By Kara Fox

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, 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," said Dr. Edith Bracho-Sanchez, associate professor of pediatrics at Columbia University Irving Medical Center, 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.