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The Joint Committee on Vaccination and Immunisation (JCVI) has issued updated advice on COVID-19 vaccination of young people aged 16 to 17.
Comment sent out 06/08/2021:
Dr David Elliman, Consultant in Community Child Health, said:
“I think this is very complex and is going to become even more so as consideration is given to even younger children receiving the vaccine. Leaving aside what the uptake may be, there are a number of important issues.
“Firstly, who is it that benefits from the vaccine when given at 16-17 years? It is the teenagers themselves, both in health and educational terms. But it is also the wider society. No numbers were provided with the JCVI statement that would allow one to look at the relevant contributions of each to the decision. Unpublished modelling data is referred to. If decisions are taking this into account, the data should be published.
“Secondly, what are the hazards of the vaccination at this age? We know that the serious adverse effects of both the AZ and mRNA vaccines increase with decreasing age. Is there enough safety data for this particular age group? (The referenced US data showed a steady increase with decreasing age with the greatest incidence of myocarditis expected in the 12-17 year age group – 56-69 cases per million doses, compared to 3-4 in those 30 years or older.) ) If there is, why was the risk benefit balance not depicted in the same way as it was for the AZ vaccine and VITT? It may, in part, be because the serious risks of the mRNA vaccines are said to be mainly after the second dose, which is still under review, but this is not exclusively so. The incremental benefit, certainly in the short term, of the second dose vaccine is not as great as that of the first dose, making the risk benefit calculation even more difficult. To complicate matters further, the risk-benefit ratio seems much more favourable in females. It would not take many young people to suffer a real serious adverse event to derail the programme and perhaps set back immunisation programmes in general.
“Finally, what are the overall benefits of the vaccine given to 16-17 year olds, in comparison with the same number of doses used in one of the many countries that cannot get hold of enough vaccine to immunise their high risk groups. It would be nice if someone could produce the comparative numbers. I imagine that this consideration is outside the remit of the JCVI, however, it is not only an important ethical issue, but also one of self interest. As has been said repeatedly, none of us are safe until we are all safe. This applies to my neighbours in UK, but also to my fellow human beings around the world. While there are areas with substantial virus circulating, the chances of variants arising remain high and the possibility of one that is of major concern arising, especially where the vaccine is less effective, is not insignificant. I know that UK has promised to provide some doses of vaccine to other countries, but more can only be better. This issue has already been raised in relation to booster doses.”
Comments sent out 04/08/2021:
(not a third party comment) Prof Anthony Harnden, Deputy Chair of the JCVI, said:
“For well 16-17 year olds prioritising the first dose of vaccine and delaying the recommendation of a second dose gives young people the choice of vaccination to offer protection to themselves and their families in the knowledge that JCVI will carefully monitor the global safety data arising from the second dose.”
Dr Camilla Kingdon, President of the Royal College of Paediatrics and Child Health, said:
“We once again thank the JCVI for their hard work on these complex issues. This group of experts is continually looking at the data as they emerge and making their recommendations accordingly and they will continue to do so.
“The roll-out of the vaccine programme for adults has been incredibly impressive but, for children and young people, it has been frankly shambolic. This is the second announcement around vaccinations for children or young people in the last three weeks but we still haven’t seen detailed plans for roll-out of the first.
“Once again, paediatricians have been left completely in the dark about how and when children and young people will be invited for vaccination. There has been no information to parents and none to young people themselves and that creates confusion and, for some families, real worry. Our members are constantly being asked questions by young people or their parents for which they don’t have the answers because the systems aren’t in place and the detailed advice has not been provided. In England, at least, the national booking system for COVID vaccinations is still not taking bookings for anyone under the age of 18, more than two weeks after the ministerial announcement.
“While everyone is concentrating on the COVID vaccine, it was good to hear Professor Wei Shen Lim remind everyone of the importance of maintaining other routine immunisations. These national programmes are highly successful at preventing sometimes life-threatening diseases and it is extremely important that these are maintained given the benefits they offer children and young people.”
