The double ethical mistake of vaccinating children against COVID-19

 

Alberto Giubilini

Oxford Uehiro Centre for Practical Ethics

University of Oxford

 

Against the Joint Committee on Vaccination and Immunisation (JCVI)’s advice that did not recommend COVID-19 vaccination for children, the four Chief Medical Officers in the UK have just recommended that all children aged 12-15 should be vaccinated with the mRNA Pfizer/BioNTech vaccine.

This is a double ethical mistake, given our current state of knowledge.

 

First ethical mistake

In a short commentary published with Prof Sunetra Gupta and Prof Carl Heneghan a few months ago, we pointed out that current evidence does not support mass vaccination of children against COVID-19. Quite simply, there is no known net benefit for children in receiving a COVID-19 vaccine at this point in time. Children are at very low risk of death and of serious complications from COVID-19 and we don’t know what the risks of vaccinating children are. As we saw in the case of the vaccine roll-out in adult people, some of the risks of vaccines (such as myocarditis or blood clots) become apparent only after mass vaccination has started. If we focus on the health of the individuals receiving the vaccine, the small risk of vaccines is worth taking for a population at higher risk of death or serious complications from COVID-19.  But, by contrast with the adult population, children are not at significant risk from COVID-19: even the risk of “long covid” is significantly associated with age, as is the risk of death. Given the uncertainty around the actual risks of vaccines, we cannot confidently say that it is in children’s best interest to be vaccinated at this point in time.  In fact, the JCVI  made exactly the same point. As they state in their recommendation,

“When deciding on childhood immunisations, the JCVI has consistently maintained that the main focus should be the benefits to children themselves, balanced against any potential harms to them from vaccination”. And also “There is evidence of an association between mRNA COVID-19 vaccines and myocarditis. This is an extremely rare adverse event. The medium- to long-term effects are unknown and long-term follow-up is being conducted. Given the very low risk of serious COVID-19 disease in otherwise healthy 12 to 15 year olds, considerations on the potential harms and benefits of vaccination are very finely balanced and a precautionary approach was agreed.”

A recent study suggests that at a time of ‘moderate’ rate of COVID-19 hospitalizations, teenage boys are 6 times more likely to suffer from heart problems after the vaccine than to be hospitalized for COVID-19 related complications.

There might well be some benefit for the adult and vulnerable population in vaccinating children, in terms of reducing the chance that a child may infect others. If children are vaccinated, they are less likely to become infected, and so they are less likely to pass the virus on to others. Some benefit for the more vulnerable would remain even if vaccines are not very effective at stopping transmission (especially with the Delta variant): to the extent that they prevent infection, they also reduce the risk of asymptomatic individuals passing on the virus. However, the public health benefit is vastly reduced by the vaccines’ relatively low effectiveness at preventing transmission. In any case, even if that benefit is considered important enough,  we need to be clear that the justification for vaccinating young people needs to be based on public health considerations and on the desire to protect vulnerable groups. It is not about protecting children.

But if the risk we impose on children in order to protect other people is too high (also in proportion to the benefit we can expect), the decision is unethical because we would simply be treating children as mere means in order to protect others, as arguably we have already been doing throughout the past year and a half with indiscriminate lockdowns and school closures.

Vaccinating children might give us (adults and more vulnerable people) some more peace of mind, but we are not entitled to peace of mind if it comes at significant cost to children.

This is the first ethical mistake: we are (once again) treating children as mere means.

 

Second ethical mistake

Interestingly, the Chief Medical Officers do not deny the points made above. They are not claiming that vaccination is in children’s best medical interest, as they evidently accept the point that the risk of COVID-19 for young people is not sufficiently high for that. What they claim is that vaccinating children would be overall beneficial to them because it would prevent the side effects of disruption in school education. They state that vaccination in that age group is “an adjunct to other actions to maintain children and young people in secondary school and minimise further education disruption and therefore medium- and longer-term public health harm”.

This is the second ethical mistake: we are assuming that the appropriate, or even inevitable, response to children getting infected is closing schools and isolating children. This is part of a broader approach to pandemic response measures, where we attribute the harms imposed by the decision to close schools and to lock down society to the virus itself. There is no reason to simply assume that we should isolate an entire classroom or even school when some child in it tests positive. Given high rates of vaccination among vulnerable populations, widespread testing facilities, and the recognition of the harm caused to children through online schooling and self-isolation, the response to a positive case among children should arguably be re-assessed. Isolating healthy children that we have no good enough reason to believe are infected and infectious is a choice we make, it’s not something caused by the virus. We could and arguably we should choose otherwise if we think that the harms to children of isolation and school closure outweighs any harm that COVID-19 poses on them.

We are in a situation where teachers and other potentially vulnerable people that children might interact with have been offered two doses of vaccines that are extremely effective at preventing serious symptoms. To simply assume that children catching COVID-19 would result in school disruptions, and to use this as a reason to recommend vaccinating young people, is a mistake. At the very least, the assumption should be questioned and critically assessed. Otherwise, we would be blaming a virus for outcomes that are the result of our own decisions. Which would be a way to evade responsibility for the harm we are imposing on young people.

