“There’s a barrier to access for many,” said Dr. Ana Luisa Pacheco, a pediatric infectious diseases specialist at the Heitor Vieira Dourado Tropical Medicine Foundation in Manaus. “For some children, it takes three or four hours by boat to get to a hospital.”

The cases in children have shot up amid Brazil’s broader explosion in infections, which experts attribute to President Jair Bolsonaro’s cavalier response to the pandemic and his government’s refusal to take vigorous measures to promote social distancing. A lagging economy has also left millions without income or enough food, forcing many to risk infection as they search for work.

Some of the children who have died of the virus already had health issues that made them more vulnerable. Still, Dr. Marinho estimates that they represent just over a quarter of deaths among children under 10. That suggests that healthy children, too, seem to be at heightened risk from the virus in Brazil.

Letícia Marinheiro was one such child, her mother said. A healthy baby who had just started walking, she had never been sick before, Ms. Marinheiro said.

Ms. Marinheiro, who was infected along with her husband Diego, 39, believes Letícia might have lived if her illness had been treated with more urgency.

“I think they didn’t believe that she could be so sick, they didn’t believe it could happen to a child,” said Ms. Marinheiro.

She recalled pleading to have more tests done. Four days into the child’s hospitalization, she said, doctors had still not fully examined Letícia’s lungs.

Ms. Marinheiro is still unsure how her family got sick.

She had kept Letícia — a first child the couple had badly wanted for years — at home and away from everyone. Mr. Marinheiro, a supplier of hair salon products, had been cautious to avoid contact with clients, even as he kept working to keep the family financially afloat.

For Ms. Marinheiro, the sudden death of her daughter has left a gaping hole in her life. As the pandemic rages on, she says, she wishes other parents would quit underestimating the dangers of the virus that took Letícia away from her. In her city, she watches as families throw birthday parties for children and officials push to reopen schools.

“This virus is so inexplicable,” she said. “It’s like playing the lottery. And we never believe it will happen to us. It’s only when it takes someone from your family.”

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With shots at schools, parks and even the beach, the U.S. races to vaccinate children.

The world’s first mass coronavirus inoculation campaign for children kicked off in earnest in the United States on Thursday after the federal government recommended making the Pfizer-BioNTech vaccine available to those aged 12 to 15.

Even as the decision was embraced by millions of parents wearied by pandemic restrictions and desperate to get their children back into classrooms, states, counties and school districts around the country were trying to figure out the most reassuring and expedient ways to offer the shots.

The various authorities were making plans to offer vaccines not only in schools, but also at pediatricians’ offices, day camps, parks and even beaches.

President Biden, who hailed the vaccine as “safe, effective, easy, fast and free,” said that as many as 20,000 pharmacies stood ready to start giving shots on Thursday.

recommend use of the vaccine.

Some states, including Delaware, Georgia and Maine, had already started to offer doses to children after the authorization of the vaccine by the Food and Drug Administration on Monday.

But the ruling by the C.D.C. was the final step in the federal process that allows for widespread inoculations of the roughly 17 million children in the United States ages 12-15.

For many parents, it could not come too soon. About one-third of eighth graders, usually 13 or 14 years old, are still in remote learning.

But the authorities must also overcome a significant amount of hesitancy. A recent survey by the Kaiser Family Foundation found that many parents — even some who eagerly got their own coronavirus shots — were reluctant to vaccinate pubescent children.

health authorities require anyone younger than 18 to be accompanied by a parent, guardian or responsible adult and to present photo identification and verification of age, county officials said.

In Maine, a parent does not need to be with the child as long as the adult provides permission over the phone or signs a form beforehand.

Federal and local officials said that there should be no problem with supply meeting demand. The expansion of the U.S. vaccination effort underscored the widening gulf in the world’s inoculation campaigns even as the pandemic gathers force in several regions.

Referring to the global situation, Dr. Oliver Morgan, director of the risk assessment department at the W.H.O., said on Wednesday, “Throughout the month of March and April, there has been a steady increase in the number of cases each week and the weekly number of cases is now higher than any time in the pandemic.”