Dr Peter English, Retired Consultant in Communicable Disease Control, Former Editor of Vaccines in Practice, Immediate past Chair of the BMA Public Health Medicine Committee, said:
“Please note my previous comments on a recent JCVI announcement.1
“Ideally the Joint Committee on Vaccination and Immunisation would “show their workings” when making announcements such as the recent one,1 and the one we heard this afternoon. Indeed, they often do go into considerable detail in their meeting minutes; but there has been relatively little detail about these recent decisions as far as I’m aware.
“The UK medicines regulator approved the vaccines from the of 12 years in early June,2 and other countries, such as the USA and Canada,3 4 have been offering the vaccine routinely to children aged 12+ for some time now, so we have an abundance of safety data for this age group.
“The JCVI seems to be adopting “an abundance of caution” with respect to recommending vaccines to this age group in the UK, despite having seen the same evidence that MHRA will have seen. Why they did not recommend vaccinating 12+ year olds outside risk groups in mid-July, and why it seems they will restrict their recommendation to people aged 16+ today, are questions that remain unanswered to my satisfaction.
“It is possible that they have taken the line that 16 and 17 year-olds are at a higher risk of Long Covid than younger teenagers and younger children, pushing the risk/benefit equation more in favour of vaccinating this age group; or that this age group is particularly social, mixing with many people, and thus very effective vectors, spreading the virus to people who are unvaccinated or in whom the vaccine did not work, increasing the wider societal benefits of vaccinating this age group.
“Whether or not they have been leaned upon by ministers (as I speculated in my previous comment), or by the NHS because of supply issues, I believe it is just a matter of time before the vaccine will be recommended for everybody aged 12 or more; and very likely, in due course, as safety data accumulate, also for younger children.”
Dr Simon Clarke, Associate Professor in Cellular Microbiology at the University of Reading, said:
“The news that 16 and 17 year olds will now be eligible to receive the Pfizer Covid-19 vaccine, as is already happening in many other countries, is unsurprising.
“This move by the Government will allow it to extend the coverage provided by vaccines further across the population and I expect younger teenagers to become eligible in due course. Given vaccination of this age group has happened extensively elsewhere, there will be a wealth of evidence as to the vaccine’s safety and efficacy.
“While it is perfectly true that this age group are highly unlikely to get seriously ill from contracting the coronavirus, they can get sick and feel rather unwell. It’s for that reason that I believe they should be offered an opportunity, which they are free to decline, to be vaccinated. Similarly, having the vaccine will reduce their chances of developing Long Covid.
“We don’t yet have a full understanding of the vaccine’s efficacy for preventing asymptomatic transmission of the Delta variant, but it’s certainly possible that providing it to 16 and 17 year olds will contribute to the overall effort to prevent infection in wider society.”
Prof Cock Van Oosterhout, Professor of Evolutionary Genetics, University of East Anglia, said:
“The need to vaccinate a potentially susceptible group can be simply understood when studying the basic SIR model in epidemiology. In this model, S, I, and R (Susceptible, Infectious, or Recovered) represent the type of people from the perspective of the virus. With more susceptible people in the population, the virus can transmit faster and more efficiently, and this has two main consequences.
“Firstly, it increases the total number of infected people, thereby putting additional pressure on hospitals, the economy, and potentially leading to more deaths. Secondly, it also allows the virus to evolve faster, because the evolutionary potential of the virus increases with an increasing number of infected people. Unvaccinated children represent a large reservoir that is susceptible to infection but tolerant to the disease. Within this group, SARS-CoV-2 continues to evolve. In summary, this unvaccinated part of the population puts more vulnerable groups at increased risk because of 1) elevated transmission rates and 2) continued evolution of the virus. Vaccinating 16- and 17-year-olds reduces this risk.
