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Mandating COVID-19 Vaccination for Children

Written by Lisa Forsberg and Anthony Skelton

In many countries vaccine rollouts are now well underway. Vaccine programmes in Israel, the United Kingdom, Chile, United Arab Emirates, Bahrain and the United States have been particularly successful. Mass vaccination is vital to ending the pandemic. However, at present, vaccines are typically not approved for children under the age of 16. Full protection from COVID-19 at a population level will not be achieved until most children and adolescents are inoculated against the deadly disease. A number of pharmaceutical companies have started or will soon start clinical trials to test the safety and efficacy of COVID-19 vaccinations in children and adolescents. Initial results of clinical trials seem promising (see also here and here).

There are strong reasons to inoculate children. COVID-19 may harm or kill them. It disproportionately affects already disadvantaged populations. For example, a CDC study published in August 2020 found the hospitalisation rate to be five times higher for Black children and eight times higher for Latino children than it is for white children. In addition, inoculating children is necessary for establishing herd immunity and (perhaps more importantly), as Jeremy Samuel Faust and Angela L. Rasmussen explained in the New York Times, preventing the virus from spreading and mutating ‘into more dangerous variants, including ones that could harm both children and adults’.

Once a vaccine is approved for use in children a number of ethical issues will arise. One especially salient issue is whether vaccination of children should be mandatory, that is, whether failure to vaccinate ought to be subject to some sanction, such as a fine or exclusion from social environments or activities. In many jurisdictions (including Australia, Italy, Ontario, and West Virginia) the vaccination of children for a range of diseases is mandatory: children must be vaccinated in order to attend public school and/or take advantage of various social benefits. The European Court of Human Rights has recently held that policies mandating routine childhood vaccination can be consistent with member states’ obligations under human rights law (Vavřička and Others v the Czech Republic (2021); see analysis by Dolores Utrilla).

We offer three arguments for mandating the vaccination of children for COVID-19 (building on previous work published in The Ethics of Pandemics). We think these arguments are especially compelling due to the fact that the vaccination of children is key to preventing the spread of new variants of COVID-19, especially variants with the potential to render current vaccines ineffective. Leaving children unvaccinated or delaying vaccinations for children leaves all of us vulnerable, for unvaccinated populations are an opportunity for COVID-19 to mutate and continue to wreak havoc.

The first argument (adapted from Pierik, 2018, 2020) takes the following form: if there is an easy, low risk way for parents or guardians to avoid exposing their children to substantial risk of harm and death,  they ought to do so. COVID-19 presents a substantial risk of harm and death to at least some proportion of children. It may cause long-term health complications, including organ damage, long COVID-19 or multisystem inflammatory syndrome (MIS-C) in children. We do not know whether and to what extent these conditions are treatable. If the COVID-19 vaccine is likely to be as safe and effective as, say, the measles vaccine, it would provide parents and guardians with an easy, low-risk way to avoid an infection that may cause serious harm or death. The state, then, has an obligation to protect children from parents and guardians who might expose them to easily avoidable risk of harm and death. Therefore, the state ought to mandate that parents vaccinate their children against COVID-19.

We accept that the state protects children from adults (including parents) in other contexts by imposing obligations on adults to, for example, use car seats and seat belts for their children when driving.

The second argument runs as follows: if, by vaccinating their children, parents and guardians can easily and safely avoid imposing a significant risk of harm and death on others, they ought to vaccinate their children. The threat to all of us from COVID-19 is significant. The risk unvaccinated children pose to all of us is especially great. Children contribute to the spread of the virus through social mixing, often in large groups (e.g. in classrooms). Moreover, the longer children remain unvaccinated the more time exists for a new more potent variant of COVID-19 to emerge and threaten us all.  If the COVID-19 vaccine is as safe, effective and available as vaccines routinely given to children, it would provide parents and guardians with an easy and safe way to vaccinate their children against COVID-19. The state has an obligation, as most agree, to adopt strong measures to protect populations from exposure to easily and safely avoidable risk of harm and death. Therefore, the state ought to mandate that parents vaccinate their children.

We accept that the state protects populations from easily and safely avoidable risk of harm and death in other contexts, for example, by imposing speed limits and vision requirements for driving. We also already accept that the state imposes obligations on parents to take measures to avoid the risk their children pose to others in many contexts. Childhood vaccinations are already mandatory in some liberal democracies, and most liberal democracies mandate that children attend school to provide them with a civic education, and prohibit children from carrying weapons, for similar reasons.

A third argument for mandating the vaccination of children turns on unique features of children’s well-being. Children might fare well in a different way than adults (Skelton, 2015, 2018; Skelton, Forsberg, and Black, forthcoming; Tomlin, 2018; Wendler, 2012). It is plausible that what matters most to the well-being of adults is reflectively endorsed values (e.g. authentic happiness or rational desires). This may not be true of (especially young) children. Children may lack the capacity to reflect on a full range or inventory of stable values. While happiness and the satisfaction of desires matter to children’s well-being, these might not be all that matters. It seems like objective goods (things that make one better off without satisfying a desire or making one happier) play a significant role in children’s well-being, for example, loving, supportive relationships, various forms of play, learning and intellectual development.

