Article By: STEPHEN MATTHEWS and JOE DAVIES - READ ORIGINAL ARTICLE
'We should be worried about the completely unknown and unknowable long-term risks of vaccination of the young.' Professor Anthony Brookes, professor of genetics and genome biology at the University of Leicester
Britain could approve Covid vaccines for children within weeks following US health chiefs' decision to green light the move, UK scientists said today.
America's regulator, the Food and Drug Administration (FDA), last night approved plans for the Pfizer jab to be given to children aged 12 and above.
No10 has reportedly already drawn up plans to vaccinate secondary school-aged children with Pfizer's two-dose jab from September.
But experts are divided on whether Britain should press ahead with the policy, given that youngsters are at such tiny risk of Covid. No10's scientific advisers today said giving jabs to children is unlikely to be the priority and may not be needed.
Professor Anthony Brookes, professor of genetics and genome biology at the University of Leicester, said 'We should be worried about the completely unknown and unknowable long-term risks of vaccination of the young.'
And professor David Livermore, a medical microbiologist at the University of East Anglia, said he expects vaccines to be approved for children in the UK but warned it poses an ethical dilemma.
He said: 'Children gain very little from the vaccination but may run some small hazard to harm.'
Giving children coronavirus vaccines is morally complicated, and UK health chiefs have already said it would only be done if it was deemed necessary.
Advocates of the move argue it would help protect older people by allowing Britain to move one step closer to 'herd immunity', curbing the spread of the virus.
They also warn that while the immediate harms of Covid seem small to children, the dangers of 'long Covid' on them are still somewhat unknown.
But critics say offering jabs to children would be unethical because it would only be done to protect older people — not youngsters themselves.
Just 57 people under the age of 20 in England have died with Covid since March 2 last year, but teenagers are thought to be just as likely to spread the virus as adults.
Cambridge University academics believe the risk of infants dying of the coronavirus is around 0.00088 per cent — or one in every 125,000. By contrast, the risk is thought to be around 15 per cent in the over-75s.
There is nothing to suggest the Pfizer vaccine will not be safe in children but some have branded it controversial because studies are still ongoing.
There is more doubt about the AstraZeneca vaccine which has been linked to extremely rare blood clots in young adults.
Britons under 40 are being offered an alternative to the British-made vaccine as a result, although this has only been possible because of how many other jabs the UK has ordered.
Professor Livermore said he expects the vaccines to be approved in younger age groups in the UK because it would help protect Covid spreading from schools to the wider population, some of which may still be un-vaccinated by the time the rollout is extended to youngsters.
He said: 'My guess is that the UK Government and SAGE will press to vaccinate children, exactly on the utilitarian argument above.
'My personal view is that this is wrong and that the ethical case against is paramount — children gain very little from the vaccination but may run some small hazard to harm.
'If they were left to themselves they’d grow up with circulating SARS-CoV2, would be exposed a few times and would develop an immunity.
'Seventy years hence, once they reach their dotage, it’d be reduced to the status of "one more sort of common cold".'
He added that children are currently vaccinated against rubella, which causes little harm to them, but these vaccines have had more extensive testing and help protect pregnant women.
Professor Brookes said: 'There are two reasons for using Covid vaccines. Neither apply to children.
'The two reasons one would normally think about using vaccines for protecting the individual and to protect society — herd immunity.
'Children do not need protecting as individuals against this virus. It’s effectively harmless to children.
'In terms of herd immunity, it’s clear that we already have more than enough herd immunity because of the degree of natural infections we had over the last year.
'Since winter we’ve vaccinated more than 60 per cent of the population, so we totally have enough herd immunity.
'We don’t need to add to that by vaccinating children.'
Dr Simon Clarke, an infectious disease expert at Reading University, said he expected British regulators to also approve the vaccine for children.
But he added: ‘I don’t see any problem with vaccinating children – but it has to be recognised that it is only being done for wider society.’
Across the Atlantic, there are also concerns over whether the project is just to protect adults, when only 0.1 per cent of US Covid fatalities have been in people under 18.
