LONDON — To vaccinate or not to vaccinate? The question is harder when it comes to kids.
While the U.S. and most of the EU offer coronavirus vaccines for children aged 12 and over, several European countries — including the U.K., Sweden and Portugal — are currently more cautious. In that trio of countries, only children aged between 12 and 15 at risk of severe illness from coronavirus can get a shot.
Last week, the committee advising the U.K. government on vaccination gave the go-ahead for 16-year-olds and over to get jabbed, putting the U.K. on par with Sweden, Finland and Portugal. Finland then went further on Thursday, opening up the offer to all aged 12 and over and joining at least 16 other EU countries in allowing all teenagers to get jabbed.
The reason for differing approaches lies not with contrasting evidence but because of tricky risk-benefit calculations made by expert advisory committees, who balance the risk of coronavirus to individual children with the risk of being badly affected by the virus.
“That balance of opinion can be different depending on who’s on the deciding committees,” said Brian Ferguson, an immunologist at the University of Cambridge. “This is when it starts to become more about ethics and opinion, and almost a philosophical discussion, as opposed to [about] the data.”
In the U.K., for example, Ferguson sees the official advice as clearly emphasizing the individual risk, in particular the very small risk of heart inflammation after vaccination. Elsewhere, such as in France and Belgium, the explanation for allowing everyone aged 12 and over to choose to be vaccinated rests on the desire to reduce overall infections in the community, even more critical in the face of more infectious variants such as Delta.
“We always have two goals: to protect the individual, but that individual’s protection also contributes to a protected community,” said William Schaffner, a professor of infectious diseases at the U.S.’s Vanderbilt University Medical Center.
He emphasized that while the risk of severe COVID is low in teens, it’s not zero. Around 400 children have died from coronavirus in the U.S.
“That’s a lot of children who could be living today had we been able to vaccinate them … So we’re protecting individuals, as well as the community. I think you can keep two thoughts in your mind at the same time,” he said.
But in the U.K., Adam Finn, professor of pediatrics at the University of Bristol and member of the committee advising the U.K. government on vaccination, said that they are “anxious to take a stepwise approach.”
“We absolutely don’t want to get into a position where we move forward and then wish that we hadn’t made the decision and try to move backwards again,” he said. “You can immunize people but you can’t un-immunize people.”
Pushback
Some experts are frustrated that those guiding their government are being so cautious.
A group of British researchers have published a pre-print, which isn’t yet peer reviewed, indicating that children in the U.K. would benefit from vaccination even on the individual level. “The U.K. strategy is out of line with many other countries, including U.S., Israel, and much of Europe & SE Asia,” tweeted one of the authors, Deepti Gurdasani.
A new poll also indicated that most Britons support including all teenagers aged 12 and over in the vaccination campaign. Some ministers, too, oppose the experts’ caution, according to both the Guardian and the Daily Mail.
Elsewhere, politicians have overruled their expert advisers. In Germany, where the committee advising the government on vaccination only explicitly recommended the vaccine for teenagers with comorbidities, regional health ministers decided unilaterally to offer the vaccine to all aged 12 and over.
The majority of EU countries have taken this broader, societal approach. Belgium’s official expert opinion concludes that the individual benefits for children “are small” but that one of the objectives around offering vaccination is to limit circulation of the virus and help prevent the rise of new variants of concern.
France gives similar justifications for allowing all teenagers to be vaccinated, with the government writing that this would help to reduce the impact of the pandemic and allow children to return to a more normal life while protecting those more vulnerable around them. And in the Netherlands, the government acknowledges that the recommendation is being given to protect against the possibility of Long COVID, and for schools and children’s sporting activities to remain open.
A matter of time
As more teens are vaccinated globally, more evidence becomes available.
It’s more a question of when, rather than if, countries will expand vaccines to teenagers, said Beate Kampmann, professor of pediatric infection and immunity at the London School of Hygiene and Tropical Medicine. The U.K.’s advisory committee has been awaiting new safety data to inform their decision, Kampmann explained. So far, it makes sense the country opened shots to 16- and 18-year-olds because they will go onto higher education shortly and are more likely to go to clubs and festivals, where the virus could spread.
“It makes sense to include them next and get the logistics in place to first vaccinate this group in an attempt to stagger the age groups further downwards,” she said.
Defending the different approaches across Europe, Finn — member of the committee advising the U.K. government on vaccination — said that it’s expected vaccination recommendations will vary across the world, largely due to the differing epidemiological picture. By way of example, Liz Whittaker, infectious disease lead at the Royal College of Paediatrics and Child Health, said that there is a “significant difference” in data on hospitalizations, deaths and the occurrence of inflammatory conditions in children following infection in the U.S. and the U.K. Underlying comorbidities such as obesity have influenced disease severity in the U.S., she said.
“I think the idea that [all countries] can be doing the same thing is clearly flawed in the first place,” Finn said in a briefing to journalists on Wednesday.
Everyone agrees that the risk of severe illness and death from coronavirus in children is extremely low. A July study indicated that while some children with pre-existing medical conditions and severe disabilities had a higher risk, the risks were “very small compared to risks seen in adults” even in these groups.
Another concern is whether children with coronavirus are likely to develop Long COVID, when symptoms linger weeks or months after contracting the virus. Recent evidence from the U.K. paints a positive picture, indicating that just a small number of children showed long-lasting symptoms.
What experts and politicians can’t seem to agree on is whether the benefit to society from having teenagers vaccinated tips the scale in favor of opening up the offer of a jab to all.
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