Australia’s Therapeutic Goods Administration (TGA) recently announced provisional approval for the Pfizer vaccine to be used in 12 to 15-year-olds.
We learned on Monday that the Australian Technical Advisory Group on Immunisation (Atagi) has advised that Aboriginal and Torres Strait Islander children aged 12-15, those who live in remote communities, and those with underlying medical conditions should be prioritised to receive the jab.
With Covid vaccination for kids being such a hot topic, we asked five experts whether we should vaccinate children in Australia against Covid-19. Four out of five experts said yes. Here are their responses:
Asha Bowen, paediatrician/vaccine expert: Yes
Yes, so long as we have a robust conversation about the direct and indirect benefits of Covid-19 vaccination for children.
Vaccination is a key tool in our arsenal for navigating the pandemic, with vaccine access prioritised for those with the greatest benefit – the elderly first. We’ve known since almost the beginning of the pandemic that children are less likely than adults to be infected, and less likely to transmit the virus. They have milder illness and very few are hospitalised.
So vaccinating children and adolescents may not have a lot of direct benefits for them right now, but as we grapple with variants this balance could change. Vaccinating children may have indirect benefits such as schools remaining open.
The Pfizer vaccine effectively protects adolescents against Covid-19. We must balance this against known side effects that occur very infrequently.
Other countries are vaccinating adolescents aged 12 years and over. Australia has passed the first step with TGA approval of the Pfizer vaccine for 12–15-year-olds.
Studies have shown the Pfizer vaccine effectively protects adolescents against Covid-19. We must balance this against known side effects that occur very infrequently such as myocarditis (inflammation of the heart muscle) and pericarditis (inflammation of the lining of the heart).
So we could be vaccinating adolescents soon – an important conversation for families and teenagers to start having now. We await the trials for children aged six months to 12 years.
Catherine Bennett, epidemiologist: Yes
Assuming we have ample vaccine supply, and that this won’t be at the expense of Australia supporting vaccine access for healthcare workers and those most at risk globally, there are three reasons to consider vaccinating children.
First, for their own health – serious illness is rare, but does occur, and some can take a long time to recover.
Second, modellers will consider how much children transmit Covid-19 to others, and therefore their contribution to community transmission. Case rates are rising in younger age groups relative to adults overseas, but it’s hard to detangle the effects of vaccination (as more older people are vaccinated) from the increased transmissibility of the Delta variant. Whatever the reason, children are playing a greater role in transmission. So they are an important group to examine to see how vaccination would reduce infections and in turn the emergence of new variants of concern.
In Australia we’ve seen more transmission in schools in recent Delta outbreaks. Vaccination will help reduce infections in schools, and therefore the contribution of school transmission in outbreaks. So the third reason for considering vaccinating children is that this should at least partially protect schools from disruptive closures.
At a bare minimum, vaccinations should be available to children who live with or frequently visit people who are vulnerable.
Julian Savulescu, medical ethicist: No
Vaccinating children is ethically justified if one of two tests is satisfied. First, if it’s in the individual child’s best interests. Second, if it protects others by reducing transmission and represents little or no cost to the child.
As far as individual best interests, Covid-19 is a small but real risk for children. The Delta variant is more transmissible and perhaps more severe. Variants continue to form.
Serious Covid-19 vaccine side effects appear extremely rare. However, Pfizer’s trials only involved about 7,500 children. As other countries vaccinate children over 12, we can learn from their safety data. A small risk of myocarditis has emerged, particularly in boys and young men. Even a very small chance of a significant side effect needs to be carefully weighed against the likely small direct benefit for children.
In terms of collective interests, are high population vaccination levels, including children, necessary to protect the more vulnerable by reducing transmission? Early reports of Delta infections in the double-vaccinated suggest excellent protection against serious outcomes but a possibly limited impact on transmission.
We also have to consider broader collective interests with limited supply: uncontrolled global spread means more variants. At this point, it might be more pressing to send doses elsewhere than to vaccinate children in Australia.
For now, the direct risk-benefit ratio for children appears finely balanced: we could give parents and competent adolescents the choice, but there are higher priorities. We should concentrate on vaccinating the vulnerable, and gathering a stronger evidence base for the decisions to come. Rather than a firm “no”, my answer is “not yet”.
Margie Danchin, paediatrician/vaccine expert: Yes
The United States, Canada and some European countries have started vaccinating children over 12, while the UK has recently recommended vaccination of high-risk children over 12 and those living with immunosuppressed adults.
It’s a complex decision to vaccinate children, and Delta has changed the game. There are, however, three main benefits.
The first is the direct benefit, which is limited because symptoms are generally mild, the risk of severe disease is low (unlike for adults), and the frequency of long Covid not well understood. But as vaccine coverage increases in adults, cases will increase among the young and unvaccinated, as we’ve seen in Israel and the UK.
The second is prevention of transmission. It’s unclear to what degree vaccinating children will prevent onward transmission to adults and subsequent hospitalisations and deaths in older adults, especially once teachers and parents and other household members are vaccinated.
The third is protecting children and their teachers against symptomatic infection and school outbreaks. School closures significantly affect kids’ mental health, wellbeing, education, and social development – especially for more vulnerable children. It’s crucial we factor in the broader public health impact of Covid, not just prevention of severe disease.
Of course, the benefits need to be carefully weighed against the risks. Rare adverse events such as myocarditis, which occurs more commonly in teenage boys and young men after dose two of the Pfizer vaccine, needs to be carefully monitored.
In Australia, we should adopt a high-risk strategy in the first instance like the UK and include healthy children over 12 once high-risk children and young adults are vaccinated, and supply increases. We also need to closely monitor the impact of Delta on severe disease and transmission in children, learn from global surveillance data and wait for clinical trial data in younger children.
Nicholas Wood, paediatrician/vaccine expert: Yes
Over the past 18 months, we’ve seen children can contract Covid-19, but this tends to result in milder illness than experienced by adults. However, there can be serious outcomes of infection in children.
If we move to vaccinating younger adolescents, it makes sense to target higher-risk adolescents first.
We do expect over time and in the context of the current Australian outbreaks, the vaccine strategy will focus more on children. Provisional approval by the TGA for use in the 12-15 age group follows careful evaluation of the available data supporting safety and efficacy. A recent study on more than 2,000 12-15-year-olds found the Pfizer vaccine had a good safety profile. Most participants in the study had only mild side effects, such as pain at the injection site or a headache. Advice for parents on recognising the very rare side effect of myocarditis/pericarditis is in development.
Our priority at the moment should continue to be on vaccinating large numbers of adults to prevent deaths and serious illness, and therefore reduce the burden on our hospitals. If we move to vaccinating younger adolescents, it makes sense to target higher-risk adolescents first (for example, those with chronic diseases resulting in a weaker immune system).
It may well transpire that lower doses are sufficient for good protection in younger children, and trials are underway looking at this question.
• Asha Bowen is co-chair of the Australian and New Zealand Paediatric Infectious Diseases (ANZPID) group of the Australasian Society of Infectious Diseases. She receives research funding from NHMRC.
• Catherine Bennett has received NHMRC and MRFF funding, and is an independent expert on the AstraZeneca advisory board.
• Julian Savulescu receives funding from the Wellcome Trust. This work was supported by the UKRI/AHRC funded UK Ethics Accelerator project
• Margie Danchin is a member of Atagi’s working group on vaccine safety, evaluation, monitoring and confidence.
• Nicholas Wood holds an NHMRC Career Development Fellowship and Churchill Fellowship.
• Phoebe Roth, deputy editor, Health+Medicine, The Conversation