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.