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Several COVID-19 vaccines are in late-stage clinical trials. Therefore, the discussion centers on who should receive these vaccines first, in the event that they are approved for use. Today we discuss two options. One is to prioritize older people. This article looks at the benefits of vaccinating children first.
The World Health Organization is discussing how best to allocate and prioritize COVID-19 vaccines when they arrive.
It focuses on the immediate crisis. To reduce deaths rapidly when extremely limited doses of vaccine are available, vaccinating the elderly and most vulnerable is expected to be the best option, even if the vaccine is relatively deficient in protecting them. This is because the elderly are much more likely to die from the disease.
But as we produce more vaccines, the goal will be to get back to normal where we can mix freely without increased risk. If vaccines are not very effective in older adults, we will need many more people to be vaccinated, including children. One possible strategy is to prioritize children.
Why children first?
The risks and benefits of certain vaccination strategies against COVID-19 depend on information that we do not yet have. For example, we still don’t know if vaccines work or are safe for specific population groups, such as the young or the elderly.
But it’s worth thinking about the ethics of different strategies beforehand. In a pandemic, time can save lives.
A COVID-19 vaccine may be less effective in the elderly because their immune systems naturally decline with age, perhaps making them less able to trigger a protective and efficient immune response after vaccination.
We see this with the flu vaccine, which only reduces flu-like illnesses by about a third in those 65 and older and deaths by about half.
Read more: Why are older people at higher risk of contracting coronavirus?
If there are similar results for a COVID-19 vaccine, to get back to normal, we may also need to prevent community transmission by vaccinating young people, which generally elicit a stronger immune response. This in turn would protect the older and more vulnerable people because the virus would be less likely to reach them.
Yes, this is controversial. Children cannot autonomously consent to being vaccinated. Adults, who make these decisions on your behalf, also likely benefit from a reduced risk of contracting the virus within their own home, making the decision a potential conflict of interest.
When would it be okay?
Sometimes we make altruistic decisions on behalf of children. Children can be life-saving bone marrow donors for their siblings, for example, despite the risks.
We can also apply the idea that we can restrict freedom when there is a risk of harming others. For example, if a child is infected with COVID-19, they should be isolated and quarantined like adults.
However, vaccination differs from both examples in one key respect. With vaccination, it is unlikely that there will be a single identified person the child will help, or who is in a unique position to help. Instead, the potential benefits are collective, for the general public.
If a child lived with a sibling who had an underlying condition that made them particularly vulnerable to COVID-19, or lived with their grandparents, vaccination could be an easier option.
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Three factors can help us decide
When considering whether children should be vaccinated before adults, we can ask ourselves:
1. How serious is the threat to public health?
So far, more than a million people have died from COVID-19. There is also the risk of overwhelming health systems and additional collateral damage in terms of economic, social, educational risk and excess non-COVID-19 deaths as a result (for example, from suicide or delayed access to medical attention). COVID-19 affects everyone in society, including children.
2. Are there alternatives?
If vaccination works well enough in vulnerable people, or if there are other strategies to achieve the same effect, such as general vaccination for adults, we should use them instead.
3. Is the response proportional to the threat?
As we vaccinate the vulnerable and the general adult population, even if it is not completely effective, we will reduce the severity of the crisis. We should assess at that stage whether the remaining problem justifies vaccinating children.
Assuming we meet these conditions, we argue that prioritizing vaccinating children, at least voluntarily, is the correct strategy.
What about mandatory vaccinations?
Mandatory vaccination may be justified if voluntary strategies fail to achieve herd immunity or do not achieve it quickly enough to protect the vulnerable.
To assess whether mandatory vaccination is worth it, we may also need to consider how lethal and infectious a virus is.
For example, smallpox had a mortality rate of up to 30% (although contagion requires fairly long contact). It was eradicated in 1979 through vaccination, which was mandatory in many countries. With COVID-19, 0.1-0.35% of infections are fatal.
By definition, compulsory vaccination involves some form of coercion. This may include withholding economic benefits or access to early childhood education (No Jab, No Pay or No Jab, No Play in Australia); preventing children from entering school (US, with specific rules that vary by state) up to fines (Italy). France even has a legal provision for incarceration for parents who refuse certain vaccines.
Mandatory vaccination (of some kind) could be justified in groups that are at increased personal risk for COVID-19, such as healthcare workers, the elderly, men, or people with other health conditions, if incentives such as increased Of freedoms or even payment is not enough. For these groups, the vaccine is beneficial for everyone: it protects others and protects the vaccinated person.
What about mandatory vaccinations for children?
The situation is more complicated with children. Unless they have underlying health conditions or a rare but serious inflammatory condition after infection, children are less likely to have severe COVID-19 or die from it.
Therefore, the risk of the vaccine itself (as yet unknown) outweighs more.
On the other hand, children benefit from relationships with grandparents and other freedoms offered by a society free from pandemics.
Read more: Children may also need to get vaccinated against COVID-19. This is what we should consider
Mandatory vaccination may be justified in children if the following criteria are met:
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The vaccine has been shown to be very safe for children (even long term, still unknown) and safer than the effects of the disease.
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children are important transmitters of infections (which does not appear to be the case for COVID-19, at least for preteens)
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There are other non-COVID benefits for children, such as a return to normal social and educational life (school) and access to normal health care services that they might not otherwise have.
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the measures are reasonable and proportionate, for example by limiting childcare benefits (rather than, for example, sending parents to prison).
Certainly, we are still not close to meeting these criteria for mandatory vaccination of children against COVID-19, especially since we do not know how effective and safe the candidate vaccines are in different populations.
Read more: 5 ways our immune responses to COVID vaccines are unique
