There have been media reports suggesting that the Joint Committee on Vaccination and Immunisation (JCVI) is unlikely to recommend vaccinating children under the age of 18 in the immediate future.
Prof Stephen Evans, Professor of Pharmacoepidemiology, London School of Hygiene & Tropical Medicine, said:
“All medicines approved for use, both drugs and vaccines, will have possible benefits and possible harms. The balance of benefits to harms for vaccines must be particularly favourable, since in general they are given to healthy people. The regulators like the MHRA will make an overall decision based on the data they have, after taking scientific advice, as to whether a vaccine could in principle be offered e.g. to children. JCVI make a decision on that balance related to the specific conditions that are operating at the time they make the decision.
“For a Covid vaccine in most children, the direct benefit to them is absolutely minimal. Children are at extremely small risk of any adverse outcome, especially death, resulting from Covid. Vaccinating them would largely bring benefits to others – adults including teachers who they may infect with the virus if the children themselves are infected. We do not know with certainty that vaccinating children will notably reduce their possible transmission of the virus to others, though we have some evidence that in general a vaccinated person seems less likely to transmit the virus. However this evidence, even for adults, is not as strong as it is for protection for the vaccinated individual.
“It is a complex question for JCVI; if the benefits to the individual vaccinated child are extremely low, are we absolutely sure that there is no very rare harm that they may suffer? If there were the balance to the child could be unfavourable. We have seen that the balance can change with type of vaccine in younger adults – we don’t have that knowledge for children. Those countries that have decided to vaccinate children may generate that knowledge, but not until many millions of children have been vaccinated will it be clear.
“So the ethics for vaccinating children to provide benefit for adults is difficult. When vaccination enables their education or other activities vital to their well-being that are unable to occur without vaccination it becomes more complex.
“A further complication is that Covid is a global problem. We could have worse outcomes for the UK by failing to vaccinate higher risk people in other (poorer) countries. Even if the ethical issue there is ignored, it could be in rich countries’ interests to ensure vaccination proceeds more rapidly elsewhere. Variants are very unlikely to arise in children in the UK but they are likely to arise in situations where people become very ill and the virus remains in someone at a high level. Variants arising in other countries may, and in fact most likely will, reach the UK.
“In summary, this is a very difficult decision and the data needed to inform the decisionmakers are missing important aspects.”
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Prof Stephen Evans: “No conflicts of interest. I am funded (one day per week) by LSHTM. They get funding from various companies, including Astra Zeneca and GSK but I am not funded by them, I have no involvement in obtaining funding from them and I am not an investigator on any grants obtained from them. I am the statistician to the ‘meta-Data Safety and Monitoring Board’ for CEPI. I am paid for my attendance at those meetings and will be paid expenses for travel if that occurs. I am a participant in the Oxford/Astra Zeneca trial, and on 13th January 2021 learnt I had received the active vaccine.”