A state advisory group of doctors, community leaders, parents and educators met for the first time Thursday to begin talks on whether COVID-19 vaccines should be required for Washington students next school year.

Thursday’s meeting was the first of three planned this month for the panel to consider the nine criteria the Washington Board of Health will use to determine whether to add the Pfizer-BioNTech COVID-19 vaccine to the registry of required immunizations for students.

The group is only advising the Washington State Board of Health on COVID-19 vaccines, and will provide a recommendation at the end of its meetings. Ultimately, the Board of Health gets the final say.

Each voting member Thursday had to decide whether:

• The vaccine containing this antigen prevents disease that has significant mortality in at least some sub-set of the population
• Vaccinating against this disease reduces the risk of person-to-person transmission, with transmission in a school or child care setting or activity being given the highest priority

After hours of presentations and discussion, the group unanimously agreed that the COVID-19 vaccine met the first criteria point, while members of the group were more divided on the question of transmission with five members either voting “no” or “unsure.”

The group heard presentations from Eric Lofgren, an epidemiologist at Washington State University, and Steve Lim from the University of Washington’s Institute for Health Metrics and Evaluation as well as staff from the Department of Health.

Kids and teens currently have the highest seven-day COVID case rate of any age group in Washington. In January, one in four COVID cases were in children 17 and younger, data from the state health department show.

“We’re in a severe pediatric outbreak at the moment,” Lofgren said.

As of Dec. 31, there have been 93 confirmed and hospitalized cases of MIS-C, an inflammatory syndrome impacting the lungs, heart and other organs, in children and teens in Washington as a result of COVID-19, and none of those children were vaccinated.

Statewide, 13 children and teens have died from COVID-19.

Balancing the risk of COVID-19 with the risk of vaccination meant examining the incidence rates of myocarditis as a side effect, predominantly in young males, after getting vaccinated against COVID-19.

Lofgren told the panel about a recent study that found there would be 70.7 cases of myocarditis per 1 million doses in 12- to 15-year-olds, and that increased to 105.9 cases per 1 million doses in 16- and 17-year-olds.

The Food and Drug Administration risk-benefit analysis of vaccinations for kids 5 to 11 shows the benefits of vaccines outweigh the risk of getting COVID-19 in this age group except in a scenario similar to June 2021, when case counts had dropped significantly nationwide.

Lofgren said it’s possible for the country to get there again, but it isn’t yet.

“We could see cases once again drop to that level,” Lofgren said. “It’s possible we’ll get there if everything breaks our way, but it’s not where we are now.”

While the COVID vaccines are effective at preventing severe disease and greatly lower the risk of hospitalization in both adults and kids, how the vaccines impact transmission is a trickier question.

There are no studies showing how effective vaccines are in slowing transmission in schools. This is likely, in part, due to the fact that vaccines for 5- to 11-year-olds have only been authorized for three months.

Lofgren said there is some indication that outbreaks have been reduced as a result of vaccine mandates at local universities.

But the technical advisory group is faced with an even more perplexing problem: there’s no way to predict how the virus will change or mutate in the coming months.

Models from IHME show that as long as omicron remains the predominant variant, cases and hospitalizations will decline significantly with the omicron wave ending by this spring.

Experts warned the panel it is still possible the virus will mutate and more variants will emerge, however, and there is no guarantee that they will be more mild than omicron.

The technical advisory group is scheduled to meet two more times in February and make a recommendation to the State Board of Health soon with the available data in front of members now.

But making that recommendation now, with the omicron variant making up 100% of the state’s most recently sequenced cases, is challenging. And research that would be pertinent hasn’t been published yet; there is not yet evidence, for example, that vaccines reduced transmission in schools or among kids and teens during the omicron wave.

Dr. Tao Kwan-Gett, chief science officer at the Department of Health and the group’s co-leader, encouraged people to vote based on the information presented.

“We’re not asking people to evaluate the evidence, what we’re asking is, given the information presented, does it fit the criteria presented?” he said.

Members of the public who want to provide public comment on requiring COVID-19 vaccines should direct their comments to the State Board of Health, not the technical advisory group, which is not fielding public opinion for its recommendation.