We need to end the pandemic to protect children from the mental and physical effects of lockdown and other restrictions, or effects of insufficient restrictions, such as school closures due to infection spread. Restrictions and effects of infection spread lead to decreased opportunities for the pursuit of well-being. Impacts on education alone are considerable, especially amongst the least well off. In addition, ending the pandemic is essential to enabling children to enjoy the so-called ‘goods of childhood’, including valuable relationships with friends and extended family (especially older adults), various forms of unstructured play, exploration and intellectual development, and to do so in a carefree way (without worries about risk) (Brennan, 2014, Gheaus, 2015).

Childhood is a relatively short period in an individual’s life. It is important for the purpose of preparing children to meet the challenges of adulthood. But it is also a time in which to enjoy particular goods in a unique way. An effective way to secure this for all children is to mandate their vaccination.

 

A version of this blog post is published in The Conversation. You can find it here.

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42 Comment on this post

  1. Alberto Giubilini

    One problem I see here is that part of the argument assumes that the risks of the vaccine for children, however small (as they will be), are smaller than the risks of COVID-19 for children. This is far from obvious, however safe the vaccine will be. That is, it’s far from obvious at this stage that vaccines will benefit children directly, given that COVID-19 poses extremely low risk ( both of death and of long covid) to children – and indeed to young adults.
    If the benefit in question is, as you say, the harm of lockdowns and other restrictions, you seem to assume that restrictions are necessarily implied by COVID-19, which is a common assumption, but is false. Restrictions on children are avoidable, and arguably should be avoided, quite regardless of vaccination policies. There is a tendency to attribute to COVID-19 costs and harms that are due to the decision, which could be avoided, to impose restrictions. But in this way, arguments become artificially inflated with points and data that are not relevant. A country could simply decide to not to have tight restrictions without vaccines.

    The arguments for vaccinating children need to rely on the benefit for others, not the benefit for the children themselves. If the good in question is herd immunity, there might be such a case for vaccinating children and perhaps for making it mandatory, but we’d need to know what level of immunity already exists in children, who are mostly asymptomatic, and what the threshold for herd immunity exactly is. It might not even be necessary. In the UK the uptake is 95% in the over 70s and 90 in the over 50s. If the vaccination rate will be that high, or even a bit lower, for the other groups, you might not need to vaccinate young children to get to herd immunity.

    The other thing is that before even thinking of vaccinating low risk individuals like children in any one country, we’d need to make sure vulnerable groups in other countries are vaccinated (this applies not only to children).

    Covid-19 is very different from measles, which is particularly dangerous for children. It is hard to apply the same argument for mandatory MMR vaccination to the case of the COVID-19 vaccine

    1. Thanks very much for your comment, Alberto! We’re not convinced the risks associated with being infected with Covid-19 are as small as you suggest. Most countries have employed measures to protect children from infection, so it’s hard to say what harms we would see in a scenario in which children were allowed to be infected on large scale. In countries that have had fewer measures, like Sweden, we do see deaths and long-term harm including MIS-C and long covid in children. Recent studies suggest that 1 in 3 diagnosed with Covid-19 develop long-haul neurological or psychiatric conditions months after being infected (https://www.thelancet.com/journals/lanpsy/article/PIIS2215-0366(21)00084-5/fulltext). The costs associated with developing conditions like these early in one’s life are very high. In some ways we might think that children and young people have more to lose by getting infected with Covid-19 than older people. So we think it’s quite clear that vaccines would benefit children directly (provided that the vaccines are safe and effective). There is definitely a group of children who might die or get seriously injured from Covid-19 infection. But we know very little at present about who is in this group and its size. Since the risks to children of getting infected with Covid-19 are not negligible, a vaccine would need to carry larger risks in order for vaccination not to be in children’s interests.

      One might of course think that we should sacrifice this group in order to avoid vaccination and other protective measures, such as lockdown, mandatory masking, school closures (ie the ‘no restrictions’ approach you mention). We have not yet seen any compelling arguments in support of that view.

      Lisa and Anthony

      1. Let’s say a) we have a larger class of people (all children) among whom there exists a smaller class of people (children who will suffer significant harm from Covid-19). Let’s also say that b) we can’t know in advance who among the larger class are also members of the smaller class, that is, we can’t know who among the class of all children will go on to suffer significant harm from Covid-19. It seems from what we know about Covid-19 that a) and b) are true. Given a) and b), mandating vaccination for all children (assuming low cost–safety and efficacy) is compelling for two reasons: i) as you say, there is a benefit to others–children who are unlikely to be harmed by Covid-19 may avoid (at least to some extent) transmission (assuming vaccines have this effect) to those who may be harmed by it; ii) consistent with what Anthony and I argue, there is a prudential benefit, since any child could be a member of the class that gets a bad case of Covid-19 and a bad case of Covid-19 is a significant setback to a child’s well-being.