Professor Adam Finn, a paediatrician at the University of Bristol and member of No10's vaccine advisory panel the JCVI, said: 'It is important we have confirmation of the safety and adequacy of immune responses of Covid vaccines in children – particularly because there are some children who are at enhanced risk of serious illness because they have underlying health conditions that render them more vulnerable.
'However, most children who get SARS CoV2 infection do not get seriously and, indeed, most don’t get sick at all.
'Although the importance of children in transmission of the virus within the community is not entirely clear, the evidence we have suggests that it is not great, especially where younger children of pre-school and primary school age are concerned.
'Accordingly immunising children is a low priority and if vaccine-induced protection in the adult population is high from high uptake, good persistence of protection and sustained protection against viral strains as they evolve to evade immunity, then it may not be necessary to immunise children in a general way at all.
'This is even more likely for young children than adolescents.'
He added: 'At this point in the pandemic, when there are global shortages of vaccines and very large numbers of people at high risk of severe disease – mostly elderly – worldwide who remain unimmunised – a priority for them but also for us – is to prevent large epidemic waves like the one currently playing out in India.
'Those outbreaks pose a global threat as they drive evolution of vaccine-resistant variants and their dissemination around the world.
'So, for now we should make sure that the doses of vaccines that exist are used as strategically as possible – and giving them to children is unlikely to be the priority, at least for now.'
Writing on Twitter today, Aaron Richterman, an expert in infectious diseases at Penn University, criticised the FDA's approval of Pfizer's jab in children.
He said vaccinating youngsters in the US over giving jabs to the world's adult population was a 'moral stain'.
The FDA's decision to grant Pfizer's jab an emergency use authorisation was based on data from a trial of 2,260 participants aged between 12 and 15.
Regulators said the benefits of vaccines for people in the age group outweigh 'the known and potential risks'.
Acting FDA commissioner Janet Woodcock said: 'Today's action allows for a younger population to be protected from Covid, bringing us closer to returning to a sense of normalcy and to ending the pandemic.
'Parents and guardians can rest assured that the agency undertook a rigorous and thorough review of all available data, as we have with all of our Covid vaccine emergency use authorisations.'
The FDA's decision will have to be ratified by the Centres for Disease Control and Prevention (CDC) at a scheduled meeting on Wednesday. If given the go ahead, vaccinations for children can begin immediately.
Dr Richard Besser, former head of the CDC told Good Morning America: 'When we think about the impact on kids, thankfully, the number of hospitalizations and deaths is not as great as in adults, but it goes way beyond that.
'The mental health impact, the anxiety and depression - the idea that now, with the vaccine, there are high school kids that could start the fall and have a normal high school experience, take off their masks, do sports, engage with their friends and not have to worry - I think that's absolutely huge.'
Insurance claims for mental health issues among Americans between ages 13 and 18 nearly doubled between January and November of 2020, compared to the same period in 2019, according to a recent Fair Health report.
Parents, teachers, paediatricians and the CDC all agree that children desperately need to be back in school to protect their mental health and ensure they don't fall behind educationally.
The CDC has said in no uncertain terms that schools - K-12 (kindergarten to 12th grade) schools as well as colleges and universities - could safely reopen prior to the availability of vaccines for students, but only so long as they could keep kids in masks and maintain social distance in classes.
But the decision sparked controversy when talks were leaked last week.
Writing in the BMJ last week with two other experts, epidemiologist Stefan Baral from the Johns Hopkins School of Public Health said the emergency use authorisation granted by the FDA uses a different measure of risk than when it was given for adults.
They said: 'Pfizer has asked the FDA to amend the existing emergency use authorisation for its vaccine to allow eligibility for children aged 12 to 15.
'Unlike for adults, however, the likelihood of severe outcomes or death associated with Covid infection is very low for children, undermining the appropriateness of an emergency use authorisation for child Covid vaccines.'
But Dr Joe Grove, an immunologist at University College London said the Pfizer jab has been demonstrated to be safe and effective in all age groups tested so far.
He said: 'Vaccinating school-aged children has two major benefits.
'First, the children gain protection from disease and, just as importantly, will be able to return to a normal and largely undisrupted education.