COVID-19 is a serious disease for some parts of the population, and its risks are unevenly distributed across different age groups.  As a result, it is important that we critically and ethically assess how we treat these different groups, carefully evaluate different risks and benefits, and are clear about why we make the policy decisions that we do. This is what it means to take responsibility for policy decisions about pandemic response. In this particular case, taking responsibility requires that we are clear about what reasons actually do and do not support child vaccination at this point in time.

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13 Responses to The double ethical mistake of vaccinating children against COVID-19

  • Jonathan Herring says:

    Thank you this post.

    On the first point, vaccinating children to protect their parents, grandparents and other family members is not ” treating children as mere means in order to protect others”. Children live in relationship with others and the wellbeing of others is tied with the wellbeing of others. Indeed, it is good for children to be raised in a soceity which values all its members and seeks give and take between citizens for the greater good. I don’t have the expterise to comment on whether this is an effective policy, but if it does protect adults and vulnearble people that is good for children. We are social beings not isolated invidiauls. The health of our communities matter to all of us.

    • Alberto Giubilini says:

      Thank you for this comment.
      It seems you’re making several different points here.
      First, you say that “it is good for children to be raised in a society which values all its members and seeks give and take between citizens for the greater good.” This is an abstract principle which is hard to deny in this formulation (also because the ‘greater good’ is quite an abstract concept. I am not sure what it means, if it means anything at all). But the relevant question is about what it implies in practice in different specific cases. It seems you assume that not vaccinating children is the same as not valuing other members of society. I don’t see that. Surely there are limits to the cost we can impose on certain groups to protect others or to show that we value others. Surely, there must be some proportionality between costs on individuals and benefits to others. It is not the case that every time we put individuals before the societal good we deny the value of other members of society. Given the unknown risks of the vaccines for children and the limited public health benefits of vaccinating them (since current vaccines are not very effective at preventing transmission), it is not clear that vaccinating them is a proportionate measure, given the uncertainties. It is far from clear that children benefit medically from it, given our current state of knowledge. If we want to appeal to that abstract principle, one could equally say that vaccinating children to protect the more vulnerable does not sufficiently value children.
      Second, you say that if vaccination “does protect adults and vulnearble people that is good for children”. Parents’ of school age children are very unlikely to be in vulnerable age groups. In any case, they have been offered two doses of vaccines, as have their grandparents. These vaccines offer an excellent protection against serious symptoms, which, coupled with the relatively low effectiveness of vaccines at preventing transmission, makes the collective benefit of vaccinating children very small, while the uncertainty around risks remains constant. This weighs against the idea the vaccinating children is a proportionate measure, given what we know now (the argument would be different for vaccines such as e.g. the flu jab, whose risk profile and effectiveness on different age groups is well established and probably weighs in favour of targeting children with vaccination policies)
      Finally, you make a third point : “We are social beings not isolated invidiauls. The health of our communities matter to all of us”. This seems to be a version of the ‘we are all in it together’ narrative that has been used to try to justify indiscriminate restrictions, and is now used to support vaccinating children. Again, it’s quite an abstract principle, but when applied to specific cases, it is also subject to some proportionality requirement. The ‘health of communities’ matters to the extent that burdens and benefits are fairly shared across its members. There is no such a thing as “the community” as a distinct entity, whose good is independent from the good of its individual members. So we need to think about how to distribute benefits, harms, and risks fairly among individuals. The point here is that placing the unknown risks of vaccines on children for a likely limited collective benefits is unfair towards children. – even if we might have become desensitised to unfairness towards young people after over an year of pandemic restrictions applied indiscriminately across all age groups.

      • A concerned citizen says:

        Amen to that, all of it.
        The current narrative is so flawed and manipulative that it has become tragically sickening. I’m grateful for your logical, polite, and articulate reply. I wish it was on every news outlet.

        To the gentleman J. Herring who states “
        All the time parents make decisions which harm children to benefit other children in the family or even parents”, well, I beg to differ. I know plenty of parents who don’t and won’t ever harm their children to benefit others – I hope you’re not referring to trivial things such as “give half of your cookie to your sibling” as a comparison. Also, since “ these vaccinations will only be given if the child wants them”: I hope you realize how kids (and adults, for what matter) can be manipulated into taking decisions based on false assumptions, lures, campaigns, and all sort of peer pressure. Which is why, incidentally, kids same age are not allowed to vote, nor to decide for themselves on other matters that potentially interfere with their health, such as driving a car, drinking alcohol, etc.
        We adults assume responsibility for their behaviours and overall well being. It is a natural parent instinct, but also our duty in front of the regulator. Suddenly, that’s not needed anymore. So in case of injury such as miocarditis, are we assuming that an injuried 15-year-old would be all of a sudden be able to provide and care for himself?

        I hope you can see how flawed this is. I also wonder if you’re a parent. Because IMHO those who have not experienced raising kids are poorly equipped to interfere in the parent/child bond, which to my knowledge is by far the strongest bond a human being could ever experience towards another fellow human being. I might be wrong here, since not all parents are equal.