“Furthermore, although there is no support of this yet happening in SARS-CoV-2, there is also a theoretical possibility of so-called “vaccine driven virulence evolution”. In that case, a more virulent strain could evolve in the vaccinated cohort and spread into an under-vaccinated population. By vaccinating this group pre-emptively (and even though this represents a largely refractory age group), this theoretical risk could be reduced. I stress this is just a theoretical possibility, and as so many other things with this virus, it is virtually impossible to quantify the exact risks of this happening. Hence, the precise benefits provided by the vaccination of children is difficult to estimate. Nevertheless, given the other two points (elevated transmission rates and continued evolution of the virus), and the fact that the vaccines are very safe also for children (based on data on the effects of vaccination in children in the US), I believe that the vaccination of the 16-17 age group is the right policy, and that vaccination of younger children may need to be considered in the future.”
Prof Lawrence Young, Virologist and Professor of Molecular Oncology, Warwick Medical School, University of Warwick, said:
“The big question regarding vaccinating youngsters has been whether the benefits outweigh the risks.
“Increasing data from the US where nearly 9 million 12 to 17 year olds have been vaccinated and the extension of vaccines to teenagers in Canada and France has provide reassurance that the Pfizer vaccine is safe with serious side effects being very rare. Vaccination of 16 and 17 year olds will protect them from getting sick and from developing long-term consequences of infection (long covid), both of which rare in this age group but can still be very debilitating. Vaccination will also reduce the ability of youngsters to spread the virus and will also prevent the generation of new variants. Perhaps the most significant benefit of vaccinating this group is to ensure that there are no further disruptions to their education once they return to school or college.
“There is still much speculation about vaccinating the 12 to 15 age group – with certain groups of vulnerable children in this age group or those living with at risk individuals being provided with the jabs. It is interesting that the possibility of vaccinating all 12 to 15 year olds hasn’t been ruled out.”
Prof Alex Richter, Professor of Clinical Immunology at the University of Birmingham, said:
“Vaccinating our 16 to 17-year-old young adults is the logical next step. We know the vaccines are highly efficacious and this is another piece in the jigsaw for the UK returning to some kind of normality.
“Young adults are at low risk, but not at no risk, of severe disease and there are increasing reports of long COVID in this age group. We must also consider the huge impact on the education of this age group and also their social development. If we can’t have a vaccine that can prevent infection altogether, then vaccinating 16 and 17 year olds seems a sensible approach.
“There is a wider societal benefit to reducing infection transmission; the less cases there are the less disruption to society, the less risk of viral mutation and the less likely our clinically extremely vulnerable population are to be exposed to the virus as many of them cannot be protected by vaccination.”
Dr Michael Head, Senior Research Fellow in Global Health, University of Southampton, said:
“It is reported that children aged 16 and 17 will not need the consent of their parents. This is correct. The Family Law Reform Act 1969 allows children aged 16 and 17 to seek surgical, medical and dental treatment without the need for consent from an adult, and this includes vaccinations. Clearly, the ideal situation would be for the decision to vaccinate to be taken with the parent or guardian. However, there is an assumption that young people of this age have the capacity to make their own decisions. As per with adults, they should be given the available information, such as risks of adverse events, and be supported with the decision-making process.”
References:
https://www.legislation.gov.uk/ukpga/1969/46/section/8 (see section 8.1)
Brief twitter thread from 2019 – https://twitter.com/michaelghead/status/1094957854228918275
This blog covers the subject in more detail – https://www.bevanbrittan.com/insights/articles/2015/children-anupdateonconsenttomedicaltreatmentanddeprivationofliberty/
Prof Russell Viner, Professor of Child and Adolescent Health, UCL, said:
“Vaccinating all 16 and 17 year olds with the Pfizer-BioNTech vaccine is a welcome and sensible step given what we know about COVID-19 risks and the safety of vaccines in this age group and where we are in the pandemic.
“The risk of severe illness from COVID-19 in 16-17 year olds was about 1 in 60,000 in England during the first year of the pandemic, with a risk of death around 6 in a million.