At the same time, many of the countries being walloped by the virus — and those where the threat of new outbreaks is growing — have not been able to secure vaccines to inoculate even health workers or those most at risk of serious illness and death.

Research shows that children are mostly spared severe disease and are not significant drivers of coronavirus spread, as they are for influenza, for example.

Young children are thought to spread the virus less often than adults do, but their ability to transmit increases with age. Teenagers may transmit the virus as readily as adults.

Vaccinating children is viewed as an important increase to the level of immunity in a population, driving down the number of cases broadly, while offering protection to more people.

While risk of severe illness in youngsters is low compared with that in adults, the coronavirus has infected more than 1.5 million children and sent more than 13,000 to hospitals, more than are hospitalized for flu in an average year, according to data collected by the C.D.C.

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C.D.C. Advisers Endorse Pfizer Vaccine for Children Ages 12 to 15

The federal government on Wednesday took a final step toward making the Pfizer-BioNTech coronavirus vaccine available to adolescents in the United States, removing an obstacle to school reopenings and cheering millions of families weary of pandemic restrictions.

An advisory committee to the Centers for Disease Control and Prevention voted to recommend the vaccine for use in children ages 12 to 15. The C.D.C. director, Dr. Rochelle Walensky, is expected to review the recommendations and approve them later on Wednesday.

“Approving Covid-19 vaccines for children 12 to 15 years of age is an important step in removing barriers for vaccinating children of all ages,” said Dr. Yvonne Maldonado, who represents the American Academy of Pediatrics on the federal Advisory Committee on Immunization Practices.

Many parents are eagerly anticipating the availability of vaccines for children, at least in part to speed their return to schools. Roughly one-third of eighth graders, usually 13 or 14 years old, are still learning fully remotely.

at least as effective in 12- to 15-year-olds as it has been in older teenagers and adults. Apart from a slight increase in the frequency of fevers, the shots also seemed to have comparable, mostly negligible side effects.

The company plans to continue monitoring trial participants for two years after the second dose to assess the vaccine’s long-term safety and efficacy.

The Food and Drug Administration reviewed the clinical data and on Monday authorized the Pfizer vaccine for use in these children, capping weeks of anticipation from parents and children about a swifter return to normalcy.

“While it’s true that children are generally spared from severe disease, the fact that they’ve been unable to be vaccinated has caused major disruptions in their lives that have real developmental consequences,” said Dr. Amesh Adalja, a senior scholar at the Johns Hopkins Center for Health Security. “Vaccination of this age cohort will allow these children to more fully return to their normal lives.”

about 20,000 pharmacies nationwide are expected to offer the vaccine for free to these children.

survey by the Kaiser Family Foundation.

Some of those parents may change their minds, as other children safely receive vaccines and resume in-person schooling, or rejoin team sports like football and basketball that involve close contact, the researchers suggested.

Others may wait until they must comply with school requirements. Public schools in all 50 states require certain vaccines, but officials may not be able to enforce compliance until the Pfizer-BioNTech vaccine gains the F.D.A.’s full approval.

The vaccine has emergency authorization now. Pfizer has applied to the F.D.A. for full approval, but that process is expected to take several months. Even after approval, students may still opt out by citing medical reasons or religious beliefs.

State and local leaders will need to make particular efforts to reach children in low-income families or in communities of color. Black and Hispanic adults have among the lowest rates of vaccination: As of May 3, just 25 percent of Black people and 27 percent of Hispanic people had been inoculated, compared with 39 percent of white people.

Making the vaccine accessible to these communities will require easier transportation and storage of doses. The Pfizer-BioNTech vaccine can be stored for only five days in standard refrigerators. The companies are planning to ship smaller packs for use in doctors’ offices, and are developing a formulation that can be refrigerated for up to 10 weeks.

Pfizer and BioNTech plan in September to submit requests for authorization of the vaccine in children ages 2 to 11.

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China Wants to Boost Births. But It’s Wary of Losing Control.

