This is a very current issue and was discussed in an editorial in The Lancet dated June 10th, 2021. 

The phase 3 trial for the Pfizer vaccine showed that it was efficacious, immunogenic and safe in children aged 12-15 years.  This data led to various countries authorising the use of the vaccine in this age group. 

However, reaction to this news has been mixed.  Although it is considered likely that children will have to be vaccinated against SARS-CoV-2 eventually, there is a question of whether now is the right time. 

Many public health figures think not.  The reason for this is that children typically experience only mild illness and many of the world’s low income and middle income countries are reporting vaccine shortages. 

Countries with enough doses to cover their children may wish to consider donating excess doses to countries that do not have enough vaccine to immunise the extremely vulnerable, older person and frontline health workers. 

A report published by the European Centre for Disease Prevention and Control on June 1st lists important considerations for public health authorities in the EU and European Economic Area countries to consider when vaccinating their children and adolescents. 

The report proposes that decisions should be made bearing in mind vaccine uptake in older age groups, the incidence of COVID-19 in the general population, and notably, issues concerning availability and access to vaccines on the global scale. 

The report emphasises that children and adolescents will experience few direct benefits from being vaccinated; rather, the goal would be to increase overall population immunity and reduce transmission. 

In some countries, vaccinating children might be a way to overcome low levels of vaccine induced population immunity due to high rates of vaccine hesitancy amongst adults. 

However, parental consent is required to vaccinate a child, and it is unlikely that parents who do not want the vaccine themselves will want it for their children. 

If the goal of childhood vaccination is to reduce transmission, it is important to consider and quantify the contribution of children and adolescents to the transmission of SARS-CoV-2.  

So far in the pandemic, evidence on this role has been scarce and conflicting.

Whereas some studies have reported higher secondary attack rates from child and adolescent index cases than from adult index cases, others reported the reverse.

Moreover, there is evidence of SARS-CoV-2 transmission in educational settings is a reflection, and not a driver, of community transmission.  Therefore, it is unclear what impact vaccinating children will have on transmission. 

Even within children, there appears to be an age gradient, with younger children seemingly less susceptible to SARS-CoV-2 and less likely to pass it on.  

Therefore, vaccination of older children might be more beneficial than a vaccine strategy that targets all children aged 12-15 years or younger. 

Overall, the ECDC report stresses that the decision to vaccinate younger age groups should consider the individual benefit risk ratio.  

The Pfizer vaccine appears well tolerated in children aged 12-15 years, although the study was too small to identify any rare side effects.

As for adults, the children who will benefit most from the vaccination will be those with underlying conditions, such as:

  • Cancer
  • Cardiac disorders 
  • Diabetes 
  • Hypertension 
  • Kidney disease

These have been shown to confer a risk of hospitalisation that is similar to the risk in some adult age groups without underlying conditions. 

Vaccinating children and adolescents will prevent long-term sequalae associated with SARS-CoV-2 infection, of which the burden in children is uncertain, and multisystem inflammatory syndrome, which has been shown to affect some children who have experienced only mild acute infections. 

Vaccination of children might also improve their mental health and wellbeing and facilitate a return to normality, including resumption of education and social interactions important for the child’s development. 

In many parts of the world, children and adolescents are contributing to an increase in proportion of total cases.  

This change in age distribution is thought to be driven by the emergence of highly transmissible variants such as:

  • Increased testing amongst school aged children 
  • Low adherence to non-pharmaceutical interventions
  • Increased social interactions as restrictions are lifted
  • Increasing immunity amongst older age groups following vaccine rollout. 

Thus, there might be a case for vaccinating children in the not too distant future. 

However, whether at present the children of high income countries should be prioritised for vaccination over vulnerable adults in low income countries is a matter of serious ethical and practical debate. 

The London General Practice commends the Government on its vaccination programme.  

The London General Practice is proud to be on the Government website for all forms of COVID testing including:

Dr Paul Ettlinger

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