The American Academy of Pediatrics (AAP) released updated guidance Monday, recommending children over the age of 2 should wear masks as they return to school, regardless of vaccination status.

The AAP provided recommendations for opening schools in the 2021-2022 school year and, first and foremost, “strongly” recommended all those who are eligible to get a vaccine. Currently, children under the age of 12 are not authorized to receive any of the coronavirus vaccines offered under Emergency Use Authorization (EUA) in the United States. None of the vaccines — Pfizer, Moderna, or Johnson & Johnson — have been formally approved by the Food and Drug Administration (FDA).

However, AAP does not believe mitigation strategies should end there and is recommending that everyone, “regardless of vaccination status,” wear masks.

“AAP recommends universal masking because a significant portion of the student population is not yet eligible for vaccines, and masking is proven to reduce transmission of the virus and to protect those who are not vaccinated,” the AAP said in a statement, adding that many schools “will not have a system to monitor vaccine status of students, teachers and staff, and some communities overall have low vaccination uptake where the virus may be circulating more prominently.”

“There are many children and others who cannot be vaccinated,” Sara Bode, MD, FAAP, chairperson-elect of the AAP Council on School Health Executive Committee, said in a statement.

“This is why it’s important to use every tool in our toolkit to safeguard children from COVID-19. Universal masking is one of those tools, and has been proven effective in protecting people against other respiratory diseases, as well,” she continued, describing universal masking as the “most effective strategy to create consistent messages and expectations among students without the added burden of needing to monitor everyone’s vaccination status.”

Despite that, AAP acknowledged the importance of children resuming in-person learning, citing the “heartbreaking toll” the pandemic has had on children mentally, physically, and emotionally.

“Combining layers of protection that include vaccinations, masking and clean hands hygiene will make in-person learning safe and possible for everyone,” Sonja O’Leary, MD, FAAP, chair of the AAP Council on School Health, said.

The AAP’s guidance coincides with the recommendations released by the Centers for Disease Control and Prevention (CDC) this month, which also identified the importance of children heading back to school but recommended that unvaccinated children wear masks.

The CDC guidance reads in part:

  • Masks should be worn indoors by all individuals (age 2 and older) who are not fully vaccinated. Consistent and correct mask use by people who are not fully vaccinated is especially important indoors and in crowded settings, when physical distancing cannot be maintained.
  • CDC recommends schools maintain at least 3 feet of physical distance between students within classrooms, combined with indoor mask wearing by people who are not fully vaccinated, to reduce transmission risk. When it is not possible to maintain a physical distance of at least 3 feet, such as when schools cannot fully re-open while maintaining these distances, it is especially important to layer multiple other prevention strategies, such as indoor masking.

The AAP’s recommendations come as the universal masking narrative resurfaces as the delta variant spreads across the country, prompting some critics to call for more drastic mitigation strategies, yet again.

Jerome Adams, Surgeon General under former President Donald Trump, said the U.S. should prepare for “more mitigation” strategies “including masks” to make up for areas that are lacking in vaccination pace. He also said he and Dr. Anthony Fauci “famously, prematurely, & wrongly advised against masks” last year:

Over the weekend, Los Angeles County re-imposed its indoor mask mandate, applying to both vaccinated and unvaccinated individuals.