      2. Alberto Giubilini

        Thet cohort of the Lancet study is COVID patients older than 10, so I am not sure whether this study is relevant to the argument about child vaccination based on the interests of children. Importantly, the Lancet study has been widely misrepresented, though. It does not say that 1 in 3 people infected with covid has long-haul neurological or psychiatric condition. That is how the media have reported it, but it is not true (if you get covid, it is not the case that you have 1 in 3 chances of developing a neurological or psychiatric condition). The study is about people who had a diagnosis of COVID-19, so it does not take into account all the asymptomatic cases and those with mild symptoms that were not diagnosed. Of the symptomatic cases, the incidence is again (as is the case with ‘long covid’) much higher in patients with severe covid, that is, the higher risk groups, that is basically the elderly. So it really is not about children.
        The AstraZeneca and now the Johnson& Johnson vaccines’ probable associations with *very* rare blood clots still suggest that these vaccines are extremely safe indeed and in the best interest of most people, since for most people the risks of covid outweigh the risks of vaccines (which is why I think there is a case for immunity passports for some population groups). But not for very young age groups. This is the reason why the UK is offering alternatives to the AZ vaccine to the under 30s: for them, the risks of covid are so small that even the very very small risks of vaccine outweigh them (given current state of knowledge. This might change of course).
        So the question would be: what kind of risk profile of the vaccine should we consider acceptable for children? Would a 0,0004% risk of blood clots, as currently estimated for adults, be acceptable for children, given that the risk of dying from covid for children is smaller than that (estimated around 0,00016%)?
        Notice that I am not saying that there is no argument for vaccinating children or for making child vaccination mandatory. What I am saying is that such argument would probably need to rely on the public interest (building up immunity at the collective level), rather than on the individual interests of children.
        An argument could be made on the basis of fact that, if the risk of the vaccine is very very small (as is the case with AstraZeneca in adults), considering the public good at stake, there is still a reason for vaccinating children and even for making it mandatory. But it depends on how small it is, which we don’ t know at the moment.

        1. That comparison assumes children have the same risk of blood clots as adults do. It could well be that children have a lower risk of blood clots as well.

          I would argue that given imperfect information that the default stance should be to prefer applying the precautionary principle to an uncontrolled pandemic disease and accepting some unknowns with vaccine risk than apply the precautionary principle to the vaccine and take one’s chances with the pandemic plague.

          One major reason is that pandemic diseases can so easily mutate and otherwise “throw up surprises” (such as the higher rate of babies dying of Covid-19 i Brazil than has been seen elsewhere). With vaccines we can decide how to modify them. Also with a vaccine one can have some control over when it’s done and choose to watch the person closely for a while after getting it. Pandemic infections don’t offer this option.

          As for the issue of children becoming long-haulers: No. It’s probably nowhere near 1 in 3. However, there isn’t that much data on that either way. Also many long-haulers from all age groups had mild or asymptomatic cases.

          1. Alberto Giubilini

            Hi Amy
            I mainly wanted to raise the question about what level of risk we should be prepared to accept for children. I gave the example of the risk we can plausibly estimate at the moment for adults (in which case I do think the risk is worth taking, given how small it is and how large the benfits of vaccines are). We don’t know about the risk of children at the moment, but we need to start now thinking about the question of what we should be prepared to accept. The authors of the blog simply assumed that the risk is worth taking, but we cannot know that now. One can say of course “if vaccines are safe”, but that does not mean much in the vaccine context: even vaccines that are very safe (like the current COVID-19 ones) do carry some risk, so the problem is not if they are safe but if they are safe *enough*.
            I am not sure I would apply the precautionary principle in the way you do. The risks of COVID-19 to children are very very small. But again, it depends on what kind of argument one makes: if the point of vaccinating children is to build up immunity at the collective level, then we need to weigh potential risks of the vaccine against the collective good; if the point is to protect children, then we need to weigh the potential risks of the vaccine against the risk posed by covid to children. And these would be very different assessments.

            1. The risk of children dying of measles or influenza is still quite small, and yet those are mandated in many countries.

              I’d say it’s a mistake to assess child risk solely in terms of a comparably low death rate. Most of the kids who got MIS-C haven’t died, and the long haulers obviously are still alive. We don’t know much about the long term ramifications of MIS-C and a childhood Covid-19 infection. For all the kids who lost their sense of taste and smell there are both probable (quality of life) and unknown (neurological?) issues for the kids (and adults) who have lost their sense of taste and smell.

              https://coloradosun.com/2021/02/22/coronavirus-has-stolen-some-kids-sense-of-smell-and-it-stinks/

              Herd immunity is definitely a reason to vaccine everyone.

              However, I’m very dubious about your willingness to be blythe about Covid-19 in low risk persons.

              Furthermore with the prospect of “wide spectrum” covid-19 and flu vaccines that are targeting future coronavirus pandemic or provide likely partial immunity to future flu strains that don’t exist…….that makes the risk of the virus you are guarding against even more theoretical.

              However, given what society has been through I think it might be worth vaccine risks in the range of existing vaccines, if it lowers the known and unknown risks of future pandemics.

          2. Thanks very much for your comment, Amy. We agree with your points.

            We didn’t mean to suggest that the risk would be 1 in 3 in children; we merely wanted to note that it does not follow that it is less than 1 in 3 in children, in the way Alberto suggested. As you say we don’t know, and this is especially hard to know given that, as you say, many individuals who go on to become long-haulers have had mild or no symptoms in the acute phase.

            Anthony and Lisa

        2. Thanks for your comment, Alberto! We agree we know very little about the risks to children, including those associated with being infected with covid, and those associated with having one of the existing vaccines. We are making decisions and acting under uncertainty. Hopefully, we will soon know more about the risks to children associated with vaccines.

