Covid jabs for UK children: a very tight decision that could be overruled | Coronavirus
It was, the scientists said, a very finely balanced decision. On the one hand, Covid vaccines undoubtedly help to reduce infection and illness. On the other, Covid vaccines – like every other vaccine in medical history – are not without their risks. In children aged 12 to 15, the threat of serious Covid is tiny, but so is the risk of serious side-effects from the vaccine.
After much deliberation, the government’s independent vaccine advisers concluded that, on the strength of evidence so far, there was a marginal benefit to vaccinating healthy children aged 12 to 15 years old. But that benefit was deemed so very marginal the advisers would not give the green light to mass vaccination of healthy children in the age group.
Instead, the Joint Committee on Vaccination and Immunisation (JCVI) broadened out the existing group of 12- to 15-year-olds eligible for Covid vaccination. Beyond the extremely vulnerable who have already been called forward for shots, the JCVI drew on research from the Royal College of Paediatrics and Child Health to include children with major, chronic heart, lung, kidney and neurological conditions. Children with sickle cell disease and type I diabetes will also be eligible.
Under the new guidance, about 200,000 of the 4 million or so UK children aged 12 to 15 will now be eligible for Covid jabs. To support its case, the JCVI released data on the risks the children faced. While healthy children aged 12 to 15 are admitted to intensive care with Covid at a rate of about two per million, among those in the vulnerable group the risk is more than 100 per million.
The JCVI discussed the potential risk of long Covid in children – the fatigue and other debilitating symptoms that can persist for months – but concluded that while some children did have continuing symptoms, the issue was less common than in adults. Moreover, it believes the impact of the symptoms may be no worse than those seen in children who have not actually had Covid, but experience the same ailments. Another factor that acted against a decision to vaccinate all 12- to 15-year-olds is that the jabs are not spectacularly effective at preventing transmission now the Delta variant is dominant.
But the JCVI’s recommendation is not the final word. Throughout the pandemic, the government has happily followed the committee’s advice. The expert group is considered to have made sound judgments on delaying second doses and the order in which people should be called forward for immunisation. This time, the government may break with that tradition. The four chief medical officers (CMOs) of England, Wales, Northern Ireland and Scotland have been asked to hold their own expert meeting next week on the question of Covid vaccines for secondary school pupils. There is a strong possibility they will reach a different conclusion.
The CMOs will not go over the same ground as the JCVI. Instead they will pull in more experts and make a final decision that takes other factors into account. Chief among these will be any benefit vaccination will have against school closures and for Covid isolation policies. Given that Covid has caused massive disruption to education – an issue beyond the JCVI’s remit – next week’s deliberations will carry considerable weight.
Members of the JCVI have stressed that it was the committee that requested that further advice be sought, noting they felt they did not have the expertise to assess the educational aspects of the issue. The move, they added, was without precedent.
One of the most pressing concerns for the JCVI is the unknown longer-term consequences of a rare side-effect seen with mRNA vaccines, such as the Pfizer/BioNTech and Moderna shots. Other countries started vaccinations on young people earlier and have more data on the side-effect, but the UK Medicines and Healthcare products Regulatory Agency (MHRA) said it saw myocarditis – inflammation of the heart muscle – in about 5.7 cases per million among those who have had two shots of mRNA vaccine, a level similar to that seen in the general population.
The cases are rarely serious, but what makes the JCVI uneasy is that there is little long-term follow-up on vaccinated children who are sent home from hospital after recovering from the side-effect. It could be several more months before that picture becomes clear.
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