'Secondly, increasing the proportion of vaccinating individuals will further disrupt the networks of transmission that drive explosive spread of coronavirus. There will be no fuel for the fire.
'I would hope and expect that safe and effective vaccines are offered to as many people as possible in this country and across the globe.'
And the Adam Smith Institute think tank said young people and their parents should be given the choice on whether to be vaccinated.
Matt Kilcoyne, the think tank's deputy director, said the move would ensure children aren't stopped from enjoying the likely benefits of vaccination as the country opens up after lockdown — including travel overseas.
He said: 'It'll help them go abroad we should reject the absurd possibility that it's 17 year olds that have to holiday in Bognor Regis while 70-year-olds are set free to travel to Magaluf.'
It comes after the Sunday Times revealed similar plans to begin vaccinating schoolchildren across the UK.
Government sources told the newspaper plans to roll-out the vaccine to children from September hinge on advice from the Joint Committee on Vaccination and Immunisation (JCVI) this summer.
Professor Adam Finn, a member of the committee, said rates of the virus over the next few months would inform the decision.
He said: 'We need to be in a position to immunise children, particularly teenagers, promptly and efficiently if we need to.'
All the main suppliers to the UK — Pfizer and BioNTech, AstraZeneca, and Moderna — are carrying out trials now to see if the vaccines work on youngsters.
Academics are testing the AstraZeneca jab on 300 six to 17-year-olds in England and results are expected by the summer.
Pfizer and BioNTech plan to test their vaccine on youngsters aged as young as five later this year.
Up to one in 10 vaccine recipients suffer side effects, including headaches, fevers and muscle pains. More adverse reactions — including blood clots — are vanishingly rare, official data shows.
The virus is very unlikely to kill children, but as more variants spread, it's becoming increasingly likely to disrupt their learning, which runs counter to most parents desperate pleas to get their children back to in-person classes.
It's worth noting that, prior to the measles vaccine, there were about 400-500 child deaths in the U.S. every year, and almost every child got the disease, according to the Infectious Diseases Society of America.
Nearly 500 children have died of Covid in the U.S., which has infected about 3.1 million people under 18, or about 4.3 percent of children - a far smaller share of children than were infected by measles before the vaccine was available.
That makes the relative risk that a child will die of Covid exponentially greater than risk posed by measles, although measles comes with a higher rate of complications like pneumonia and brain swelling. But more children have been hospitalized for COVID-19 (778,080) than were in a typical year for measles (448,000) prior to the vaccine.
Every year, about 91 percent of American children get the MMR (measles, mumps and rubella) vaccine, which is required by schools, despite the low risk of death or hospitalization from that virus.
Vaccinating children against measles is also important to protect their mothers, for whom measles infection can cause miscarriage or stillbirth and raise the risk of premature delivery.
The Covid shot and measles vaccine, developed in 1963 and updated in 1968, are of course two different vaccines, so side effects will not be identical, but so far, neither appears unsafe.
So far, there is no evidence that side effects from the vaccine are dangerous to children, or that those side effects will cost them nearly as many days of class as the virus itself.
Pfizer reported that the side effect profile was comparable to what people ages 16-25 experienced, including fatigue, sore arms and achiness, headache and sometimes fever and chills.
Generally speaking, this younger group of adults has had more significant side effects than older adults. This is common in vaccines, because the immune system becomes slower and less active with age.
Children's immune systems are a little different, too.
'With younger children, their immune systems aren't fully developed. We know that teenagers are different beasts with all the hormonal flux that they go through and that does change immune responsiveness,' Dr Stacene Maroushek, a specialist in paediatric infectious diseases at the University of Minnesota told Kare11.
'There tends to be some sort of a peak group where people have those really bad side effects, the chills and the fever, sort of in the 20s and 30-year-olds. But when you get up to the 60-year-olds a lot of them aren't having those same side effect.'
But, she added that she's not particularly worried about side effects for children, instead, she was concerned the vaccines simply wouldn't work in them.
'I think that the immune system is such that they might not mount the same response and I think that's something we really need to look at. They very well may, but we don't know,' she said.