        Finally, a sobering consideration. I’m a senior communication professional. It is my job to create content that influences people’s behavior. People can be led to think what a campaign suggests, to adopt a lifestyle, buy a certain brand – it happens all the time and it works fairly well, otherwise I won’t have a job.
        Using the same techniques to manipulate people into taking decisions that might affect their health is worrisome. When they’re under age, I believe it also criminal.

        • Jonathan Herring says:

          Dear concerned citizen

          I am a parent and am proud by children often seek to put others before themselves, volunteer at charities and donate to good causes. It seems very odd you might think it a bad thing to encourage children not to be selfish.

          There is all the difference in the world between a case where a child is agreeing to something which is supported by nearly every medical experts around the world and a child doing something generally thought to be harmful as a result of peer pressure.

          • Glen Brownhill says:

            You seem to be falsely attributing a Child taking a vaccine to ‘being unselfish’

            This is a simply Government propaganda and ironically come from some of the most selfish people on the planet. Please don’t fall for it.

            The logic is deeply flawed when the evidence strongly suggests that the vaccines do not do a great job of preventing transmission. It is really not worth risking your Children’s long term health for, I urge you to think twice before putting them forward for this vaccine.

          • Alan says:

            “..nearly every medical experts around the world”

            This tells me you’re a shill. You’re literally posting fake drivel under a post about the LACK of science supporting masks.

    • Daolski says:

      But not if it comes at a cost to the children themselves. How may children is it acceptable to harm with myorcarditis or any other AE or even death to protect older people? Answer: none. What are the risk s of these outcomes -higher than zero. And in the case of myocarditis significantly higher. What is the certainty of protecting others anyway? No certainty at all – you can even beginto reliably assess this outcome We should not under any circumstances sacrifice children for others.

      • Jonathan Herring says:

        All the time parents make decisions which harm children to benefit other children in the family or even parents. Family life is impossible if every decision must benefit a child. Indeed it would be very harmful for a child to be raised with every decision being made to promote their benefit. So “sacrficing children for others” is inevitable and good. But I agree with Alberto there is are issues of proportionality and allocation of risks and benefits in each case. Whether that is well struck in the case for vaccinations is a matter of debate. It certainly can’t simply be said children should never be harmed for the good of others.

        We should remember these vaccinations will only be given if the child wants them. So the child gets to decide if they want to make the sacrifice. If their parent is extremely vulnearable and the vaccine not effective, it hardly seems unreasonable for the child to prefer the risk of vaccine to the risk of their parents death.

    • jamie cronin says:

      Urghhh

  • Jonathan Herring says:

    Thank you Alberto for your thoughtful reply. I wanted to move beyond the straight forward idea that vaccinating children is unjustifiable because it was using children as a means to benefit adults. I think your further comments thinking about proportionality and the limits of what can be expected of members of the community are precisely the right way to think through these issues.

    • Alberto Giubilini says:

      Yes I agree, proportionality is key. My main concern is about what we don’t know at this stage, which makes the assessment of proportionality very difficult. Recommending a vaccine for children because the risks are proportionate to the benefits seems premature to me. This will change as we get more data, but it takes time. Hopefully, the Government strategy will work out well both for children and the wider community. Time will tell.

  • Alex Starling says:

    Dear Alberto –

    Many thanks for this. I agree wholeheartedly. I have written about this here: https://reaction.life/vaccinating-kids-against-covid-is-a-big-mistake/ – some of my arguments overlap with yours.

    I have a couple of points to add to yours. Not only is this decision potentially one of ‘net harm’ to each child, it also potentially harms children in general, as well as the population at large.

    Consider this statement from the BMJ: “Once most adults are vaccinated, circulation of SARS-CoV-2 may in fact be desirable, as it is likely to lead to primary infection early in life when disease is mild, followed by booster re-exposures throughout adulthood as transmission blocking immunity wanes but disease blocking immunity remains high. This would keep reinfections mild and immunity up to date” by Lavine et al (1).

    It is therefore entirely possible that not only is the decision to press ahead with vaccination for 12-15 year olds (and, on a sliding scale, older people as well) unethical due to the net harm they might be afflicted with, the very fact that it is plausible that a greater harm will be bestowed on their future selves – as well as mankind as a whole – makes it even more imperative that we pause while more information is gathered.

    The second point relates to the coercive nature that is to be employed to push these vaccines. In the absence of any rational reason why such a vaccination programme is needed, why not limit it strictly to those that ardently wish to participate? This would address the needs of those that have fear of missing out, while protecting those who are too young to resist the sirens calls of peer pressure and an aggressive state marketing machine. Perhaps you are better placed than me to comment on the ethics of a marketing campaign to underage children, with the UK Chief Medical Officers requesting that a “child-centred approach to communication and deployment of the vaccine should be the primary objective”. Up is down; left is right. The primary objective should be to protect our children from danger.

    This all feels very wrong.

    First, Do No Harm.

    (1) https://www.bmj.com/content/373/bmj.n1197

  • Daisy Williams says:

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