With news that jabs for secondary school pupils may begin in 10 days time, Harry de Quetteville asks experts if rewards outweigh the risks
The AstraZeneca vaccine should be given to everyone. Hang on, it should only be given to over-30s. Sorry, over-40s. Give Pfizer to young adults. But we should definitely concentrate on vaccinating adults. OK, adults and 16-17-year-olds too. Wait, scrap that. Now we might need to jab 12-year-olds as well.
The advice seems ever changing. The news that the NHS is gearing up to jab 12- to 15-year-olds as soon as September 6 has caused more uncertainty and worry, particularly among parents and youngsters as they try to balance the risks and rewards.
The prospect of vaccinating healthy children, who have a vanishingly low risk of illness from Covid, raises a spiky moral dilemma, says Russell Viner, professor of adolescent health at University College London and a member of the Scientific Advisory Group for Emergencies (SAGE) .
“If you factor in transmission, you’re saying you’re going to vaccinate teens to protect adults. As soon as you do that you have a whole bunch of ethical issues. There’s very little in it for them, but a lot in it for other people.”
The most obvious issue is safety. The UK has delayed rolling out the Covid vaccine to the under-16s – unlike other countries, including Israel, the US and France – because of concerns over a rare side effect: a type of heart inflammation called myocarditis.
The problem with this, says Michael Fitzpatrick, GP and Telegraph columnist, who runs a vaccination clinic in Hackney, east London, is that, unlike the blood clotting side-effect linked to the AstraZeneca jab, “myocarditis is not only very rare but actually quite a mild and transient condition”. He also points out that there is a wealth of safety data from America, where teen vaccinations were approved in May, and Israel, where they began in June.
Not all agree. Viner says “we are still in the early stages of understanding the risk” of myocarditis. He says that “you have to start with the maths” – weighing the risks of serious illness and death against the risks of vaccination. Given that the risk to children of illness from Covid is “very, very low”, he says it is hard to recommend jabs for teens while the dangers from myocarditis are not completely understood.
Even once this debate over safety risk-reward is settled, however, there are other issues in play – for example, the potential for more disruption to schooling. Viner has a paper out next week showing significant impact to children from missing out. “We need to be incredibly careful about disrupting our children’s lives,” he says. “The harms of school closures are very strong.” That would seem to be an argument in favour of teen vaccinations. But he points out that, in fact, almost all the disruption caused before the summer holidays came not from the disease, but from our efforts to control it – notably isolating entire “bubbles” after a single infection. That is being replaced from this term, and studies have shown that daily testing of classmates after a case is at least as effective as sending home bubbles. But will teachers and their unions be happy to stick to this new regime in the event of major school outbreaks?
All of which leads to the big issue of transmission. In Scotland, Covid cases are on the rise, which many are blaming on the reopening of schools. “Transmission among secondary school children is significant – they’re not given to social distancing, as we know,” says Fitzpatrick.
However, even this has been disputed: a recent study by Public Health England found the prevalence of the virus in schools was lower in June than it was in the autumn term, concluding that schools are not “hubs of infection”.
The question of how easily adolescents spread Covid muddies the risk-benefit calculation of vaccinating them. As Fitzpatrick adds: “Vaccinating children is of some benefit – not great – to them, but of significant benefit to the rest of society.”
Viner says the simple medical principle of “do no harm” enforces greater than usual caution in this medical bargain between young and old. “The safety bar [when there is no benefit to one side] is much higher.”
Such a “tradition of caution”, he adds, has “served the UK well historically” and he thinks the Government should resist knee-jerk pressure to change course: “Many countries have jumped too quickly because it looks like an obvious thing to do.” Understandably – all too often in this pandemic, policy course-correction has come too late to prevent spiralling infections. And as Fitzpatrick notes, the annual flu jab is given to children, largely to prevent transmission to vulnerable adults, “so we have this ethical model already”.
The dilemmas don’t stop there. Manufacturing and supply difficulties mean that, despite near limitless orders, vaccine stocks on the ground have frequently run low. Is it wise to expend limited supplies on teens? Can we guarantee there will be enough for them and for boosters – which in Israel are being administered to all those over 60? Some argue it would be better to focus on improving adult take-up. But latest figures show the UK has partially vaccinated around 47.6 million people, representing some 88 per cent of the vaccine-eligible 16-plus population. Around 77 per cent have had both doses. Convincing those still holding out is increasingly hard. “Getting to more adults is not going to work,” says Fitzpatrick. “We’ve bent over backwards, we’ve done everything to bring them in. Everything.”
