Tfour chief medical officers (CMOs) in the UK have recommended that vaccinations against Covid-19 be offered to all children aged 12 to 15 years. reason to recommend vaccination of healthy young people aged 12-15 without any other medical in other words, that the profit margin is too small to be worth it. But CMOs have also been asked by the Secretary of State for Health and Social Care to consider the potential benefits of education and mental health – issues outside the remit of the JCVI.
Decisions to vaccinate children have several moving parts. We need to balance the risks and benefits of vaccination for the young person themselves, while taking into account the ethical issues involved in ensuring an overall increase in vaccination rates for children in the wider society – this group is less likely to have severe Covid symptoms themselves.
Only Pfizer and Moderna mRNA vaccines are considered for children, both of which appear to be very effective in this age group for whom CMOs have recommended only a single dose. There are about 2.6 million young people aged 12-15 in England and 350,000 have already been offered two doses as they are at higher risk of complications due to their significant medical condition.
The data suggest that a vaccine is about 55% effective in preventing infection; based on this modeled by the Department of Health, if 60% of the 2.2 million currently unvaccinated teenagers in the UK receive a single dose, this would prevent about 30,000 infections in this group over the next six months.
The main concerns about vaccinating children are known and unknown side effects. The main concern is rare heart disease (myocarditis or pericarditis), which, according to U.S. data, appears to occur 160 million times in boys aged 12-15 and 13 million girls, especially after the second shot. Most cases are mild, but there are a small number of arrhythmias, although these are rarely severe. Other unknown side effects may occur, but are likely to be disappearing rarely, given that more than 11 million teenagers have been vaccinated worldwide.
My colleagues and I analyzed data for the whole of England from the first year of the epidemic, which showed just nine deaths among 12-15 year olds, at a time when more than 100,000 adults have died from Covid. Although the deaths of any child are too many, seven of them have died from other serious illnesses and are already eligible for vaccination. In the same year, about 150 young teens were admitted to the intensive care unit because of problems with Covid, in most cases under different circumstances.
Summarizing these figures, it can be concluded that English vaccination of 12-15 year olds who are not yet eligible for vaccination can reasonably be expected to result in two deaths and 30-40 intensive care in one year, but at the cost of up to 170-180 cases of myocarditis – all likely to be mild. For society as a whole, these numbers are very small, although of course devastating for those involved. The decision of the co-market organizers to administer healthy young teenagers only once dramatically reduces the risk of myocarditis, but also reduces the chances of preventing diseases caused by – very rare – serious infections.
Vaccination may also reduce post-Covid syndromes. It is best estimated that 2-14% of children and young people have more persistent symptoms after infection, although the vast majority recover very quickly.
The wider benefits of vaccinating children between the ages of 12 and 15 potentially include less disruption to education, which has played an important role in the decision on the CMO. The interruption of the summer semester was largely due to the mandatory isolation of large school bubbles, which has now been replaced by a daily antigen test at school. However, vaccination will reduce the number of infected children and drop-outs – the benefit will be about 100,000 fewer days of school loss over the next six months.
The benefits for the wider society are largely due to a possible reduction in transmission. At the time of the epidemic, children who took infections home from school were a problem. It is difficult to give an exact number of how many cases can be averted, and our hopes that vaccines will prevent transmission have died from the Delta variant. The benefits of preventing transmission are reduced if teens receive only one vaccine, although high natural immunity (about 40-60% of teens have antibodies) can help with this.
Medically, vaccinating children and young adolescents in this group has low personal benefits and low risks, and these risks are very subtly balanced. The CMOs considered that the wider benefits, especially in relation to keeping children in school, changed the decision to offer vaccination to reduce the damage caused by the epidemic. I strongly support this decision, and it is right that it will be made now that we finally have enough safety data to support vaccination of young teenagers. In the future, decisions will be made to vaccinate even younger children, which may make this decision seem like a walk in the park.
Any vaccination is only as good as the number of people vaccinated. Great results have been achieved so far in the UK, but the low benefits for individual children make it very likely that some parents and young people will hesitate. Data on parents are reassuring, with 86% of a recent survey reporting that their child would be vaccinated. However, staff at the OxWell Student Survey found that hesitation can be much greater for younger teenagers themselves, especially from poorer families.
Experience and data show that vaccine uptake is likely to be lowest in poorer families, as both have suffered the most from Covid and their children have lost the most schools. Offering vaccines to younger children and teenagers was the right decision, but we need to work directly with them to address the concerns and develop new ways to reach vaccinating families to make the whole program a success.