School is in session, with unvaccinated children bearing the brunt of Delta

(CNN) With school now well underway and the Delta variant raging, Covid-19 cases and hospitalizations are surging in children and raising alarm. In the United States, there's been a 240% increase in pediatric cases of the virus since July, the American Academy of Pediatrics said Monday, with reopening without proper masking a likely contributor, according to experts. Vaccines continue to play an integral part of this puzzle, with more children hospitalized and attending the emergency room in states with lower vaccination rates, according to the US Centers for Disease Control and Prevention (CDC). "This virus is really going for the people who are not vaccinated," Dr. Edith Bracho-Sanchez, associate professor of pediatrics at Columbia University Irving Medical Center, told CNN, adding: "And among those people are children who don't qualify for the vaccine and children and teens who qualify but are choosing not to get it." In the US, where kids as young as 12 have been able to access vaccinations since May, takeup appears to be plateauing around 40%, according to the latest CDC data. Meanwhile, a handful of countries have already begun to inoculate young children, with Cuba becoming the first country in the world to vaccinate toddlers as young as 2 in a bid to get kids safely back into the classrooms.

• Cuban scientists say their homegrown vaccines are safe and effective, but have so far provided little data to outside observers -- although the country says it will seek World Health Organization (WHO) approval for the shots. The government initially planned to focus on vaccinating health care workers, the elderly and the hardest hit areas, but following a spike in infections among children believed to be attributable to Delta, it announced it would also prioritize young kids.

• In Chile, health authorities on Thursday approved the use of the Chinese vaccine Sinovac for children aged 6 and over. In China, Sinovac was approved for emergency use in children as young as 3 in May, while the CoronaVac vaccine followed in June. In El Salvador, children as young as 6 will soon be able to get vaccinated while in the United Arab Emirates -- where Sinopharm is approved for 3-year-olds -- the government has made it clear that the vaccination program will be optional.

• The United Kingdom has now recommended the vaccine for children aged 12-15 following advice from its chief medical officers, placing it in line with the US and many other European countries, which have been inoculating this age group for months. The chief medical officer for England, Professor Chris Whitty, said on Monday that it is hoped this measure will reduce the spread of Covid in schools, although he said vaccinations would not eliminate it and that policies to minimize transmission should be kept in place.

• The UK's new guidance has reinvigorated a debate on consent, especially when a parent and child disagree. While parents in the UK generally need to authorize vaccination for children under 16, children can overrule vaccine-hesitant parents if a clinician considers them "competent" to do so.

• In the US, most children can't take that power into their hands, with 41 states requiring parental consent for children under 18 to be vaccinated. Nebraska requires parental consent until the age of 19. Five states do have a "mature minor doctrine," meaning that there is no specific age requirement, with providers able to decide if a minor possesses the maturity to consent themselves. Dr. Anthony Fauci, the director of the National Institute of Allergy and Infectious Diseases, said on Sunday that if more people aren't persuaded to get vaccinated by messaging from health officials and "trusted political messengers," additional mandates from schools and businesses may be necessary. Last week, US President Joe Biden announced vaccine requirements that include a mandate for businesses with more than 100 employees to require vaccination or regular testing.

• American children between 5 and 11 could get the green light for vaccines from the US Food and Drug Administration sometime this fall, according to Fauci. Pfizer's CEO said Tuesday that the company plans to submit data on its vaccine from studies involving that age group by the end of this month.

• Meanwhile, the debate on booster shots continues. Three separate articles published last week in the CDC's Morbidity and Mortality Weekly Report suggest that we don't need them, and a group of international vaccine scientists say the current evidence does not appear to support a need for booster shots in the general public. But a study from Israel, where the third shot has already been rolled out, indicated that the vaccines' power to keep people from getting very sick with Covid-19 diminished over time. Last month, Biden announced his administration's intention to start a booster program by September 20, despite WHO's call for nations to wait until vaccines are more widely available around the world.

YOU ASKED. WE ANSWERED.

Q: Why does approval of Covid vaccines for younger children need more time?

A: Millions of adults have been safely and effectively vaccinated against Covid-19, but those outcomes are not a substitute for the research needed in kids.

Dr. James Versalovic, interim pediatrician-in-chief at Texas Children's Hospital, explains why. "As we are fond of saying in pediatrics: Children are not small adults. Children are children," he said. "Their bodies are developing and will react differently, and we need to treat them differently."

For people as young as 12, vaccine makers built off the adult trials with an approach known as "immunobridging," a process that looks for an immune response in children that is similar to adults.

The data showed that for this age group, the immune response was the equivalent of adults'.

Companies take a similar approach with the younger kids, but in early August, out of an abundance of caution, the FDA asked for six months of follow-up safety data, instead of the two months it asked for with adults. It also asked Pfizer and Moderna to double the number of children ages 5 to 11 in clinical trials. Read more here.

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Will Biden's vaccine mandates work? France's experiment may provide clues  

In July, with France's vaccination rate stagnating and coronavirus cases surging, French President Emmanuel Macron imposed sweeping vaccination requirements for much of daily life, Saskya Vandoorne, Melissa Bell, Eliza Mackintosh and Joseph Ataman report.

As of August 1, anyone without a "health pass" showing proof of their vaccination status, or a recent negative test, would not be able to enter bars and cafes, or travel long distances by train. Health care workers -- a group of roughly 2.7 million people in France -- who are not vaccinated face being fired or suspended without pay.

Despite some early opposition, Macron's gamble looks to be reaping significant rewards. Immediately following his speech on July 12, there was a spike in vaccination appointments in France. Thanks in part to its swelling vaccination rate -- along with a massive increase in testing linked to the Covid pass, and the reintroduction of mask mandates in regions badly hit by the Delta variant -- mainland France managed to largely sidestep the fourth wave that swept through Europe and the US. A month into France's new health pass regime, data from the country's health agency show an overall decline in hospital and ICU admissions since the summer highs.

China's strict 21 day quarantine under question after new outbreak

A man who completed 21 days of mandatory quarantine upon returning to China from overseas has been identified as the likely source of a new outbreak, raising questions over the sustainability of the country's zero-Covid strategy, among the strictest in the world, Nectar Gan and Steve George write.

The man had tested negative for the virus nine times during the 21 days of quarantine, before testing positive on Friday -- 37 days after entering China, according to state media. Chinese authorities did not reveal when, where or how the man caught the virus, but an incubation period longer than 21 days is highly unusual.

The fresh outbreak in Fujian province on China's southeastern coast has infected more than 60 people, including 15 elementary school pupils. It emerged just two weeks after China contained its worst coronavirus flareup in more than a year, highlighting the increasing challenge posed by the highly contagious Delta variant -- even in the face of the most stringent measures.

TOP TIP

Don't be afraid to ask questions at your child's school

One of the highest-risk settings during school hours is during mealtime, when kids aren't wearing masks and could be crowded together. As a parent, you can take steps to reduce risk by asking what provisions your child's school can offer during lunch and snack time, says CNN Medical Analyst Dr. Leana Wen

Ask questions like: Might kids be able to eat outdoors? Could that be a choice offered to some kids?

You can also ask about quarantine protocols. How will you know if another child tests positive? Is everyone in the class required to quarantine, or is testing an option that can reduce the need for a long quarantine -- -- and with it missed in-person schooling time. This is another case where rapid, frequent testing is helpful; what kind of testing options are made available for students and their families?