Vaccinating all 12-15-year-olds against Covid has not been recommended by the UK’s advisory body, though it has issued guidance that children with particular health problems should be offered the jab.
Chief medical officers in the four nations will now have the final say on vaccinating all teens, after ministers asked them to look at “a broader perspective” than health alone.
What we do know?
There is general agreement that this was a really tricky call to make.
Scientists, doctors, teachers, and parents have all voiced their strong opinions.
The Joint Committee on Vaccination and Immunisation (JCVI) has focused solely on the health benefits of vaccination for children, rather than the impact on their education or other people.
Children’s risk from Covid isn’t zero but the chances of them becoming seriously ill from Covid are incredibly small. Deaths among healthy children are extremely rare – most have life-limiting health conditions.
That means there needs to be a clear and obvious advantage to giving them a jab.
However, a very rare side-effect of the Pfizer and Moderna vaccines has made that calculation a lot more complicated.
According to Paul Hunter, professor of medicine at the University of East Anglia, the JCVI has been under a lot of pressure, and he understands why they are being cautious.
“I’m not sure what the answer is – I’m on the fence about it. There isn’t enough information to be certain.”
So what are the unknowns?
According to research on millions of people who have received the mRNA vaccines (Pfizer and Moderna), there is a very small risk of myocarditis, or heart inflammation, which is more common in young people – particularly younger boys – after a second dose. It can cause chest pain and a racing heart, but symptoms usually go away within a few days.
No vaccine or drug is ever completely safe, and data from the United States shows that the number of children affected is very small.
For every million Pfizer second doses given to 12-17-year-old-boys, around 60 had the condition (compared with 8 in a million among girls). The rates in this age group are higher than in older ones – and it’s why only one dose for 16 and 17-year-olds in the UK has been recommended, for now.
However, being infected with Covid has health consequences for teenagers, including their hearts, so how serious is that risk?
“A key unknown is the risk of myocarditis from Covid infection itself,” says Prof Neil Ferguson, an Imperial College London government adviser.
“If it is comparable to or higher than from vaccination, vaccination is more likely to be beneficial.” But he says it’s “impossible” to provide a definitive answer right now.
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Why have other countries come to a different conclusion?
Just because countries have access to the same data does not mean they will reach the same conclusion on this delicate issue.
Countries are influenced by a variety of factors, ranging from adult vaccination rates to political pressure and fears of another Covid outbreak.
The US, for example, has vaccinated more than 10 million over-12s and concluded that the benefits of protecting against Covid illness and its complications “far outweigh” the small potential risk of an adverse reaction to the vaccine. France, Italy, Canada, Spain and Israel are all vaccinating this age group for the same reason.
But the US is also seeing sharp rises in children’s hospital admissions in some states with low vaccination rates. There are also widespread fears that the delta variant, which spread through the UK earlier this year, could dominate there.
The UK, in the form of the JCVI, is placing more importance on the safety of vaccines to children, compared with the benefits they bring. The long-term effects of myocarditis are still unknown and that’s a major sticking point for the JCVI, although it says a few more months’ follow-up data could offer more insights.
With a national health service, the UK can quickly and efficiently target high-risk groups of children for vaccination, which countries with more fragmented health systems find more difficult.
It is clear that the United Kingdom is becoming more of an outlier. Until a few weeks ago, Germany’s policy was similar to that of the United Kingdom, but it has since changed course, moving from vaccinating only vulnerable adolescents to all over-12s.
The country’s independent vaccine committee cited more reliable US risk data, uncertainty about the scale of long Covid, and the possibility that delta would cause more infections in that age group.
Prof Christina Pagel, from University College London, believes the case for vaccinating three million younger teens in the UK is “overwhelming” and points to a recent US study for grounds for this. It suggested having Covid-19 could be six times more likely to trigger myocarditis in young men than the vaccine, with a rate of about 450 per million infections.
But the JCVI’s caution may mean it’s not persuaded by the data it has seen to date. The last thing it wants is to give the go-ahead and then for a series of adverse events to dent parents’ confidence in other childhood vaccines.
What would jabbing children achieve?
Vaccinating secondary school-age children would not prevent the virus from spreading in schools or society as a whole.
“Even if every person in the UK was immunised – and their pets – the virus would still spread,” Prof Hunter says.
Vaccines for teenagers, on the other hand, are still likely to reduce infections in that age group and could help keep more children in school over the winter, though it’s unclear how much it would limit wider community spread.
According to the government’s scientific advisers, 40-70 percent of children in secondary schools may have been infected by the start of the school year, implying that many have some built-in protection.
Taking a broader view of the benefits of vaccinating children may influence the JCVI’s decision, but “that’s a very difficult judgement,” according to Prof Calum Semple of the University of Liverpool.
Then there’s the question of whether encouraging more over-18s to get vaccinated would be a more fruitful goal, given their higher risk, with more than 12% still refusing to get one.
It could be, but that isn’t the JCVI’s primary focus. In the end, it comes down to a fine balance between a very rare side-effect of the vaccine and a very low risk of Covid to children themselves.