School shootings feel random in their location yet predictable in their occurrence. Killers target elementary, high school and college students in urban, suburban and rural communities. The children killed are Hispanic, white, Black, Asian, Native American, gay, straight, transgender and cisgender.
This year school shootings have occurred more than weekly on average with 27 in 2022 (so far). Many go virtually unmentioned on the national stage, however, until the “unthinkable” happens, and 19 nine- to 11-year-old children and two teachers die unspeakable deaths at Robb Elementary School in Uvalde, Texas. Yet these killings aren’t unthinkable. We’ve been here before—at Columbine, Sandy Hook, Marjory Stoneman Douglas High School in Parkland, Florida and too many other schools.
We are researchers and pediatric emergency medicine physicians who study firearm injuries. After many hard, politically fraught years of investigating this subject, we believe that it is our collective responsibility to address, head on, the interlinked issues of gun availability, gun safety, gun regulations and gun violence prevention research—and, dare we say it, the politicization of guns taking priority over public health. With thousands of children killed each year in the U.S. by firearms, we must, as a country, ultimately reckon with the essential question of what is most important: Is it the narrow focus on individuals’ rights or the broader vision of societal responsibility?
Are pediatric gun deaths really a problem in the U.S.? Our work and others’ show the answer is unequivocally yes. Guns kill more U.S. children and adolescents between one and 19 years old than any other means. Guns kill more children than motor vehicle collisions, cancer, infections or any other disease. And this is a uniquely American problem. Though horrifying and sensational, school deaths represent only a small fraction firearm deaths. Most firearm injuries and deaths happen in homes or neighborhoods. In 2020 10,197 children and young adults age zero to 24 year old died by guns, a 55 percent increase over the decade prior.
Gun deaths are also a health disparity issue. Over the past decade, Black teenage boys died by guns at rates about five times higher than those of white teenage boys, though their names rarely register in the national consciousness.
There are at least 400 million guns in the U.S. We don’t really know how many because most states don’t track gun sales or require gun registration, thanks to successful lobbying by the gun industry and progun politicians. Last year 18.9 million guns were sold in the U.S. And between the beginning of 2019 and middle of 2021, an estimated 7.5 million people became first-time gun owners. This includes 5.4 million people who previously lived in homes without guns. Twenty years ago a majority of gun owners used guns for hunting and sports. Today 88 percent of them state they own their guns for self-protection. Most of those owners say having a gun at home makes them feel safer, and about 40 percent keep one loaded and “easily accessible” at all times. In 2021 four in 10 children, representing approximately 30 million kids, had at least one gun in the home. Even in homes with children, 73 percent of these guns were stored unlocked and/or loaded, putting those children at risk of injury and death. If you keep a gun in your home, storing it unloaded and keeping the gun and ammunition locked away separately can decrease the risk.
Unlike cars and virtually every product sold in the U.S., there are no regulatory safety requirements for guns. That bears repeating: guns are exempt from safety standards set by the federal Consumer Product Safety Act. Between 2015 and 2021, there were 2,446 unintentional child shootings, resulting in 923 deaths and 1,603 injuries. Thus, while pill bottle makers, hair dryer producers and motor vehicle companies constantly work to improve their products’ safety, the U.S. government has decreed gun manufactures do not need to consider whether a two-year-old should be able to pull the trigger on a gun or whether a teenager should be able to fire a gun they don’t own.
Beyond these lack of safety requirements, in 2006 Congress passed the “Protection of Lawful Commerce in Arms Act,” which shields firearm manufactures against liability for any injuries or deaths from guns. Thus, gunmakers have minimal incentive to improve gun safety technology, despite the development of safer gun technology over the last decade in the form of personalized “smart” guns, which use fingerprint technology (like your cell phone, radio-frequency identification (RFID), or other methods) to allow only the authorized user to fire the gun. This simple fix would prevent curious children, suicidal individuals, and unauthorized people from finding a gun and shooting the weapon. It would save countless lives each year.
We know that states with stronger firearm laws are associated with lower firearm deaths. We also know no one law or strategy will address the problem of U.S. gun violence. We need a multipronged strategy, and we need it to encompass all states.
One approach would treat owning guns like owning cars: meaningful age limits for purchase and possession and licensing, registration and insurance requirements. Some states, including New York, Connecticut and California, do have meaningful age limits and licensing and registration requirements. Other states, including Florida, Georgia, Tennessee and Rhode Island, specifically prohibit gun registries. Nearly two thirds of Americans, including 53 percent of Republicans, support moderate or strong regulation of gun ownership. And after every school shooting, federal firearm legislation, such as universal background checks or raising the legal age to buy a long-gun from 18 to 21, is proposed once again. It is the most practical start to decreasing firearm deaths, yet the most quickly dismissed. So we are left with “thoughts and prayers.”
We also need laws to minimize access to firearms among individuals at risk of harming themselves or others (such as people who have been charged with domestic violence or who have homicidal ideation). These needed measures include universal background checks (supported by 81 percent of Americans) and extreme risk protection order (“red flag”) laws that allow a judge to prohibit at-risk individuals’ purchase or possession of a firearm for a time limited period. Nineteen states plus Washington, D.C., have red flag laws. These laws are frequently passed by bipartisan consensus in Republican-led states. Yet people slip through the cracks, so we need to both increase awareness of the laws in the states that have them and to have more states pass them.
As pediatric emergency physicians, we specifically concern ourselves with children accessing their parents’ guns. Strong child access prevention laws, currently in 34 states and Washington, D.C., hold adult gun owners liable if a child can or does access a firearm. However, we and others have concerns about criminalizing grieving families and non-discriminatory applications of these laws. Another approach would be to incentivize gun owners to store their firearms more safely.
And then there is funding. Because of a dearth of federal research funding, there are substantial gaps in knowledge about the victims and perpetrators of gun violence, as well as effective interventions. There was no Congressional federal funding for firearm research at the Centers for Disease Control and Prevention after Congress passed the Dickey Amendment in 1996—and no such funding for the National Institutes of Health after the amendment was extended to that agency in late 2011—until 2019, when $25 million was appropriated. This is a drop in the bucket, compared with the number of people affected by gun violence. In contrast, the National Heart, Lung, and Blood Institute has a budget of $3.8 billion to support research related to conditions such as heart disease and cancer.
But while we consider these approaches, we must remember these names. They are sons and daughters, children whose parents had hopes and dreams for them, youth with goals and aspirations for themselves:
Jacklyn “Jackie” Cazares
Makenna Lee Elrod
Jose Flores, Jr.
Eliana “Ellie” Garcia
Amerie Jo Garza
Tess Marie Mata
Annabell Guadalupe Rodriguez
Maite Yuleana Rodriguez
Alexandria “Lexi” Aniyah Rubio
Jailah Nicole Silguero
Eliahana Cruz Torres
And never again should we have to list the names of innocent children shot and killed in their elementary school. Yet history, and a contemptuous lack of action from our elected officials, predicts we will. We must demand more, especially when there are actions we can take. We must do better for our children, our youth and our society. We must.