In all this, it’s easy to forget about the children themselves. What do they think? A new survey by the Children’s Society suggests they are largely in favour of being jabbed. Some 62 per cent want a vaccination, while only 11 per cent were strongly opposed. A recent study in the US found even greater enthusiasm, with almost three-quarters in favour. That tallies with Fitzpatrick’s experience: “It’s a ‘get out of jail’ card. They want to go to festivals, get on a plane, go out, and to do that you need a jab,” he says.
For parents though, a natural instinct to protect a child from unnecessary interventions can make such a decision less straightforward.
Trading risk and reward when children are involved is, all agree, a minefield. With teens, the issue is even more delicate because they occupy a grey zone of medical consent, which normally starts at the age of 16. Exclusive parental consent endures before children become adolescent. In the teenage years, child and parent must decide on most treatments together. “In 99.999 per cent of cases they do,” says Viner, himself the father of a 15-year-old.
Yet if parental consent cannot be secured, and the child can show they understand the risks of a treatment regulators deem beneficial, the child can consent alone “regardless of the parent’s wishes”. Again, he says, there is precedent, with the HPV vaccine given to teens today. Some households may need to prepare for a whole new avenue of teenage arguments.
It is all fantastically delicate. “There is no easy answer,” says Viner. Any decision to jab 12- to 15-year-olds will depend on a formal decision by the Joint Committee on Vaccination and Immunisation, which habitually errs on the side of caution.
Yet to jab teens or not ultimately plays into a greater debate about managing this coronavirus – which few experts now believe we can eliminate. Rather, the wide expectation is that Covid-19 is becoming endemic and will, like the four other coronaviruses that affect humans, eventually do no more than cause a sniffle – or, like flu, adapt to kill a few thousand of the vulnerable each year.
Either way, governments are today in the business of navigating the path to that reality. There will be bumps along the way. But it is hard to say for sure whether jabbing teens will help avoid one, or steer us more deeply in.
Would you like you child to have the Covid jab? Two parents give their views
‘As long as he makes an informed decision based on the facts, I will support him’
Clare Friel, 36, mother-of-two and founder of Friel marketing agency, from Ipswich
Stanley, my 12-year-old son, moved to secondary school last year, but suffers from anxiety. So the amount of change over the past 18 months – from e-learning to being in a bubble with his class, then self-isolating when someone tested positive – has been very difficult for him.
We’re currently on holiday, and discovering that he will have to take a Covid test when he goes back to school next month has taken its toll on him.
I’ve been double-vaccinated, so I’m in no danger of him bringing Covid home to me. So I’d be happier to wait a bit longer until the effects of the vaccine on children is better understood.
If Stanley consents to have the jab – and it’ll be a decision for him on the day – as long as he makes an informed decision based on the facts, I will support him.
I think if the Government is going ahead with these plans, they should do it as soon as pupils get back to school, so it becomes part of their routine and doesn’t cause further disruptions for the school year. Of course it will be something that I will present to him and go through together, I would feel a lot happier.
But I won’t be able to cope with the guilt if he has the vaccine and then develops complications. My 18-year-old daughter has been double jabbed, and I was concerned at first because she was given the AstraZeneca vaccine, but she’s been fine. So Stanley would be able to have a conversation about it with her, too.
As told to Yolanthe Fawehinmi
‘My wife and I have been vaccinated, but I think this is just a precautionary measure too far’
Leon Hady, 40, former head teacher and father of two, from Lincoln
I think it’s quite strange for the Government to ask a 12-year-old to decide whether they want to take the vaccine or not. Normally, the only time this age group is regarded as adults is when we have to pay for seats on planes.
I don’t want my daughter, Amira, taking the vaccine yet. I think it’s a grey area in terms of need for that age group. It’s not something we need to do for the good of their health.
It’s also a huge minefield, not least the influence teachers can have on pupils, how peer pressure from friends will affect who chooses to get vaccinated.
My wife is a GP and a clinical lead for vaccination centres in east Lincoln, so we discuss the ins and outs a lot. We’ve both been vaccinated, but I think this is just a precautionary measure too far.
I know we have got a history of school nurses administering vaccinations such as the Tetanus jab. But I understand why the Government has chosen to do vaccinations at schools – because the people in this target age group don’t go out much. They wouldn’t queue in a vaccination centre like adults. So if you want them to have the vaccine, you’ll have to bring it to them.
As told to Yolanthe Fawehinmi