          We changed the formulation re the Lancet study. Thanks for pointing that out. We changed it to ‘one in three diagnosed with covid’, which is more accurate. As you say, we don’t know what things are like for asymptomatic or undiagnosed individuals. One thing is clear, however: it does not follow, as you suggest, that the risk is less than one in three. That would follow only if we knew that there were no such effects in asymptomatic or undiagnosed individuals, which, of course, we don’t. It’s equally possible that the risk is in fact higher than one in three. So we should be mindful of encouraging misleading narratives.

          It is true that the prevalence of prolonged symptoms is lower in children under the age of 12 than in adults. However, the ONS recently reported that “for both males and females and across all age groups, the percentage of study participants who reported symptoms that persisted for at least 5 weeks was statistically significantly higher following a positive test for COVID-19 than in the control group. These results suggest that the prevalence of ongoing symptoms following COVID-19 infection is higher than the background prevalence of these symptoms in the population, irrespective of sex or age.”

          We agree mandatory vaccination of children would be justified on grounds of the protection of others. We maintain, however, that prima facie it would also be justified on grounds of their own well-being. And given what we know right now, with unknown long-term risks to children associated with being infected with covid, a policy that proceeded on these assumptions would be justified (given a safe, effective, and readily available vaccine).

          We also think, more generally, it is important to challenge the narrative that Covid-19 is ‘risk-free’ or extremely low risk to children and young people. The risks to children have been underestimated in at least some countries (like Sweden) that have imposed few restrictions or measures to protect them, resulting in many children being seriously ill for more than a year, potentially developing chronic or long-term conditions, etc. Children and young people and those who care for them deserve to get accurate information about the risks a lack of protective measures entails to young people.

          Anthony and Lisa

          1. The narrative that children are not at risk or at extremely low risk from being infected with Covid-19 is itself a danger. The truth is we don’t know exactly how great the risks are, but the riskfreeness narrative leads people to be cavalier, to underestimate the risks, and to act inappropriately in respect of children affected.

            One of the main dangers with the narrative that covid is risk-free or extremely low-risk to children is that it encourages practices in which Covid-19 in children goes undetected or is detected very late. Limited detection prevents us from learning more about the effects of Covid-19 in children. And failures to detect it and late detection risk more severe injury or death among children who are seriously affected by covid and prevents treatment from being as effective as possible.

            We see what this narrative does eg from the events described in this article: https://www.bbc.co.uk/news/world-latin-america-56696907

            On deaths, it states, for example, that:

            “Between February 2020 and 15 March 2021, Covid-19 killed at least 852 of Brazil’s children up to the age of nine, including 518 babies under one year old, according to figures from the Brazilian Ministry of Health. But Dr Marinho estimates that more than twice this number of children died of Covid. A serious problem of underreporting due to lack of Covid testing is bringing the numbers down, she says.”

            And of course in addition to deaths there are the many cases of long-term and potentially life-altering injury.

            Lisa and Anthony

    2. What you are claiming about children being at risk of covid is not true. The article in the Lancet that you mention about long covid does not include children. It is obvious by now that the vaccines are more dangerous to children than the virus. Florida and Texas are other good examples of children not being at risk from covid. It seems you are pushing your own agenda, God know why or with what purpose.

  2. The risk of death to the under-18s is miniscule: Sweden has recorded 12 within that age bracket with schools largely open throughout.

    The 1-in-3 claim for longer harms for children suffers from a lack of evidence and is also otherwise implausible. The Lancet paper on longer term consequences is not a comprehensive account of longer term ill effects and does not include data on under-11s. I am a teacher and have personally heard no account of any important personal harm to pupils _at all_ despite much of the adult staff and many parents suffering unpleasant covidian episodes.

    The long-term side effects of any of the emergency-use vaccines are unknown with the worst possibility being that the vaccine increases susceptibility to sufficiently different variants through antibody dependent enhancement, as may be occuring currently in Brazil; an exhaustive calculation outputting expected value should be carried out to weigh all possibilities up.

    The WHO correctly advise against using children as a means to an end – the second argument hinges on this. In any case, there is good evidence that children already help to attenuate the virus’ effects on the community: for instance, one very large study found parental covid severity decreased with increasing numbers of cohabiting offspring, perhaps through attenuated infection or exposure from the latter.

    Lastly, arguments couched in ‘mays’ and ‘likely tos’ using references predominantly picked from the pop sci press ‘may’ not be found to prompt much reflection on the reader’s part.

    1. Thanks for your comment, Andy! Sweden has generally not tested children for coronavirus—in spring 2020 there was virtually no testing of children there—so it is hard to say something definite about how widespread infection is and has been among them. A smaller number of deaths have been recorded, though, and there is emerging evidence of long-term injury among Swedish children, including long covid and MIS-C. For some interesting discussions re the (very limited) Swedish data in children, see eg here: https://www.sciencemag.org/news/2021/03/critics-slam-letter-prestigious-journal-downplayed-covid-19-risks-swedish and the replies to a widely criticised study by Ludvigsson which claimed that children were not at risk here: https://www.nejm.org/doi/full/10.1056/NEJMc2101280. Note also that Swedish schools have stayed open only for certain age groups and not the whole time, eg children in the equivalent of sixth form have had distance learning for much of the pandemic. As we said in the post, currently available data seems to indicate that the risk of long-term injury to children is a greater threat to them than the risk of death. It also seems that some of the new variants may pose a considerably greater threat to young people than the ‘original’ strain, which means policy decisions based on the lower risk to children around the beginning of the pandemic may need to be reconsidered. Of course, there are other steps that ought be taken in addition to vaccination while we wait for a vaccine that is safe and effective in children, such as masking mandates and physical distancing measures in schools and improved ventilation.

