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Pfizer Jab Approved for Children, but First Other People need to be Vaccinated

Dominic Wilkinson, University of Oxford; Jonathan Pugh, University of Oxford, and Julian Savulescu, University of Oxford

Moderna and Pfizer have released data suggesting that their vaccines are well tolerated in adolescents and highly effective in preventing COVID-19. Canada, the US and the EU have already authorised the Pfizer vaccine in children as young as 12. And the UK has just approved the use of the Pfizer vaccine in children aged 12 to 15. But there may a case for holding out on an immediate rollout, for several reasons.

Whether a vaccine is beneficial for someone depends on three things: how likely they are to become seriously ill from the infection, how effective the vaccine is, and the risks of vaccination.

Children have less severe COVID-19 than adults. A recent study across seven countries suggests that there were less than two in a million COVID deaths in children. Even if the vaccine is highly effective in children, it can only eliminate an already tiny risk. Of course, there are other problems, such as long COVID, but we don’t know yet how common this is in children.

We also have to weigh the benefits against vaccine side-effects. So far, trials are reassuring, but those studies only gave the vaccine to about 3,000 young people (aged 12 to 17). They are not large enough to identify rare events. For example, the blood clots associated with the AstraZeneca vaccine were not seen in the much larger initial adult trials.

The US Centers for Disease Control and Prevention (CDC) is looking into reports of heart inflammation in teenagers and young people who have received COVID vaccines. We don’t know whether these are indeed related to the vaccines, what a true rate might be or if this relates to children.

Because of residual uncertainty about the safety profile and the relatively small benefit in a low-risk population, we cannot be sure that COVID vaccines will overall be in children’s best interests.

The moral questions

As well as direct benefit, vaccines have an important indirect benefit: they reduce the spread of the virus and stop other people from being infected. If you can help others in a significant way, at little personal cost, risk or burden, you have an ethical duty to do so – a so-called duty of easy rescue.

Vaccinating children could help to achieve herd immunity and protect older adults. For this reason, some ethicists advocate targeting flu vaccination programmes at children.

There is data to suggest that adults living with children may be at increased risk of infection and hospital admission. There is also some concern that a large number of cases of new variants may be occurring in younger people.

Meanwhile, evidence is emerging that the COVID vaccines do prevent transmission of the virus. However, vaccine-induced herd immunity may not be possible if virus variants are able to evade antibody protection.

Next, a duty of easy rescue only applies if an intervention is low risk. It applies to tried-and-tested vaccines, such as flu, but we don’t know that for sure about COVID vaccination in children.

Also, despite their low risk from COVID itself, the pandemic has had a huge toll on children’s mental health and educational development. It may not be fair to impose further duties on them, given the sacrifices they have already made for older people.

If herd immunity is indeed possible, it can potentially be achieved by vaccinating 60% to 70% of the population. In the UK and many other countries, that would be possible without vaccinating children.

But there is a final, even more important reason why, at the present time, vaccinating children would be wrong. There are massive inequalities in global vaccine distribution and access. For example, last month Nepal suspended its vaccination programme because of lack of vaccine supply, despite a massive surge in cases. Only 2.5% of its population have been fully vaccinated so far.

Peru, which recently recorded the highest number of COVID deaths per capita in the world, has only fully vaccinated 4% of its population. Given current data, 13 million vaccine doses (enough to vaccinate all of the UK’s children) could prevent many thousands of deaths in a country like Peru.

This argument is partly altruistic. The UK, for one, should be giving vaccines to adults at high risk of serious illness in countries in urgent need of vaccine, rather than to low-risk populations, such as children within its own borders. But it is also in the UK’s interests.

As others have highlighted, the emergence of more transmissible coronavirus variants in countries with low vaccination rates means that the UK may be facing a particularly dangerous phase of the pandemic. In the short term, we urgently need to achieve widespread vaccination of the vulnerable in countries at greatest need. If the virus is allowed to rage in countries unchecked, there will be a risk of further waves of coronavirus even in countries with high rates of vaccination.

These concerns are likely to change. Greater evidence will lead to greater confidence that vaccinations are safe in children and young people. Greater international distribution of the vaccine would mean that doses for young people in developed countries will not come at the cost of those in poorer countries at a much higher risk of dying.

But for the coming months, and possibly longer, COVID vaccination campaigns in high-income countries should not include children.The Conversation

Dominic Wilkinson, Consultant Neonatologist and Professor of Ethics, University of Oxford; Jonathan Pugh, Research Fellow in Applied Moral Philosophy, University of Oxford, and Julian Savulescu, Visiting Professor in Biomedical Ethics, Murdoch Children’s Research Institute; Distinguished Visiting Professor in Law, University of Melbourne; Uehiro Chair in Practical Ethics, University of Oxford

This article is republished from The Conversation under a Creative Commons license. Read the original article.

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1 Comment on this post

  1. An interesting associated link arises between this blog article, the COVID-19 one by Frances Kamm and the ongoing ethical and regulative discussion in the UK about assisted dying.

    That association appears at its most basic as a tribalism, but is more complex as the points presented create the tensions promoting a necessary balancing criteria which become(s) the projected value(s) providing some form of answer. These common mechanisms allow individual, social group, and societal worldviews to be spoken of as the same, and yet the tensions between each perspective do not so easily become each other, requiring a further mechanism to mask difficult differences, be that language, type of communication, physical distance and so on.

    Using Frances Kamms’ post as one example;

    Because of the criteria chosen in the post it has an ideological or nationalistic focus, which to a large extent limits and defines the perspective(s) of any outcome, but it is not too badly balanced between individual and societal arguments, potentially leaving a limited set of interpretations open to a reader.

    Using the debate in the UK on assisted dying;

    Many of the presented points rely upon promoting the good of the individual over that of society and sometimes inherently include the emotive suffering of associated individuals in the arguments for assisting the individual to end their life. Yet they take little note of the message the larger social group (society) would then communicate:- Whilst you are of use to use we will not allow you to take your own life, but once that usefulness is reduced or over, we will allow you to kill yourself. A social group which communicates that type of message appears to me to be straying from sound ethical grounds no matter how humane they otherwise are and also partially refocus effort from a curative focus to a humane ending of life focus.

    Using this article;

    The points raised in this blog article appear more persuasive, move beyond a merely nationalistically (ideological/tribalistic) perspective, and in doing so link themselves to altruistic motives which transcend nationalist emotions but are weakened by the difficulties associated with distance. The altruistic perspective is well known and may be easily sidelined leaving the motivations to be weakened by distance and over time.

    If the wars social groups have fought in the past were a mix of personal interest and then more frequently ideological purposes, and even so societies progressed in their moral and ethical outlooks, which parts of the above articles stand the most chance of furthering that progression? Or from other perspectives, is such a progression right and sound?

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