When Fan Jianhua had her third daughter last April, she was afraid that she would be fined for violating China’s birth limits.

Ms. Fan was already heavily in debt paying for treatment for her 6-year-old, who has leukemia. To her relief, when she registered her new baby with the police, she didn’t have to pay the $7,500 fine.

“I was really happy and could finally relax,” said Ms. Fan, 34, a stay-at-home mother in the central city of Danjiangkou, in Hubei Province.

Slowly, in fits and starts, China’s ruling Communist Party is loosening its long-held restrictions over childbirth and women’s bodies. Some local governments have tacitly allowed couples to have more than two children. Beijing has said civil servants will no longer be fired for such infringements. Party leaders have pledged to make population policies more inclusive, a signal that some have taken to mean the rules will be eased further.

decline in birthrates. A once-a-decade population census, released on Tuesday, showed that the number of births last year fell to the lowest since the Mao era. Low fertility translates to fewer workers and weaker demand, which could stunt growth in the world’s second-largest economy.

But the party is wary of giving up control and has resisted scrapping birth restrictions wholesale. Instead, Beijing has been taking a piecemeal approach by slowly dismantling the once-powerful family-planning bureaucracy and carving out exemptions. In many places, police officers, employers and city officials are deciding how strictly, or loosely, to enforce the rules.

That can mean more freedom for some, like Ms. Fan, to have more children. But it also creates uncertainty about the risks, adding to a reluctance about having more children.

The strategy could also founder amid broad cultural changes. Anxiety over the rising cost of education, housing and health care is now deeply ingrained in society. Many Chinese simply prefer smaller families, and the government’s efforts to boost the birthrate, including introducing a two-child policy in 2016, have largely fizzled.

“If the restrictions on family planning are not lifted, and they are encouraging births at the same time, this is self-contradictory,” said Huang Wenzheng, a demography expert with the Center for China and Globalization, a Beijing-based research center. He said that removing all birth limits would convey an important message. “I think such a step has to be taken.”

official murmurs about a reconsideration of the one-child policy surfaced but were quickly dismissed. It took years before the government moved to allow all couples to have two children.

Now, the population is aging more rapidly than those of many developed countries, including the United States, and some argue that the government cannot afford to keep any restrictions on procreation.

“We have to take advantage of the fact that a certain number of residents now are willing to give birth but aren’t allowed to,” China’s central bank said in a working paper it published on April 14. “If we wait to lift it when no one wants to give birth, it will be useless.”

harshly enforced family-planning rules in what Beijing has depicted as a fight against religious extremism. The campaign has led in recent years to a rise in sterilizations and contraceptive procedures — forcibly imposed in some cases — in the region’s Muslim-dominated areas.

China’s family-planning policy has long given local officials a powerful weapon of control — one that may be hard, or costly, to wrest back. Before they were unwound, family-planning agencies hired around eight million people, down to the village level, who corralled women to be fitted with intrauterine devices or coerced them into abortions.

The officials also collected large fines from couples who broke the rules. One senior researcher at the Central Party School estimated in 2015 that the fees amounted to between $3 billion and $5 billion annually.

In recent years, the government has been reassigning family-planning employees to roles including in population research and tackling Covid-19. But local governments retain the power to enforce birth limits as they see fit, which has led to inconsistencies.

The central government said in May last year that civil servants did not have to lose their jobs for violating birth limits, yet months later, a village committee in the eastern city of Hangzhou fired a woman after she had a third child — prompting a public outcry.

Ultimately, the fate of China’s family-planning policies may change little. A generation of highly educated women are putting off marriage and childbirth for other reasons, including a rejection of traditional attitudes that dictate women should bear most of the responsibility of raising children and doing housework.

Liu Qing, a 38-year-old editor of children’s books in Beijing, said getting married and having children were never in her future because they would come at too great a personal cost.

“All the things that you want — your ideals and your ambitions — have to be sacrificed,” Ms. Liu said.

Ms. Liu said Chinese society imposed a motherhood penalty on women, pointing to the discrimination that mothers often faced in hiring.