      The vaccination of children would not obviously entail using them as a mere means, since a safe and effective vaccine would benefit children. Whereas willing the infection of children in the hope of acquiring herd immunity by natural infection or, as you suggest, in the hope of giving their parents some protection by cross-immunisation would seem to be a case of using children as a mere means. In willing the infection of children in the hope of acquiring herd immunity by natural infection we would knowingly expose them to (as of yet unknown) risk of long-term injury, which would therefore, in our view, be morally impermissible (and even more so since it is very unclear indeed that herd immunity could even be achieved in this manner). (If you are referring to the small Scottish study, though, that investigated the potential protection other coronaviruses may offer against covid, not SARS-Cov2.)

      The dire situation in Brazil is largely due to inadequate infectious disease control measures, and insufficient vaccination. The vaccines we currently have may be less effective on new variants, which is an important reason to implement measures to control their spread.

      We use the language of may and likely to because (i) there is insufficient data at present, and (ii) many effects will vary depending on context, eg across jurisdictions. We refer to popular science articles to make the post accessible to the general public. The popular science articles in turn refer to the studies in academic journals they present, so these are easy to find for those wishing to engage the original studies. We very much hope that this will encourage honest reflection and public discussion.

      Anthony and Lisa

      1. Thank you very much for your reponse.

        a) CMO Chris Whitty said in a recent briefing that the case for vaccinating children is not straightforward given the hugely different ‘risk ratio’ to that pertaining to the elderly, for example. Judging these risks is difficult given the absence of a ‘test of time’ for the vaccines and the disinclination of experts to give P(unforeseen side effects for a vaccine at this stage of development); perhaps you could offer a figure or range to help us calculate our risk ratio?
        b) Can you quantify the extent of long-term injury to Swedish children at all?
        c) New variants may prove more dangerous but presumably surveillance could pick up this threat ahead of time with vaccination only then deployed – a ‘boxing-clever’ strategy.
        d) My point regarding the protective effect of children is only to placate those who would seek to vaccinate children for reasons of self-interest as they then would be reassured that there is not much to be gained. The problem is that whereas the underspecified risks of vaccination may apply to all children vaccinated, we know that this is not the case for Covid as a good proportion of the population have pre-existing immunity (either from encounters with other similar viruses, from having been infected or from having gained immunity without infection). Perhaps one might consider testing for existing immunity before vaccinating, in order to reduce the risks. Mandating vaccination of all children (not unlikely, given the illogical enthusiasm elsewhere to force a % of adults to be jabbed beyond that required for herd immunity) would expose a greater number of children to the vaccination risks, above the number that would be exposed to the virus in the wild.
        e) Note that Brazil, SA and the UK were the sites of AZ trials so could the most troublesome variants be a consequence thereof?
        f) Those members of public who can parse the arguments on this blog will be bright enough to understand as much of the original studies as most of the journalists do (speaking as someone who is closely acquainted with the science editor of a national broadsheet – a man who is an English grad, natch).

        1. Still no ballpark figure for the chance of long-term adverse effects?

          Presumably the manufacturers came up with an estimate that then prompted them to clamour for indemnification…

          1. Really amazing counter argument from you Andy , couldn’t have put it better myself no matter how hard i tried , well done .

  3. A couple of points…

    We do not yet know the long term consequences of Covid-19. If it eg causes organ damage, this could have consequences for the rest of the child’s life – a harm that adds up cumulatively. And we should also consider the harm done to children if their family members are harmed or killed by the disease.

    The UK has not mandated vaccination since it repealed laws mandating smallpox vaccination last century. The general consensus amongst those involved with vaccination in the UK that mandation would generate a backlash that would undermine any benefits.

    In many countries vaccines are “mandatory”; but not always in the way that we might think. Sometimes mandation means that local services must provide the vaccine, free of charge, and set up call and recall systems. And sometimes it means that people will be denied eg child benefit or access to schooling if not vaccinated. It seldom means that people’s children will be forcefully vaccinated, against the wishes of their parents; and rarely means that parents will be penalised if they don’t get their children vaccinated..

    1. The first part is definitely true. Becoming a long-hauler can utterly ruin a child’s life. The child might have longer term health effects we don’t know about. The missed schooling can drastically alter educational and possibly occupational trajectories. If this long-haul thing proves to be at all like CFS/ME we know people can remain sick with that for decades. So a 12 year old gets the long-haul and gets better at over 30? Devastating to the kid, the family, and no small cost to society.

      That said, it would be a big mistake to assume that most vaccine mandates are simply toothless. I can tell you from experience that the authors of US vaccine mandates utterly mean business. While the large majority of Americans never find themselves ordered to report to a clinic within 48 hours for a vaccine within 48 hours or face a $1,000 or higher fine:

      1) It does happen:
      “https://abcnews.go.com/Health/york-city-issues-fines-1000-people-refused-vaccinated/story?id=62501784”

      2) In 1905 the Supreme Court upheld not only general mandates and fines as ways to enforce vaccine mandates but also suggested that given a severe enough national emergency states could go a notch or two further than that.

