Health section.qxp_Layout 1 23/09/2021 16:35 Page 70
MENDIP TIMES
Vaccinating children – the pros and cons SHOULD 12-15 year olds have a Covid vaccine? It’s not a simple choice, but many older children are able to make up their own minds. Here’s what you need to know.
Arguments against vaccinating the 12-15s You may never get Covid, although you’re By Dr PHIL very likely to come across the virus. You HAMMOND may well already have had Covid, and already have good immunity. If you are infected, it will likely be symptomless (43 to 68 percent) or a mild infection. Only 25 children have died from Covid in the UK (2 per million), nearly all of whom had other serious illnesses that made them vulnerable to respiratory infection. Such children are now offered vaccination. Although the Delta variant is more harmful for adults, that doesn’t seem to be the case in children. Children who get infected generally mount a good antibody response, make better antibodies and retain them longer than adults. Children’s antibodies do well against the known variants too. The other strand of the childhood immune response, T-cells, is usually excellent. Healthy children have better intranasal and mucosal immunity at the points of entry of the virus and this, combined with their energetic immune response, may rapidly dampen the viral load. They may also have innate cross-protective immunity from other coronaviruses common in children. This means naturally acquired protection against future infection in children may be better than vaccination protection (although they can, of course, infect vulnerable adults while they have it). The primary purpose of vaccination should not just be to protect others. We do justify this in existing vaccination programmes – rubella is a mild infection in children, but we vaccinate them to prevent future fetal malformations in pregnancy-acquired rubella. HPV vaccination in boys protects women against future cervical cancer and genital warts, but also protects boys against HPV-related cancers and warts. We do vaccinate young children against flu to stop them super-spreading to adults, but it took four decades of research and data before extending the vaccines to children. Some experts think we need much more data before extending Covid vaccination to children when their risk of serious harm and death from the illness is currently very low. Some experts argue that letting children become infected while adults are protected will eventually mean SARS-CoV-2 becomes a much less frightening, mild infection for children. Some experts argue that vaccinating children will put more pressure on the virus to evolve a vaccine resistant mutation. The mRNA vaccines licensed for children and adults are “reactogenic” and often caused temporary pain and fatigue in trials. However, rarer more serious potential side-effects only show when they are rolled out to large populations. These include pericarditis and myocarditis – inflammations affecting the heart. Because drug companies collect data on their own vaccines and don’t release it in real time, we may only have full data on vaccine effects and side-effects in 2025.
It is reasonable to offer mass emergency vaccinations to adults in a pandemic when so many are dying (more than 1,200 a day at the UK’s January peak) and so much harm is also caused by containment measures (lockdown). But the argument for mass vaccination of children on medical grounds is far less clear. Any mass vaccination programme has a cost and an opportunity cost. The time and money could be spent on mental health support or other vaccine programmes. As with adult boosters, the available vaccines might be better donated to countries where below ten percent of the adult population have been vaccinated. This, ultimately, might control the pandemic better. Arguments for vaccination of the 12-15s SARS-COV-2 is a deeply unpleasant, multi-system virus, the long-term effects of which are not fully understood. It may turn out that the long-term effects of infection in children are far worse than any long-term effects of vaccination. With currently more than 8,000 Covid admissions and nudging 200 deaths a day in the UK, and no masks, bubbles, scant ventilation plus unvaccinated children mixing closely, the virus remains a significant risk to the 10.8 million over-16s who haven’t had both jabs, particularly five million adults who’ve had no jab. If hospital admissions keep rising, we may be heading back to lockdown. The vaccines have proven highly effective at preventing severe illness and death in most (but not all) recipients. The risk of the side effect of myocarditis and pericarditis is greater in males and greater with the second dose (3 to 17 per million after one dose, 12 to 34 per million after the second). 12 to 15year-olds will be offered one dose only. Vaccinating one million children would prevent 2.5 paediatric intensive care admissions with Covid, 93 hospital admissions and 28 cases of paediatric multisystem inflammatory syndrome. Long Covid in children appears less severe than in adults, but is still significant and much is unknown. Vaccination should reduce the risk. Many other countries have started vaccinating 12 to 15-year-olds. Vaccination may reduce the need for schools closing. It may also make it easier for young people to travel to countries where children are expected to be vaccinated. It may make it easier to gain access to sports and music events if vaccine passports come in. What would Dr Phil do? If I was 15 again, and healthy as I was, I wouldn’t opt for a Covid vaccine yet on medical grounds, but I would if it protected my family and community, and improved my access to places I wanted to be (school, concerts, sports stadia, holidays). If I was like one of my teenage patients, with ME/CFS (myalgic encephalomyelitis/chronic fatigue syndrome) triggered by a prior unpleasant virus, I would definitely want a vaccination. I’m very grateful at 59 for the Covid vaccines I’ve had, but still demand full data transparency from the companies that make them. Fully informed choice should always be the aim.
Dr Hammond’s Covid Casebook is out now. It is a Sunday Times Best Seller
PAGE 70 • MENDIP TIMES • OCTOBER 2021