“I’m furious about this environment,” she said. “I’m not the kind of person who would accept this reality and compromise. I just won’t.”

For other Chinese, having fewer children is a matter of necessity when holes in the country’s social safety net mean that a major illness can lead to financial ruin.

Ms. Fan, the woman in Hubei who was spared a fine, said that she and her husband, a laborer, were getting increasingly desperate. Public health insurance had covered half the cost of her daughter’s treatment for leukemia, but they were on the hook for $76,000.

She had a third child only because she heard that a sibling’s cord blood could help in the treatment of leukemia. But she later learned that such treatment would cost more than $100,000.

“I don’t dare think about the future,” Ms. Fan said. She added that if her daughter’s condition deteriorated or they went broke, they would have to give up treatment.

“We can only leave it up to her fate,” she said.

Research was contributed by Claire Fu, Liu Yi, Albee Zhang and Elsie Chen.

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To Vaccinate Younger Teens, States and Cities Look to Schools, Camps, Even Beaches

Not all teenagers long for the vaccine. Many hate getting shots. Others say that because young people often get milder cases of Covid, why risk a new vaccine?

Patsy Stinchfield, a nurse practitioner who oversees vaccination for Children’s Minnesota, has stark evidence that some cases in young people can be serious. Not only have more children with Covid been admitted to the hospital recently, but its intensive care unit also has Covid patients who are 13, 15, 16 and 17 years old.

The F.D.A.’s new authorization means all those patients would be eligible for the shots, she noted. “If you can prevent your child ending up in the I.C.U. with a safe vaccine, why wouldn’t you ?” she said.

Mr. Quesnel, the East Hartford, Conn., superintendent, said the most powerful message for reaching older adolescents would probably appeal just as much to younger ones. Rather than focusing on the fact that the shot will protect them, he said, they seize on the idea that it will keep them from having to quarantine if they are exposed.

“They’re not so afraid of the health care dangers from Covid but the social losses that come along with it,” he said, adding that 60 percent of his district’s seniors, or about 300 students, got their first dose at a mass vaccination site run by Community Health Center on April 26. “Some of our greatest leverage right now is that social component — ‘You won’t be quarantined.’”

Michael Jackson of North Port, Fla., can’t wait for his 14-year-old son, Devin, to get the vaccine. During the past year, he said, his son’s beloved Little League games went on hiatus and the family had to suspend their regular Sunday suppers with grandparents And Devin, an eighth grader, had to quarantine three times after being exposed to Covid.

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FDA Authorizes Pfizer-BioNTech Vaccine for Children 12 to 15

Vaccinating children is crucial to building up population levels of immunity and curtailing the spread of the coronavirus. Though children spread the virus less efficiently than adults do, they make up about 23 percent of the population.

Experts have said that the country is unlikely to reach the “herd immunity” threshold — the point at which virus transmission essentially stalls — but vaccinating children will be important for getting as close as possible.

Ty Dropic, 14, one of the trial participants, urged others his age to be vaccinated so they could build up widespread immunity and protect themselves. He had no side effects, leading him to suspect that he got the placebo. If that turns out to be the case, he plans to be immunized as soon as possible.

“I know it can be kind of scary, but it’s really not as bad as it seems,” he said. “If you do get Covid, it’ll be a lot worse than getting stuck with a needle for, like, two seconds.”

Ty’s three siblings, ages 8, 10 and 16, are also enrolled in vaccine trials for their age groups. Their mother, Dr. Amanda Dropic, a pediatrician in northern Kentucky, said that in her practice, most parents were eager to have their children vaccinated so they could regain some semblance of normalcy.

“The anxiety and depression that we’re seeing with kids, the social delays, has been tremendous,” she said.

Dr. Dropic said her children understood the risks and were willing to volunteer because they saw it as a civic duty. Every medicine available today came to be because “somebody was willing to go first,” she added.