      3) The more prosaic requirments to get vaccines to enroll in school, apply for certain jobs, live in a university dorm, join the armed forces, work as a civil servant and more are collectively hard to avoid!!!

      1. Thank you, Amy. We agree with this, too. Long covid could be utterly devastating for children themselves and for their families. It would also be very costly for society.

        Thanks also for the information re vaccine mandates; that is very helpful!

        Anthony and Lisa

      2. This smacks of catastrophising; what proportion of children infected with Covid are set to be ’18-year+ long-haulers’? What % have been three-month ‘long-haulers’?

    2. Thanks for the opportunity to clarify our view, Peter. We agree with your first comment. It captures nicely some of the reasons favouring mandating vaccination. It is certainly of no benefit to a child to be fearful that school attendance or participation in other activities may threaten their parents or families.

      We agree that mandates may take a variety of forms. We had the standard kind in mind, including those you’ve helpfully mentioned.

      Anthony and Lisa

  4. This blog carries the crest of the University of Oxford. At a place in the Fens where teachers encouraged students to know what they were talking about before venturing into print, we were encouraged to discover from primary sources, evidence about the subject we intended writing about. Would the authors of this blog kindly tell us what sources they have studied, to educate them selves about the vaccine industry and it’s products, in recent decades ? The financial power of the pharma/vaccine industry is such that no professional nor public media outlet will counternance printing negative facts nor comment on vaccines, the writers of this blog may have been too busy to have looked elsewhere. Perhaps they will tell us ?

  5. Vaccination of children with Covid-19 vaccine products is unethical.
    Note that these are called Covid-19 vaccines, not SARS-CoV-2 vaccines…
    Do these ‘vaccines’ prevent infection with the virus, and transmission? Do they provide sterilising immunity?
    Apparently not, considering this report from FiercePharma, i.e.: “Patients will “likely” need a third dose of Pfizer and BioNTech’s COVID-19 vaccine as the shot’s protection wanes, CEO Albert Bourla said in a recent interview with CVS Health Live. And after receiving a third shot, people should expect re-vaccination every year, he said. That could spell extra sales for Pfizer in the short term, and turn its mRNA-based vaccine Comirnaty into a revenue spring for years to come.”
    So people are being set up for repeated vaccination throughout life with these so-called ‘vaccines’, creating a hugely lucrative market for the vaccine industry.
    Older people with limited years ahead might think it worth the risk to have these experimental medical interventions but, in my view, it’s grossly unethical to subject children, and others not at serious risk of Covid-19, to a lifetime of Covid vaccination.
    It seems the intention is to make people dependent upon the vaccine industry, and those who control it, for life, to in effect steal people’s own effective natural defences against the coronavirus.
    Again, it is grossly unethical to mandate vaccination for people not at serious risk of disease.

    Reference:
    Pfizer chief Bourla raises ‘likely’ need for annual COVID shots, teeing up vaccine sales for years to come | FiercePharma, 16 April 2021.

  6. This post makes a lot of assumptions that aren’t grounded in reality. It’s arguments are useless and impractical.

  7. The Pfizer trial involves 2260 volunteers so would be unlikely to pick up a rare effect such as the AZ thrombosis. Given the extremely low death rate (in England in the under 20 age range only 8 have died without pre-condition) a very small risk from the vaccine becomes a far more critical consideration.

    You also have to remember that biologically children are not just small adults and especially pre-puberty there are significant differences, the immune system is still under development.
    The different response to CV19 in younger children (less infections, less infectious) shows this clearly.

    Essentially to mandate a vaccine for children at low risk of disease for ‘the good of society’ is a very slippery moral slope to descend. Once the vulnerable are effectively protected there really isn’t a case for enforcement.

    1. Agreed. This is a remarkable devolutionary step. Where the elderly dictates that the young must suffer to prolong their own life. A disturbing revalation

  8. Additional information about Australia: we do not mandate childhood vaccinations here either. Yes, there may be some financial benefits that are not provided if children are not fully vaccinated but this tends to punish those that are already disadvantaged and provides little motivation to those who actively avoid vaccinating their children (mostly well-educated parents).

    Also, it is only access to pre-school that requires vaccination. Once the child reaches the age of 6 (the age of compulsory education), vaccination is no longer required. Again this punished those already disadvantaged families.

    The Royal Australiasian College of Physicians, which includes Paediatricians, is not in favour of these coercive measures as it believes they are unethical and contrary to the idea of informed consent, which must be given free from coercion.

    Finally, if any of the vaccines were able to stop infection or transmission then some of your arguments would make sense. In the absence of these attributes, vaccination does not lead to herd immunity and does not prevent variants being created nor being transmitted.

  9. As an extremely concerned member of the public, in reference to your article of which advocates ‘mandating Covid-19 vaccination for children’, I ask you to reply to each of the following points:

    1. You are clearly biased and have vested interests, and so cannot be trusted to be impartial.

    By studying your record of academic work, and the policy positions of the academic networks and organisations you have affiliations with, clearly there is strong evidence to suspect biases that should openly be declared. It is obvious for career and funding incentives to be involved at some point, and that you are advocating policies for wider organisational purposes, including various academic, business, government and financial interests. Therefore, you are invested in a position that is not academically impartial, unbiased or objective, as is essential in such an important public health debate, but have conflicts of interest on personal and institutional levels. In particular, I am referring to the vaccine industry interests and objectives of the Wellcome Trust and its partners in connection with the Oxford Uehiro Centre’s funding and activities. It would not be unexpected for these associations and relationships to have influence on your work, and it is just to question them.

