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Should children get the COVID-19 vaccine?
Around the world, some countries have been opening up their vaccination programmes to under-18s. With the vaccination programme in the UK continuing apace, the Government is still considering whether to follow suit. But with children seemingly less susceptible to the virus - and with just 25 under-18s dying in the whole of the UK in the first year of the pandemic - would this be the right call?
Benefits for children
Risk of long COVID
With children's risk of dying from COVID-19 so low, not everyone is convinced that vaccination is necessary in this age group. Even serious illness is extremely rare - in the first year of the pandemic in the UK, 1 in 50,000 under-18s were admitted to intensive care as a result of COVID-19. However, looking at death rates doesn't paint the whole picture.
"While the death rate is thankfully extremely low in children, it's not the case that kids don't get ill with coronavirus. Just counting deaths is something that is the tip of the clinical iceberg. Many thousands of children have been hospitalised with COVID-19 during the course of this pandemic," explains Dr Stephen Griffin, virologist and Associate Professor at Leeds Institute of Medical Research. "There is also good evidence now that somewhere around 8% of children who get infected with COVID-19 develop long COVID."
The symptoms of long COVID include an ongoing cough, joint and muscle pain, breathlessness and even damage to major organs such as the heart, lungs and kidneys. Based on that risk alone, it is clear that COVID-19 may not be life-threatening, but it may well have a serious impact on children's lives.
A stable environment
It's important to remember that even children who aren't physically affected by the virus have had their lives turned upside down for the past 18 months due to the impact on the wider population.
"Look at the impact on staffing in schools, the size of the bubbles that need to collapse when there's an outbreak, the rigorous routines schools are having to follow in order to go about their business," says Griffin. “Also consider the transmission amongst the community which is mirrored by schools and propagated by schools to an extent. This would all be minimised if children have their jabs."
Therefore even though children do not seem to be particularly susceptible to COVID-19 the vaccine will work to protect the stability of their lives - schooling, exams, and future work can all fall into a more predictable rhythm as COVID-19 is reduced.
Is it safe?
It's natural for parents to worry whether a relatively new vaccine is safe for their children. But those with concerns should be reassured by the current data, which not only suggests that vaccines are safe, but that they may have an efficacy of up to 100% in some children.
"The trials aren't as big as adult trials, but so far they've had extremely positive safety reports, and up to 100% efficacy in some cases," says Griffin. "There are also real-world data - for example, Israel has vaccinated teenagers without problem."
There has been some concern over a small number of cases of myocarditis and pericarditis (inflammation of the heart muscle) occurring in young people following their second dose of the Pfizer mRNA vaccine. The cases remain very rare - just a few hundred out of millions of vaccinations given - and the majority of these have resolved without additional care.
"If this does prove to be an issue, it may well be improved by reducing the initial dose, or increasing the gap between doses," says Griffin. “And other vaccines are coming online at a rapid rate.
"With any medicine you have to balance the potential harm with the potential benefit and my belief is that the potential benefit is profound."
Because of the much lower risk to children and young people from COVID-19, it is crucial that any possible health risk from the vaccine is outweighed by the benefits - which the World Health Organization stated is the case in their updated guidance.
What about those overseas?
Of course, COVID-19 is a worldwide pandemic. And sending 'spare' vaccines out to vulnerable countries remains a priority, both for altruistic reasons and to reduce the risk of new mutations arising in other countries and arriving on our shores. One of the arguments against vaccinating children is that it's unethical to vaccinate young people at low risk in the UK when in some countries, 95% of the population doesn't have access to the vaccine.
Likewise, there are concerns that 'Nobody is safe until we're all safe'. In other words, if large swathes of the world population remain unvaccinated, there is more scope for yet more dangerous COVID-19 variants to emerge.
But whilst helping others is crucial, it does not have to be an either-or situation. "If you look at the amount of vaccines we've bought in the UK - around half a billion - we're not going to have a shortage. To vaccinate children will just take a fraction of these vaccines," explains Griffin.
As well as the vaccine reducing the direct risk to children from COVID-19, vaccinating this demographic will also benefit society as a whole in a number of ways.
Creating herd immunity
In addition, vaccinating children will reduce the amount of virus circulating in the general population. This will help the UK get closer to so called 'herd immunity'.
"Real 'herd immunity' means having a sufficient number of the population vaccinated so that when you do get outbreaks - and you will get outbreaks - the number of susceptible people it can spread to is so limited that it won't become an exponentially growing epidemic but self-limiting," explains Griffin. "Now that we have the highly-transmissible Delta variant, this may mean vaccinating up to 90% of the population, including children."
Reducing the risk of new variants
Over time, viruses tend to mutate and alter - which can lead to more dangerous or transmissible variants occurring, as in the case of the Delta variant. The more of the population vaccinated, the less likely it is that this will occur. And leaving the job 'half done' may actually increase the risk of mutations occurring. "The worst situation you can have in terms of a new virus variant is to have insufficient numbers of people vaccinated, or a mixture of vaccinated and unvaccinated people with high prevalence of the virus - this puts pressure on the virus to change. If you let it run in school kids who aren't vaccinated but whose parents are, it's a dangerous idea," explains Griffin.
Finally, it goes without saying that children don't stay children for ever. Leaving children unprotected may mean a generation of vulnerable adults in just a few years' time. "Children get older, and COVID-19 is going to be out in the world for years to come. So if we do the roll-out and then stop, eventually school-aged children will grow up and become adults and we'll have another outbreak."
"The best way of ensuring ongoing protection is incorporating it into the school vaccination programme," explains Griffin. "This is illustrated by the outbreaks of measles and mumps we've had in recent years in young adults who weren't vaccinated against these diseases in childhood. These diseases are serious - people die. But they are vaccine-preventable.
"COVID-19 is also now a vaccine-preventable disease. The UK is in a privileged position. We have bought up all these vaccines and this obliges us to do the job properly."