one’s getting COVID-19.”

How does that affect timelines for herd immunity?

Pate said children can’t be left out of the equation. About a quarter of Idaho’s estimated 1.8 million population is under 18 years old, Census estimates from 2019 say.

“In order to achieve herd immunity,” Hahn wrote in a Friday email, “we will most likely want children to be immunized — the percentage of the population that will have to be immune to achieve herd immunity and prevent outbreaks is not yet scientifically known, but may be as high as 80-85% of the total population.”

If children will have to wait even longer for the vaccine, that puts a greater responsibility on people who can receive it, Pate said.

“It really is incumbent upon the rest of us, for as many of possible to get vaccinated,” he said.

Immunizations in Idaho schools

Idaho has both one of the lowest flu vaccination rates and some of the most lenient vaccine requirements for children to attend public school. According to the National Conference of State Legislatures, Idaho is one of 15 states that lets parents opt out of school-required vaccines for their children due to personal beliefs. All states allow children to be exempt for medical reasons, and many other states allow religious exemptions.

Meanwhile, the Centers for Disease Control says just 44.9% of Idahoans were vaccinated against the flu in the 2019-2020 flu season. Idaho’s flu vaccine rate was about 6 percentage points lower than the national average. Only Florida and Nevada had lower flu vaccine rates than Idaho.

“We already have low enough vaccination rates,” Gardner said. And now, officials would “be potentially asking parents to immunize your children with a new vaccine. … Regardless of how quickly and how broad of scope the clinical trials are with the vaccine, it’s still new.”

“It’s going to be a challenge for pediatricians and other pediatric providers to really put a lot of pressure on parents who are challenged with this decision,” Gardner said.

The most recent district-level immunization data comes from the 2018-2019 school year. Nearly all eastern Idaho districts had records of the measles vaccine for more than 90% of their students. Madison School District was the exception with 89% confirmed for vaccines.

Many of the diseases that have vaccine requirements need a high level of vaccination to achieve herd immunity. Superintendent of Public Instruction Sherri Ybarra told lawmakers in 2018 that the State Department of Education advocates for a 94% immunization rate. Less than a tenth of school districts met that mark during the 2019 school year, with 86.5 of all Idaho students having full immunization records.

Bonneville Joint School District Superintendent Scott Woolstenhulme used the measles vaccine as a comparison. Outbreaks of measles in Idaho and Washington in 2019 were tied to declining numbers of children being vaccinated against the disease by age 12.

Coronavirus in schools

Eastern Idaho Public Health has confirmed 2,265 cases of the coronavirus among children between the ages of 5 and 17 since the beginning of the pandemic. Over the course of the school year, the health district has told school boards that it doesn’t see schools as the major source of those cases.

“We would support a (COVID-19 vaccine) requirement if we feel it’s a significant step in preventing transmissions in schools,” Woolstenhulme said. “For the strains of the virus that we see right now, I don’t think that is true.”

Hahn said in an email Friday that the state health department is “not exploring” a requirement that children be vaccinated against COVID-19 to attend school “at this time."

Similar feelings were shared by officials with Idaho Falls School District 91 and Jefferson Joint School District 251. Representatives from both districts said there have not been major conversations about the need to vaccinate students and would go along with whatever decision was made by the Department of Health and Welfare.

Reporter Kyle Pfannenstiel can be reached at 208-542-6754. Follow him on Twitter: @pfannyyy. He is a corps member with Report for America, a national service program that places journalists into local newsrooms.