    2. You are not scientifically qualified to make such conclusions, and to be an expert authority.

    Your academic backgrounds are in medical law and philosophy, not medicine or science, and with no practical experience in the related professions. So it is reasonable to question if are you actually qualified to make such claims and conclusions? You are of course entitled to your academic views and arguments, though posturing as an expert authority in the relevant subject areas is misplaced.

    3. The supporting evidence for the arguments is insufficient, and academic standards are lacking.

    The ‘burden of proof’ is on you to first present a strong evidence-based case that critically requires thorough deliberation amongst the wider scientific community by peer review and other methods, before such views are even considered to be of an acceptable standard for serious examination. This is especially important in such an area where there are multiple and complex risks to be assessed concerning necessity, efficacy, safety and potential adverse effects and harms to children’s health. Overall, the evidence provided to support the argument and its central points is insufficient, and as such, the conclusions are premature. Generally, academic standards are lacking in this article.

    4. You take no responsibility for your conclusions and the consequences, though you are liable.

    Lawyers often use hypothetical situations as a device while making a legal argument, so ‘let us assume’ the proposals outlined in the article are acted on by government officials to inform public health policy, and it is later found were the direct cause of injurious harm to patients. Could you clarify on the details of what responsibility you would take for your role in this situation? Would you consider yourself liable for these acts of negligence? As you know there are legal procedures for malpractice in many professional areas of work, do you agree this also applies to your work?

    As I argue that while you are very willing to make premature conclusions that are intended to be acted on, you would generally be unwilling to accept and seek to avoid responsibility for your involvement in the damaging consequences of these actions. Though if held legally responsible at all stages, you would be inclined and required to be sufficiently rigorous in your academic work. In any case, you are liable for harms resulting from negligence, as defined by human rights laws.

    I request for you to reply personally to each specific point, a general public relations style statement is inadequate. I am aware it may require time to prepare a detailed response, though I can wait.

    1. In addition to my previous letter sent, I bring to your attention an open letter by Dr. Ros Jones (retired consultant paediatrician and member of Health Advisory and Recovery Team) with 40 other UK doctors and health experts, to Dr. June Raine, Chief Executive of the Medicines and Healthcare Products Regulatory Agency (MHRA), of which details many concerns about the proposals for Covid vaccination of children. There is also a related parliamentary petition on this matter.

      Read the letter here:
      https://www.hartgroup.org/open-letter-child-vaccination/

      Further information here:
      https://www.hartgroup.org/caution-child-vaccination/

      I urge you to respond to the key points and conclusions outlined in the letter that challenge the rationale and validity of the proposals in your article. Please do not avoid the questions on this issue, when there is a need for proper public, scientific and ethical debate.

  10. In addition to my previous letter sent, I bring to your attention an open letter by Dr. Ros Jones (retired consultant paediatrician and member of Health Advisory and Recovery Team) with 40 other UK doctors and health experts, to Dr. June Raine, Chief Executive of the Medicines and Healthcare Products Regulatory Agency (MHRA), of which details many concerns about the proposals for Covid vaccination of children. There is also a related parliamentary petition on this matter.

    Read the letter here:
    https://www.hartgroup.org/open-letter-child-vaccination/

    Further information here:
    https://www.hartgroup.org/caution-child-vaccination/

    I urge you to respond to the key points and conclusions outlined in the letter that challenge the rationale and validity of the proposals in your article. Please do not avoid the questions on this issue, when there is a need for proper public, scientific and ethical debate.

    Adam Carter

  11. Your Health is Your Responsibility.
    You never have the moral right to interfere with someone else’s body by force.
    And since you cannot delegate a right you do not have, no other person or group acting on your behalf can ever have the moral right to interfere with someone else’s body by force.

    1. Damn straight!

      Any & all coercion or enforcement to push anyone into taking a so called vaccine that has NOT undergone the typical 9-14 years safety testing all for a propaganda driven illness is nothing short of crimes against humanity and should be dealt with accordingly!

  12. William Shakespeare RIP

    The authors of this need to be tried in a Nuremburg 2.0 style trial as accessories to reckless endangerment of children, full stop. You have made yourselves accessories to the murder of any children who die from these so-called “vaccines.” I would not want to be in your shoes in a few months when the damage you have helped cause becomes obvious.

  13. I will keep this short as others (esp. Adam Carter) have pointed out the shortcomings in your work.

    You do not mandate unlicensed vaccines, especially ones for which long-term health effects are unknown, on children whose risks are negligible (not substantial as stated in your article) in order to make adults “feel safer”.

  14. You views on mandatory vaccination of children (and for adults) are unethical and appalling.There are a significant and increasing number of severe adverse reactions and deaths being reported on the UK MHRA and US VAERS websites, which are historically known to be a small percentage of possible adverse reactions.
    Children are at extremely low risk from covid death and long term effects.
    How you could possibly consider mandating these injections in children without clear and unequivocal evidence that they would do no harm to a child is beyond belief.

