COVID-19: WHAT ABOUT THE CHILDREN? ANY VACCINATION?

When restrictions in England are removed on 19 July, as is the plan, under 18s will not have been vaccinated. 

When the undoubted success of the adult vaccination programme is discussed, there is rarely any mention of children.

Fortunately schools will be breaking up around 19 July, so children will not be mixing with each other much until September.  But what are the likely consequences of removing restrictions on children and communities?

Indeed should under 18s be vaccinated? In deciding whether to do so, we need to consider:

• Risks of COVID-19 to under 18s
• Risks of infected youngsters to those around them
• Balanced against drawbacks of vaccination

Let’s explore.

RISKS OF COVID-19 TO UNDER 18s

There are three key risks for the children themselves, in addition to being mildly ill:

• Needing to be off school for several days, and thus disrupting their education.
  
• Risk of serious illness, albeit low
• Risk of Long Covid, which is serious ongoing symptoms due to infection by COVID-19.  There are now reports of over 2 million people in the UK who have had symptoms for over 3 months.  But it is not clear how many of these are children, or how seriously.  Nonetheless there are groups such as LongCovidKids to help kids with significant symptoms

The NHS A&E units are already being overrun by children with other minor symptoms, as primary care is struggling to see them.  In part because of Long Covid amongst adults seeking medical attention.  More children contracting Covid-19 would only be making matters worse.

 
RISKS OF ILL YOUNGSTERS TO THOSE AROUND THEM

• Children off school currently require other children in their bubble to self-isolate off school, thereby disrupting the education of a larger number of children.  The Guardian reports a quarter of million children were off school in one week recently.  A significant problem.
• Children can easily pass on the virus to siblings
• Children off school often require their parents to take time off work, with consequent disruption to livelihoods and employers
• Children can easily pass the illness to adults. The efficacy of vaccines for adults is very good but not perfect.  Furthermore not all adults are vaccinated. As discussed here, estimates of first jabs amongst adults will only be around 89% by 19 July, with older more vulnerable adults having peaked around 90%, as shown below. That means some 10% of adults will likely remain unvaccinated and vulnerable

Vaccine uptake by age group per PHE

DRAWBACKS OF VACCINATION

So COVID-19 is a significant problem for the children themselves, as well as parents and other adults.  Vaccination of children therefore looks highly beneficial.  That is provided the vaccines are safe for each age group within children.  

So far safety appears adequate to allow vaccination:

• In addition to formal trials, widespread use of vaccines in children in America, Israel and other European countries gives good information on safety
• The relevant authorities in each country would not allow vaccination unless they were satisfied about safety.  Approval can also be quickly withdrawn, such as we have seen for younger adults with the AstraZeneca vaccine

The other reason against vaccination is ethical.  Shouldn’t vaccines be provided to the vulnerable in foreign countries first?

• A major issue in many countries is limitations in the distribution of any vaccines supplied, even after improving logistics.  Provided as many vaccines are being used as being supplied, then there would be an excess available for use in well-vaccinated countries
• In any case it could be argued that countries that have developed and funded the vaccines should get priority, and the quantity required is a very small fraction of those being provided to other countries

As with any vaccination programme, there is the matter of cost.  Given the benefits, vaccinating children would be money well spent.

WHAT IF CHILDREN ARE NOT VACCINATED?

From the discussion above, it would appear that if children remain unvaccinated:

• COVID-19 infection will spread through children until most have been exposed to the illness, and sufficient natural immunity has developed to achieve ‘herd immunity’ amongst children
• Illness will be seriously disruptive to their education and to their parents in having to take time off work to look after them
• Some children, albeit a small proportion, will develop serious symptoms and/or Long Covid
• Illness will spread to adults, with some becoming seriously ill, requiring hospital treatment and some of these dying  
• The pressure on NHS services will get worse, both for primary care and A&E

Whilst the spread of infection will be lower over the summer, the risk is that infections will take off from when schools are back in September and into the winter.  There is then a higher risk of one or more Variants of Concern arising in children, providing more risk to both children and adults.
 

WHAT ABOUT KEEPING EXISTING RESTRICTIONS IN SCHOOLS?

Currently restrictions for children include:

• Children are in ‘bubbles’ within schools
• Children in the same bubble as an infected child are expected to stay at home
• Masks are worn by some children, both within school and on public transport

Will all these restrictions be removed on 19 July?  If so, infections will spread faster when schools are back in September than if some or all restrictions are retained.

ON BALANCE 

On balance, vaccination has major benefits, provided vaccines are considered safe for children.  This has to be considered for each age group, such as pre-school, infants, juniors and seniors.    

Indeed not to vaccinate children risks major problems for the NHS, especially once schools are back in September.  That provides time to get a lot of children vaccinated over the summer.

How about starting with 12-17 year olds? What do you think?