Involve me Talk to me Help me understand
These are words I read from the summary slide from the new NICE guidelines for babies, children and young peoples experiencing healthcare. This was developed in consultation with young people.
I heard these words in a webinar, Vaccination in Children: Evidence, Ethics, and Equity, given by the British Medical Journal, Medical Research Council and University of Bristol. It can be found in full here.
Just days after this webinar I was pleased to read:
“As a paediatrician, I believe it’s right to vaccinate young people aged 12 to 15”
This quote from Russell Viner, paediatrician and professor at the UCL Great Ormond Street Institute of Child Health appeared in Tuesday’s Guardian.
Webinar on Vaccination in Children: Evidence, Ethics, and Equity
The webinar contains a full and lively debate on questions surrounding vaccination in children with the knowledge that children do not tend to get extremely ill with Covid-19 unlike some adults. I was particularly drawn to hearing about children’s views in the webinar.
Katie Parsons, University of Hull, started the discussion by saying:
“I’m here to advocate and incorporate children’s voices into the Covid -19 vaccine debate. 2019 will go down in history as being the year that saw the start of the largest ever youth movement. However, just one and a half years later and the millions of politically active young people are virtually absent from the pandemic debates and political decisions. Beyond the climate movement, I would argue that when it comes to coronavirus, there’s been a systematic under-representation of young people throughout the pandemic.”
Katie highlighted the several articles that we should be adhering to according to the United Nations Convention on the Rights of the Child (UNCRC).
“Participation is being involved
“Voice means a right to express views freely and to be heard
“Agency means to be able to make decisions influence change and give evidence”.
The UN CRC has influenced laws in the UK as evidenced by legislation like the Children’s Act and the ‘Every Child Matters’ Initiative. This year the Scottish Government became the first in the UK to begin to fully incorporate the convention into law.
Studies in schools
We then heard about studies that have gone into schools to try and determine risks of Covid-19 infection in schools. Most infections in schools are due to multiple introductions of the virus by different children and staff bringing the virus in. Children get infected and the proportion of children who develop antibodies against the virus is similar to that in adults.
However, young children tend to make better antibodies than adults after infection and they appear to retain those very functional antibodies longer than adults, for at least 12 months. Along with the knowledge that children often get lesser disease this has been taken as a rationale for children not needing the vaccine.
It seems that the risk of transmitting the infection is far lower from children than from adults with the infection. The risks of transmitting the virus in schools is fairly low but if a child took the virus home, then the risk to the family members is high. A problem with many of these studies is that children often have asymptomatic infection and the only way to know if infection is there is by a blood test to look at antibodies before and after the infection. This is not routinely done.
Ethics and global effects
The discussions on ethics and the global effects of vaccination in children partially centred around knowledge that many children do not get very sick with Covid-19 and that many people in poor countries are not getting access to the vaccine.
Shouldn’t the vaccines meant for children in rich countries be send to poorer parts of the world?
If you give the vaccine to people are very low risk (children) then you’re not giving them to people who are at very high risk around the world.
In the webinar it was discussed that one of the cons of vaccinating children may be that those who immunize children with other vaccines would end up vaccinating children with the Covid vaccine resulting in disruption of those programmes and therefore more deaths from cancer, meningitis, etc.
Ethics and sustainability
The last session was on sustainability and ethics in relation to child vaccination. The background problem essentially is that there are a limited number of vaccines in the world, and most of those vaccines are held in rich countries through a variety of different kinds of purchase agreements or orders. There are excess deaths related to Covid-19 and Covid-related issues of approximately 18 million people over the last two years. Many of these deaths would be preventable, had they had vaccines.
In this session we heard the complexity involved in getting the vaccine to different parts of the world. If we decide not to vaccinate children because there are people in other places in the world that needed more then the question is would the vaccines actually get there?
There is the issue of procurement and purchasing; a substantial number of steps would have to happen such that we could make a decision that children should not get vaccinated, and those vaccines should go to other countries. Most of the vaccines have been purchased through private entities and through private purchasing using all sorts of commercial agreements.
The other point is that in the UK, at present has about 200 million excess doses of vaccines. This does not include vaccines for all 16-year-olds and above and it does not include booster shots. And this does not count the approximately 400 or more million doses that are still on order. As well there are millions of doses that are going to waste. In the United States, approximately 15 million doses have been wasted since March.
Questions from children
Lilly Norman 16 years old, asked how children would know the pros and cons of the Covid vaccine. She said:
“How do we find that information?”.
The answer referred to The Gov.UK website, which has child readable text.
“My brother has type 1 diabetes and epilepsy so he already has a vulnerable immune system. What should he do, have the vaccine or not? And then what should I do? Should I have it to protect him or am I better just not having it?
The advice given was – have the vaccine; he is unlikely to be problems with the vaccine.
One speaker’s advice was for Lucca to have the vaccine and another that Lucca should not have it as it wouldn’t be in the guidelines.
“Why is AstraZeneca not recommended for children under the age of 18?”
This is because of a small, but significant risk of bleeding and clotting in young ages and it is not worth risk of giving AstraZeneca.
“Are you aware of any specific side effects for young people who have the vaccine versus those who have not?”
Myocarditis is the most severe side effect; this is short term especially after the second vaccination. However, is myocarditis extremely rare and may happen in those who have Covid-19.
By vaccinating, children’s lives will be saved. Although the at-risk children would have been vaccinated anyway, would we really have known which children were at risk?
In the UK I am pleased that children aged 12 to 15 will be invited to have the vaccine for Covid-19.