FOR countries with high adult vaccination rates against COVID-19, the next crucial issue will be decisions about vaccinating children and teenagers. Across Europe and North America, some countries have jumped already to vaccinate all teenagers, but others are being more cautious.

The core questions relate to the balance of risks and benefits to children compared with risks and benefits for broader society (especially adults).

We know children get SARS-CoV-2 infection but usually mildly (Delta variant data are still emerging). Why are children so resistant? Aren’t vaccine-preventable diseases meant to be the special scourge of children? Better innate immunological resilience, cross-protection from prior exposure to other respiratory coronaviruses and higher adaptive immunity are touted, and likely, explanations.

This resilience of healthy children begs the question of whether they need to be routinely vaccinated against COVID-19.

Children have a very low rate of severe complication or death. It is striking that for each child death from COVID-19 in the US (about 400 in total), more than 1500 adults have died (> 600 000 deaths). The UK has had over 100 000 deaths in adults; there were just 25 child deaths in the year to March 2021, a rate of about two for every million children.

The annual number of Australian children that could be saved by COVID-19 vaccination is clearly very small. Australia has witnessed nearly 1000 adult COVID-19 deaths, with none in children. But could the impact on herd immunity of vaccinating children, by contrast, be of substantial benefit to others, especially adults? Quality modelling, just released by the Peter Doherty Institute, suggests not. Routine vaccination of well teenagers aged 12–15 years adds little to the reduction in COVID-19 transmission through the community.

What about long COVID-19? Long COVID-19, defined as persistence by 3 months of chronic symptoms such as breathlessness and “brain fog” (reductions in attention, concentration, reasoning and verbal expression), may occur in 5–15% of adult cases; more so if the case required intensive care, after which an average IQ deficit of 7 points has been described. Research on children just released from the UK shows that of nearly 2000 COVID-19 cases in children, less than 2% had persistent symptoms by 2 months’ follow-up — usually headache and fatigue, more often in older than younger children.

So, should children be vaccinated with newly developed COVID-19 vaccines when direct (acute COVID-19 and long COVID-19) and indirect (herd immunity) benefits are very limited, and when their long term safety and immunogenicity are still to be determined? Further, how can informed consent be well informed, with the unavoidable uncertainty over longer term (1 year or more) safety?

We suggest a pause for thoughtful discussion; child and adult deaths are so much more common in low income countries. Many adults in developed nations have received free vaccination, and some decide to payback and give forward by donating to the UNICEF COVAX facility to vaccinate highly at-risk adults and children in low income nations.

Considering what children have already suffered for the benefit of adults, through lockdowns and school closures, by way of damage to their education, socialisation and mental health (here, here, and here)  and the uncertain benefits of vaccination, let’s collect more real-world data on COVID-19 and its prevention by novel mRNA vaccines. Millions of US children have recently been vaccinated against COVID-19; let’s review the data as they become available.

Robert Booy is a former Director of the National Centre for Immunisation Research and Surveillance and an Honorary Professor at the University of Sydney. He chairs the Scientific Committee of the Immunization Coalition. He consults to all vaccine companies in Australia.

Professor Russell Viner is Immediate Past President of the Royal College of Paediatrics and Child Health. He is Professor of Adolescent Health at the UCL Institute of Child Health in London.




The statements or opinions expressed in this article reflect the views of the authors and do not represent the official policy of the AMA, the MJA or InSight+ unless so stated.


Children must be included in the COVID-19 vaccine rollout
  • Strongly disagree (68%, 1,384 Votes)
  • Strongly agree (26%, 522 Votes)
  • Agree (3%, 65 Votes)
  • Disagree (2%, 36 Votes)
  • Neutral (1%, 28 Votes)

Total Voters: 2,035

Loading ... Loading ...

12 thoughts on “COVID-19 and vaccination in children

  1. Anonymous says:

    It should as with everything be a choice. If parents feel that they need to have their children and themselves vaccinated so be it. No jab no pay play or even school is not an option and is dicriminating. Cultural, moral, religious and medical conditions and concerns should be respected and considered without discrimination of the choice of not being vaccinated. Afterall there is a 99% recovery rate from this disease

  2. Anonymous says:

    No vaccine for children

  3. M G says:

    When any of the vaccines are going to proven 100% safe and more importantly when their need is going to be warranted, then this notion of using children as guinea pigs can be entertained.

  4. Anonymous says:

    Since mRNA and DNA vaccines are effectively “bit” vaccines and as such may induce “immune original sin”. The failure of the AstraZeneca vaccine in respect of the Beta variant may be instructive. It may be better to allow child population reinforcement of adult vaccine immunity to possibly create more comprehensive and adaptable immune responses over time rather than attempt to chase variants with updated vaccines. Perhaps more preventative action in respect of preventing lifestyle co-morbidities may be more effective than attempts to mass vaccinate for a range of respiratory viruses.

  5. Anonymous says:

    Children are not Guinea pigs, either are adults for this matter, however children are more vulnerable and have not yet built up a natural immune system response to deal with the vaccine side effects.

    This should be done naturally S this is what our bodies are designed to do.


  6. Caz says:

    With so few deaths in kids globally, I see no risk/benefit ratio for them. And if we argue they get vaccinated to save Grandma, then that argument is only valid with a vaccine that promotes sterilising immunity which we see these don’t.

  7. Meryl Dorey says:

    The idea of using children as guinea pigs for an experimental jab to try and prevent an infection where they are not at risk of long or short term severe consequences shows us once again how important the Nuremberg Treaty truly is in this day and age.

  8. Dr. Alexandra Bernhardi says:

    Thank you to the authors of this well-balanced article.
    We need to stop making fear-driven decisions and start applying evidence-based and holistic concepts.

  9. John B. Ziegler says:

    While it is true that children suffer less in the way of physical harm from SARS-CoV-2 infection it could be argued that were a child to bring the virus home to his or her family the harm to the child could be considerable via such potential resulting effects as financial and emotional and social impacts on the child. IN any case, the risk of infection and disease for the child is not zero while the vaccines are very safe. I would like to see a calculation of the risk of disease versus the risk associated with the vaccine, especially in a high prevalence setting.

  10. Anonymous says:

    Novel vaccine technology.
    No long term safety data.
    Emergency use authorisation.
    Manufacturers’ liability waived by law.
    I’ll give my kids a pass.

  11. Margaret Heffernan, OAM, PhD says:

    With the uncertain benefits of vaccination, I support the cautious approach of “let’s collect more real-world data on COVID-19 and its prevention by novel mRNA vaccines” before we rush and vaccinate Australian children. This article makes a compelling case for an evidence -based decision. We have no data on the long term impact. In the meantime, education of and compliance with hygiene and prevention approaches (e.g. masks, social-distancing, hand washing, nutrition) needs to be reinforced within school settings.

  12. Anonymous says:

    Children aged between 12-15 years living in boarding schools should be included in the priority groups to prevent outbreaks in schools.

Comments are closed.