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Parents Are Reluctant to Get Their Children Vaccinated for Covid-19, Poll Shows

The American public’s willingness to get a Covid vaccine is reaching a saturation point, a new national poll suggests, one more indication that achieving widespread immunity in the United States is becoming increasingly challenging.

Only 9 percent of respondents said they hadn’t yet gotten the shot but intended to do so, according to the survey, published in the April edition of the Kaiser Family Foundation’s Vaccine Monitor. And with federal authorization of the Pfizer vaccine for adolescents ages 12 through 15 expected imminently, the eagerness of parents to let their children be vaccinated is also limited, the poll found.

Overall, slightly more than half of those surveyed said they had gotten at least one dose of the vaccine, a finding that matches data from the Centers for Disease Control and Prevention.

“We’re in a new stage of talking about vaccine demand,” said Mollyann Brodie, executive vice president of Kaiser’s Public Opinion and Survey Research Program. “There’s not going to be a single strategy to increase demand across everyone who is left. There will be have to be a lot of individually targeted efforts. The people still on the fence have logistical barriers, information needs, and lots don’t yet know they are eligible. Each strategy might move a small number of people to get vaccinated, but all together, that could matter a lot.”

With a growing number of scientists and public health experts concluding that it is unlikely that the country will reach the threshold of herd immunity, the Biden administration has stepped up efforts to reach those who are still hesitant. On Tuesday, the administration announced steps to encourage more pop-up and mobile vaccine clinics and to distribute shots to primary care doctors and pediatricians as well as local pharmacies.

The survey also showed that confidence in the Johnson & Johnson vaccine had suffered a significant blow after the 10-day pause in dispensing it while the authorities examined rare incidents of life-threatening blood clots in people who had taken it. While 69 percent of people said they had confidence in the safety of the vaccines made by Pfizer and Moderna, only 46 percent felt confident about the safety of the Johnson & Johnson vaccine. Among adults who have not been vaccinated, one in five said that the news about the Johnson & Johnson shot had prompted them to change their minds about getting a Covid-19 vaccine.

The survey did show that there had been some progress among Republicans, who have been among the firmest holdouts. Among that group, 55 percent said they had gotten a shot or intended to do so, up from 46 percent in March. The percentage who will “definitely not” get the vaccine is shrinking as well, down to 20 percent from 29 percent in March.

The results were based on telephone surveys of a nationally representative sample of 2,097 adults from April 15 through April 29.

A consortium of universities that includes Harvard, Northeastern and Rutgers has been conducting online polls during the pandemic and recently focused on parents. The group’s latest survey, conducted throughout April and reaching 21,733 adults across 50 states, found that the divide between mothers and fathers in views about the vaccine for children had widened.

Fathers are becoming more accepting, with their resistance falling to 11 percent from 14 percent since February. But over a quarter of mothers, researchers said, still say they are “extremely unlikely” to vaccinate their children. Both genders are more resistant to the vaccine for younger children than for teenagers. Other research shows that mothers tend to have more sway over the final decision than fathers.

The responses from parents may well change over time, experts say. Just as adults were far more reluctant last summer when the vaccine was still a concept, parents surveyed several weeks ago, when imminent authorization for children under 16 had not been widely discussed, might also have been reacting to a hypothetical situation rather than a reality.

But pediatricians and others who are seen as trusted sources of information are already aware that they have considerable work to do to instill vaccine confidence in this latest cohort.

Dr. Sean O’Leary, a pediatrician in Denver who is vice chairman of the committee on infectious diseases for the American Academy of Pediatrics, predicted that just as adults had swarmed Covid vaccine providers during the initial weeks of distribution, parents and pent-up young teenagers would rush for it at the start, too.

But Dr. O’Leary, who often gives talks to pediatricians about how to motivate patients to accept vaccinations, worries that a slowdown will inevitably follow. To persuade hesitant parents, he said, “we have to make the vaccine available in as many places as possible.”

He added, “If parents and patients are in the pediatrician’s office and the doctor can say, ‘Hey, I’ve got it,’ that may be enough of a nudge for them to say, ‘Let’s go ahead and do this.’”

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