“These risks are very low but they overlap with the risks for 18-19 year olds, who are eligible for vaccination. So this decision recognises the biological continuities between 16-17 year olds and 18-19 year olds but also that there are important social and educational benefits for protecting young people and reducing transmission in the upper years of secondary school.
“There are risks from any vaccine and we now are clearer that the risks of inflammation of the heart or heart linings (myocarditis or pericarditis) are also low (around 30-100 per million) and most cases are mild and recover quickly.
“Any decisions about vaccinating children and teenagers must balance risks and benefits and this is never easy. Vaccinating older teenagers is a reasonable first step and will be important for young people themselves in the return to school and also benefit wider society including the elderly and younger children. This step is particularly useful now as high vaccination levels are concentrating infection amongst the unvaccinated children and teenagers.
“We need further safety data before we consider vaccinating younger teenagers.”
Comments sent out on Wednesday morning in response to media reports suggesting what the JCVI were set to recommend, before the detail was published:
Prof Peter Openshaw, Professor of Experimental Medicine, Imperial College London, said:
“Children and adolescents have very high SARS-CoV-2 transmission rates, amongst the highest of any age group. Infections are generally mild but some are not; both the short and long-term effects of COVID can seriously disrupt education and leisure.
“Teenagers have not had the benefit of being naturally infected in early childhood and therefore have no immunological resistance to infection with highly transmissible variants. Estimates of the proportion of young people affected by long COVID varies, but symptoms range from mild to disabling and COVID may present in unfamiliar ways in childhood.
“The information that we have so far shows that vaccines are highly effective and safe in childhood and adolescence. There are reports of rare cases of myocarditis and pericarditis in young males after mRNA vaccines, but the reasons for this and the frequency has yet to be proven. The USA and France are already vaccinating children.
“JCVI are right to continue to monitor safety data from UK studies and from other countries, balancing risks and benefits of vaccination vs. natural infection at different ages.
“Vaccination of teenagers may have a major effect on the return of COVID next winter, assuming that the rates will drop this summer. Full vaccination takes time, so the sooner we start the sooner this age group will be protected.”
Prof Rowland Kao, Chair of Veterinary Epidemiology and Data Science, University of Edinburgh, said:
“Because we have thus far not yet vaccinated younger age groups in large numbers, information on possible side effects directly relevant to the UK is scant. However, while evidence exists that severe vaccine side effects can occur more frequently in teens, these side effects are at most rare. Where infection risk itself is low, cautionary principles would therefore lead towards avoiding vaccination of teenagers. However, infections in the UK, while going down, are still high – and therefore there remains a substantial risk that teenagers get infected (per capita, infection rates in teenagers are higher than any other age group in GB). Thus, vaccine side effect risks are to some extent, counterbalanced by the risk of severe disease which is substantially reduced by vaccination and does sometimes occur in teenagers (albeit at much lower rates than for older people). Vaccination should also reduce the amount of disruption due to COVID in schools. The key question is the relative balance of those risks; this is one thing that JCVI is likely to be reviewing. As well, evidence of more rapid reductions in viral loads, even when vaccinated individuals become infected, is an indicator that vaccines are protective against transmission, even where they fail to prevent infection – and therefore protecting others in the population, especially those with higher risk of severe COVID. While this should not be the primary reason for vaccinating teenagers, it is an additional argument for recommending they do get vaccinated, as, unlike young children, there is good evidence that older teenagers can perpetuate transmission chains.”
All our previous output on this subject can be seen at this weblink:
www.sciencemediacentre.org/tag/covid-19
SMC Q&A Briefing with paediatricians.
Declared interests
Prof Peter Openshaw: “Peter Openshaw has served on scientific advisory boards for Janssen/J&J, Oxford Immunotech, GSK, Nestle and Pfizer in relation to immunity to viruses (fees paid to Imperial College London).”
Prof Anthony Harnden: Deputy Chair of the JCVI
None others received.