The question of whether or not to inoculate children against Covid-19 has been a key subject of debate, but now the government has taken a decisive step. The Joint Committee on Vaccination and Immunisation (JCVI) is recommending that all 16- and 17-year-olds are offered a first dose of the vaccine, with no need for parental consent.
Much of the debate centres around the health risks posed to children by Covid-19, which remain extremely low: they are being vaccinated not for their benefit, but for that of the rest of society. Yesterday, as the government made its announcement, new research from King's College London showed that the few children who do become ill with coronavirus rarely experience long-term symptoms, with most recovering in less than a week.
However, data has shown that older teenagers are one of the groups with the highest rates of infections. The Government’s change of heart comes amid growing concerns that unvaccinated teenagers will drive a new wave of cases once schools reopen in September.
"The majority of transmission in recent months has been pinned on secondary schools and adolescents, and we know that being vaccinated reduces transmission by about 50 per cent,” says Beate Kampmann, a paediatrician who directs the London School of Hygiene and Tropical Medicine’s Vaccine Centre.
So while an ethicist might question the argument for vaccinating a healthy group of people with a vanishingly small risk of becoming ill with Covid, an epidemiologist would argue this is outweighed by the benefits for the race against the virus. Scientists are worried that children could play a key role in transmitting the virus to unvaccinated populations – such as vaccine skeptics who have refused the jab – or older individuals who did not mount a proper immune response to their vaccines, leaving them vulnerable. The rise of the Delta variant in recent months has also made limiting viral transmission chains with society even more critical. A growing number of studies demonstrating that Delta can contribute to so-called “breakthrough infections”, where even those who have been doubly vaccinated end up contracting Covid-19.
While coronavirus vaccines have been authorised for 12- to 16-year-olds in the US and a number of other countries including France, Spain, Israel and Japan, the UK has taken much longer to go ahead. Decisions have been complicated by a number of reports in the US – where the vaccine has been available to over-16s since last December, and all over-12s since May – linking the jab to cases of myocarditis or heart inflammation. While this appears to be a very rare side effect – a recent analysis from the US Centers for Disease Control and Prevention estimated that for every million second dose vaccinations of children aged 12-17 over 120 days, there are somewhere between 64 and 79 cases of myocarditis – the JCVI has been cautiously assessing the data in recent months.
One of the reasons the JCVI has been particularly wary is that it is very rare for a vaccine to induce this kind of side effect. While myocarditis in children can be triggered by a variety of causes, ranging from bacterial and fungal infections to autoimmune diseases, only a handful of immunisations have previously been linked to the condition.
There are increasing reports of parents in the US becoming reluctant to let their children have the vaccine, due to safety concerns. Here, a recent YouGov poll showed more than half of parents would be willing to have their children vaccinated against Covid-19, though one in five said they would not and another 29 per cent were unsure.
But scientists say that the risks have been overblown. Of the cases of myocarditis that have occurred, most have been swiftly treated with steroids.
“It is a very rare safety event, and on balance, the data shows that the benefits of receiving the vaccine still outweigh the risks,” says Kampmann. “Overall, it is not a serious condition, so people shouldn’t be deterred from using the vaccine.”
For Judith Guzman-Cottrill – a paediatric infectious diseases specialist at Oregon Health & Science University who identified some of the first reported cases of vaccine-induced myocarditis in adolescents earlier this year – the decision to have her 13 year old daughter immunised against Covid-19 was ultimately a straightforward one.
Guzman-Cottrill was not only concerned about the health risks coronavirus might pose to her daughter, but the potential long-term impacts of the continued disruption to her education from the pandemic. “Looking at this autumn, the goal is to try to get children back into the classroom,” she says. “A lot of kids are seeing vaccination as their pathway back to a normal life, their pre-pandemic life. And that's how my daughter saw it.”
However, in the UK, the JCVI is still awaiting more data on the potential benefits of vaccinating younger children before following suit. It remains to be seen whether the vaccines will be authorised for use anywhere in under-12s. Pfizer and Moderna are both conducting clinical trials in this age group to assess safety, with results expected in the autumn.
One of the key question marks about inoculating younger children is whether the vaccines administered to adults are still suitable for the developing immune system. Vaccines often need to be tailored specifically for young children because they are more likely to have a reaction. Pfizer and Moderna are trialling Covid vaccines on children as young as six months of age, using lower concentrations. But Kampmann says that more data is still required before decisions can be made on this. “You need to take safety extremely, extremely seriously,” she says. “It’s important to make sure that there isn’t anything else untowards emerging.”
However, unless there are serious risks – and despite previous noises from the Government – it is now seemingly inevitable that the UK’s vaccine rollout will continue in younger age groups, as what many scientists see as the only definitive means of ending the pandemic.
“I really feel children are part of the herd when we talk about herd immunity,” says Guzman-Cottrill. "This pandemic has been really challenging for them, the isolation has really taken a toll. Vaccines offer a way of returning to a semblance of normality.”