‘There can be no keener revelation of a society’s soul than the way in which it treats its children’ – Nelson Mandela
IF, A year ago, someone had asked if we should give children a brand-new vaccine with no long-term safety data for a disease that barely affects them, they would have been laughed out of court. But here we are today, considering doing exactly that and not even with the pretence that it is for their own safety. It is because adults think it is okay to ask children to take a medicine which may cause them harm to protect us. Yet the adults clamouring for this have all been vaccinated already.
Two weeks ago, 40 UK doctors wrote to the Medicines and Healthcare products Regulatory Agency (MHRA) and the Joint Committee on Vaccination and Immunisation (JCVI) calling for a halt to any proposals to widen the temporary emergency authorisation for Covid-19 vaccines to include children on the grounds of major safety concerns. We now learn that this is such a complex ethical question that the JCVI will pass the responsibility to the Prime Minister. The entire management of the pandemic has been politicised to the detriment of open scientific and ethical debate and it is totally inappropriate for child health to become a potential political football. The urgency for such debate has increased by the approval, first in North America and now Europe, for vaccination of 12-to-17-year-olds, and Pfizer’s application is currently lodged with the MHRA. So what is the medical, ethical and legal basis for such a move?
The medical case for children
Children are mercifully at incredibly low risk for Covid-19, with the vast majority having mild to no symptoms, few hospital admissions and even fewer requiring intensive care. There were nine Covid-associated deaths in under-15s in the whole of 2020, all with prior life-limiting conditions and accounting for 0.3 per cent of all cause deaths in this age group. Any adolescent at extremely high risk may already receive a vaccine and this should not inform policy for an entire age group. Long covid has also been raised as a concern, but in children it is milder and shorter-lived than in adults, with studies reporting complete recovery.
So if the disease is extremely mild for children, what of potential adverse effects of vaccination? Tragically, in recent weeks we have seen reports of thrombotic thrombocytopenia (VITT), an extremely rare condition, occurring in a significant number of young adults following vaccination, with cerebral venous strokes, some fatal. VITT was not detected in any of the trials but the MHRA now quotes the incidence following AstraZeneca vaccination as 1 in 77,000, stating ‘the data shows there is a higher reported incidence rate in younger adult age groups compared with older groups’. Doctors advising an individual on benefits and risks are left to guess how much higher but AstraZeneca vaccine was withdrawn for under 30s and latterly under 40s, and the Oxford children’s trial was suspended. Pfizer appears to have similar thrombotic problems though possibly at a lower rate and this is likely to be a class effect involving the spike protein. With Pfizer, the Israel Health Ministry have confirmed that myocarditis is occurring at a rate of 1 in 41,730 for the 2nd dose in young men aged 16-30s, but highest in 16-19s. These are not trivial side-effects: they are potentially fatal or life-changing and appear to be occurring at a rate which is higher than that of severe outcomes for childhood Covid infections. This is without considering any as yet unknown longer-term adverse effects and bearing in mind that only 1,134 children were vaccinated in the Pfizer trials. Following the tenet ‘First do no harm’, routine vaccination of children against Covid-19 is contra-indicated.
Societal benefits from vaccinating children
The consensus appears to be that children do not need this for themselves, but it is argued that vaccinating them could help reduce upward transmission from schools to older adults. In reality, schoolchildren have played only a small part in transmission of Covid-19, and adults living with young children have a reduced risk for severe illness. All older or vulnerable adults understandably concerned at the prospect of catching SARS-CoV-2 have now been offered one if not two doses of a vaccine which we are assured is highly effective.
Concerns about possible variants emerging in the unvaccinated have been questioned; trivial infections amongst schoolchildren might actually help boost the immunity of their adult contacts. It has also been suggested that vaccination could reduce disruption of education but of course there is a much simpler solution, which is to ensure that children who are unwell do not attend school and self-isolate with their household contacts as at present, while ending the requirement for all their healthy classmates to do the same. It is this measure, never used in any previous pandemic, which has done most to disrupt education, with an average of 40 pupils missing two weeks’ schooling for every one child with a positive test.
Law of consent
The principle of informed consent is central to good medical care. Consent must be given voluntarily and freely. Information should be relevant to the individual patient, covering benefits and risks, with questions answered fully and no inducement or coercion. It is, then, particularly worrying that teaching materials circulated to London schools show pictures of smallpox and polio victims followed by ‘When will I get the vaccine?’ and emotive questions such as ‘Would you take the vaccine to protect your friends and family?’ The teachers’ union ASCL has offered to facilitate vaccinations in schools, with peer pressure helping to ensure high uptake. It has also been hinted that relaxation of other measures such as face-masks in Welsh schools could be linked to vaccine rollout. ‘Gillick competence’, overriding parental consent, is technically possible too for 12-15s. Is this really the way that we would wish the nation’s children to be presented with this decision?
Children have had a year of educational and emotional turmoil to protect those at the opposite end of the age range, who we are assured are now protected by their own vaccinations. It is now time, as it always should be, for adults to protect children. I hope our Prime Minister will agree.