University of Oxford
COVID-19 is a serious disease for some parts of the population, and its risks are unevenly distributed across different age groups. As a result, it is important that we critically and ethically assess how we treat these different groups, carefully evaluate different risks and benefits, and are clear about why we make the policy decisions that we do. This is what it means to take responsibility for policy decisions about pandemic response. In this particular case, taking responsibility requires that we are clear about what reasons actually do and do not support child vaccination at this point in time.
In a short commentary published with Prof Sunetra Gupta and Prof Carl Heneghan a few months ago, we pointed out that current evidence does not support mass vaccination of children against COVID-19. Quite simply, there is no known net benefit for children in receiving a COVID-19 vaccine at this point in time. Children are at very low risk of death and of serious complications from COVID-19 and we don’t know what the risks of vaccinating children are. As we saw in the case of the vaccine roll-out in adult people, some of the risks of vaccines (such as myocarditis or blood clots) become apparent only after mass vaccination has started. If we focus on the health of the individuals receiving the vaccine, the small risk of vaccines is worth taking for a population at higher risk of death or serious complications from COVID-19. But, by contrast with the adult population, children are not at significant risk from COVID-19: even the risk of “long covid” is significantly associated with age, as is the risk of death. Given the uncertainty around the actual risks of vaccines, we cannot confidently say that it is in children’s best interest to be vaccinated at this point in time. In fact, the JCVI made exactly the same point. As they state in their recommendation, “When deciding on childhood immunisations, the JCVI has consistently maintained that the main focus should be the benefits to children themselves, balanced against any potential harms to them from vaccination”. And also “There is evidence of an association between mRNA COVID-19 vaccines and myocarditis. This is an extremely rare adverse event. The medium- to long-term effects are unknown and long-term follow-up is being conducted. Given the very low risk of serious COVID-19 disease in otherwise healthy 12 to 15 year olds, considerations on the potential harms and benefits of vaccination are very finely balanced and a precautionary approach was agreed.”
Against the Joint Committee on Vaccination and Immunisation (JCVI)’s advice that did not recommend COVID-19 vaccination for children, the four Chief Medical Officers in the UK have just recommended that all children aged 12-15 should be vaccinated with the mRNA Pfizer/BioNTech vaccine. This is a double ethical mistake, given our current state of knowledge.
Vaccinating children might give us (adults and more vulnerable people) some more peace of mind, but we are not entitled to peace of mind if it comes at significant cost to children.
Oxford Uehiro Centre for Practical Ethics
This is the second ethical mistake: we are assuming that the appropriate, or even inevitable, response to children getting infected is closing schools and isolating children. This is part of a broader approach to pandemic response measures, where we attribute the harms imposed by the decision to close schools and to lock down society to the virus itself. There is no reason to simply assume that we should isolate an entire classroom or even school when some child in it tests positive. Given high rates of vaccination among vulnerable populations, widespread testing facilities, and the recognition of the harm caused to children through online schooling and self-isolation, the response to a positive case among children should arguably be re-assessed. Isolating healthy children that we have no good enough reason to believe are infected and infectious is a choice we make, it’s not something caused by the virus. We could and arguably we should choose otherwise if we think that the harms to children of isolation and school closure outweighs any harm that COVID-19 poses on them.
There might well be some benefit for the adult and vulnerable population in vaccinating children, in terms of reducing the chance that a child may infect others. If children are vaccinated, they are less likely to become infected, and so they are less likely to pass the virus on to others. Some benefit for the more vulnerable would remain even if vaccines are not very effective at stopping transmission (especially with the Delta variant): to the extent that they prevent infection, they also reduce the risk of asymptomatic individuals passing on the virus. However, the public health benefit is vastly reduced by the vaccines’ relatively low effectiveness at preventing transmission. In any case, even if that benefit is considered important enough, we need to be clear that the justification for vaccinating young people needs to be based on public health considerations and on the desire to protect vulnerable groups. It is not about protecting children.
This is the first ethical mistake: we are (once again) treating children as mere means.
But if the risk we impose on children in order to protect other people is too high (also in proportion to the benefit we can expect), the decision is unethical because we would simply be treating children as mere means in order to protect others, as arguably we have already been doing throughout the past year and a half with indiscriminate lockdowns and school closures. First ethical mistake
Interestingly, the Chief Medical Officers do not deny the points made above. They are not claiming that vaccination is in children’s best medical interest, as they evidently accept the point that the risk of COVID-19 for young people is not sufficiently high for that. What they claim is that vaccinating children would be overall beneficial to them because it would prevent the side effects of disruption in school education. They state that vaccination in that age group is “an adjunct to other actions to maintain children and young people in secondary school and minimise further education disruption and therefore medium- and longer-term public health harm”.
Second ethical mistake
We are in a situation where teachers and other potentially vulnerable people that children might interact with have been offered two doses of vaccines that are extremely effective at preventing serious symptoms. To simply assume that children catching COVID-19 would result in school disruptions, and to use this as a reason to recommend vaccinating young people, is a mistake. At the very least, the assumption should be questioned and critically assessed. Otherwise, we would be blaming a virus for outcomes that are the result of our own decisions. Which would be a way to evade responsibility for the harm we are imposing on young people.
A recent study suggests that at a time of ‘moderate’ rate of COVID-19 hospitalizations, teenage boys are 6 times more likely to suffer from heart problems after the vaccine than to be hospitalized for COVID-19 related complications.
University of Oxford