Why experts are divided on the decision to vaccinate under-12s against Covid

The JVCI is currently deciding whether to roll out Covid vaccines to those aged five to 11, as Science Editor Deborah Cohen reports

It’s a complex and often polarised debate - should we roll out a mass Covid vaccination campaign to our five to 11-year-olds?

A dose for this age group has been approved by the UK drug regulator, and children with certain underlying health conditions have already been invited to have it.

But the JCVI - the committee that makes decisions about vaccinations - has yet to announce their recommendations about younger children more broadly.

SAGE adviser Russell Viner describes how children have been "collateral damage" amid the pandemic

Vaccine experts and pediatricians I’ve been speaking to say it’s one of the most complex decisions that public health officials can make. It might normally take them years. But in the context of the pandemic they’re having to weigh up the evidence as it emerges.

As with any medicine, experts need to weigh up the benefits against any potential harms. One direct benefit would be; does it stop children getting sick?

Dr Liz Whittaker, a specialist in paediatric infectious disease, says that vaccination prevents hospitalisation, severe disease and death.

“It doesn’t prevent infection. And in this age group hospitalisation, severe disease and death is thankfully extremely rare,” she said.

But some countries have begun vaccinating children in this age group - such as the US, France and Germany - and evidence from those countries show that serious side effects are very rare. Data also suggests that the jab may reduce the risk of rare inflammatory reaction caused by Covid in children.

“If that’s true that’s a really good motivation to vaccinate children in this age group,” she said, adding: “That’s the reason as a paediatrician I’m most likely to see a child who has had Covid in hospital."

But she says the evidence is patchy on the impact of vaccination on Long-Covid in children. She says it’s important to look at all the evidence when making such important decisions, but overall, based on what we currently know, she thinks the direct clinical benefit to children outweighs any harms.

With vaccines, another benefit to look at is their impact on transmission.

'We need to redouble our efforts to focus back on this generation'

Here Dr Whittaker says the evidence isn’t so good. So too does Professor Saul Faust, a paediatric immunologist. He says the current vaccine is unlikely to have much impact on transmission of Omicron.

This means vulnerable people living with children will need to make sure they’re protected by boosters.

Prof Faust says what will have the biggest impact on the course of the pandemic in this country is making sure the millions of people who have not had two doses - or vulnerable people who aren’t boosted - have their jabs.

Lots of children have already had Covid. So he says the JCVI will be thinking about future variants and if any age group in particular may benefit. For example, those in year six starting secondary school in September.

There may be other indirect benefits too. But they’re harder to measure.

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Prof Russell Viner, a paediatrician and a Sage adviser, says there are other issues to consider too. Will vaccinations help those children and families who have anxiety because of Covid and how much will they limit educational disruption?

“We actually really need to think about children that are at home due to their parents' anxieties or their anxieties,” he says. Some children may be staying away from school because of this.

But there are also broader issues to think about too when rolling out mass vaccinations. Decisions about healthcare often go beyond the direct clinical benefit of that treatment.

Prof Viner says there are practical considerations when it comes to vaccinating the five-11 age group too.

“We need to be vaccinating children in a place of safety by staff who are trained to vaccinate children,” he says.

With many more primary schools than secondary schools, it’ll take a lot of planning. It could be done in mass vaccination centres, but it too will take training and time, he says.

“It will be costly and it will displace something. Nothing ever occurs without displacing something else,” he says.

As ever with healthcare - and as many experts have said to me - these are complex decisions for committees and it’s sometimes better to take time over them. Not that everyone agrees. 

Government scientific adviser describes the collateral damage of the coronavirus pandemic on childrenAround one million children in England were absent from school last Thursday - most of them for reasons indirectly related to Covid, such as a household member testing positive.

Professor Russell Viner, a paediatrician who advises the government on Covid, said official figures for January 20 highlight the "collateral damage" coronavirus is having on children and their education.

"There are a lot of children who have never gone back to school once school has reopened in January," Mr Viner told ITV News.

Although many youngsters have been indirectly hit by Covid, others have been physically infected. Figures released on Friday show cases are rising the most sharply among children from nursery to primary school age.

As a result, government medical advisers are considering whether the vaccine should be rolled out to children aged five to 11-years-old.

Prof Viner said this is among the "most difficult decisions the JCVI is ever going to make".

He said the JCVI must cover several factors, such as the fact that vaccines don't tend to prevent Omicron infections, rather they aim to prevent severe illness and deaths.

"We need to be careful about making assumptions that vaccination is going to stop children catching Omicron and therefore reduce educational disruption," he said.

Prof Viner also warned about "overprotecting" youngsters from the virus, citing school closures as an example.

"So much of our Covid response has been shutting down our children's lives to protect the middle-aged and elderly. Actually, we’ve harmed children by doing that. The mental health harms are very clear," he said.