  15. This is disgusting. SIGNIFICANT RISK plastered everywhere. Ok we get it you are trying to scare people into submission to your idea. I propose a question. If there is the remotest of chances that this vaccine is not safe long term, especially for children, how do you protect society against the risk of a catastrophic man made pandemic. It will have been spread by fear and group thinkers like yourself. These vaccines have been in circulation less than a year and COVID-19 kills a tiny population of those infected. These are undeniable facts.

    1. Well said. Children seem to be at greater risk from vaxx than Covid. If this is correct these guys are criminals.

  16. I’m not fucking even reading this. Medical fascism must be stopped at all costs. Open your minds people, realise that Covid is the biggest hoax in human history. Actually it’s genetic experiment, conducted by alien species, believe it or not.

  17. This piece would be more interesting if it dealt with the imperfect realities: a risk of blood clots and myocarditis emerging from vaccines, likely failure of vaccines to prevent transmission, and comparatively high rates of natural immunity, probably especially in children who attended school at key periods which seems to confer protection. Moreover, an unknown risk of long-term risks that are yet to emerge.

    Of course if vaccines were risk-free, these arguments would stand. The more interesting ethical questions are the real ones: how many people can you impose known risks on to protect the majority (including fatal risks such as myocarditis and blood clots), and how confident do you need to be there are no long term risks eg increased autoimmune disease 5 years down the line?

  18. This matter goes to the heart of ‘informed consent’.
    In this regard, I submit here my recent email to Dr Fiona Godlee, Editor in Chief of The BMJ, forwarded on 20 May 2021.
    My letter is titled: Why should people not at risk of covid-19 be pressed to have covid-19 injections?

    See my email to Dr Godlee below:

    Dear Dr Godlee, in a recent article on The BMJ, Mohammed Razai et al “offer an overview of vaccine hesitancy and some approaches that clinicians and policymakers can adopt at the individual and community levels to help people make informed decisions about covid-19 vaccination”.[1]

    Currently it appears the covid-19 vaccine products aren’t claimed to prevent infection/transmission re SARS-CoV-2, they’re purported to reduce the symptoms of the disease covid-19. (This is an important distinction, which I realised after publication of my BMJ rapid response last year, requesting clarification of whether these were really covid-19 vaccines…or SARS-CoV-2 vaccines?[2] I question the status of the covid-19 ‘vaccines’ and the quality of the ‘immunity’ they provide, and prefer to describe these products as covid-19 ‘injections’.)

    But if people aren’t at serious risk of covid-19, why should they be pressed to have covid-19 injections? This applies to most people, particularly children and young people, who are not greatly affected by SARS-CoV-2.

    Why are people not at serious risk of covid being set up to have covid injections throughout their entire lives?

    This includes many people who may already be naturally immune. Their own effective natural immune response will be interfered with via these injections.

    It’s planned to press these covid injections on the entire global population throughout life. We have no idea of the long-term consequences of this medical intervention to purportedly protect against a disease which isn’t a serious threat to most people.

    Who initiated this plan to inject the entire global population with covid-19 injections, how was this plan evaluated? Certainly there was no public consultation about this rushed and unprecedented global covid-19 injection rollout, which is relevant to us all.

    Now vaccine industry CEOs announce people may face a lifetime of covid injections, with Pfizer CEO Albert Bourla saying “people will likely need a booster dose of a covid-19 vaccine within 12 months of getting fully vaccinated” and “it’s possible people will need to get vaccinated against the coronavirus annually”.[3] How many billions will the vaccine industry make out of the booming covid injection market?

    With covid-19 injections now being pressed upon people of all ages, including children in some countries, there must be public discussion on the ethics of injecting people who are not at risk with covid-19 with covid-19 injections, and the unknown cumulative consequences of covid injections throughout life, on top of the other vaccine load.

    Dr Godlee, it’s commendable that Mohammed Razai et al are keen “to help people make informed decisions about covid-19 vaccination”, but clinicians and policymakers must think very carefully about pressing people not at risk of covid-19 to have covid-19 injections, potentially for the rest of their lives, as this is an ethical and legal minefield.

    Razai et al and clinicians and policymakers and others would do well to pay careful attention to the points raised by Noel Thomas in his BMJ rapid response relevant to informed consent, e.g. “The many things that UK law expects of doctors when obtaining informed consent, include discussion of all material risks that a reasonable person might be expected to wish to know about” and “The fact that covid-19 vaccine makers have all declined to accept any compensation liability for their products, would surely be essential information to explain to any reasonable person, who might, in other circumstances, wonder at the wisdom of accepting an electric kettle, a bicycle, or a car, whose maker similarly lacked confidence in their product?”[4]

    Just how informed is ‘the consent’ being given by the millions of people around the world being pressed to have covid-19 injections?

    Dr Godlee, people not at serious risk of disease should not be coerced by doctors and others to have medical interventions of questionable benefit for them.

    Sincerely
    Elizabeth Hart
    Independent person investigating the over-use of vaccine products and conflicts of interest in vaccination policy

    My email to Dr Godlee has been published on the TrialSiteNews website, see this link for references: https://trialsitenews.com/why-should-people-not-at-risk-of-covid-19-be-pressed-to-have-covid-19-injections/

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