There follows a guest post by Dr Ros Jones, a retired consultant paediatrician and member of HART.
If, a year ago, someone had asked if we should give children a brand-new vaccine with no long-term safety data for a disease that barely affects them, they would have been laughed out of court. But here we are today, considering doing exactly that and not even with the pretence that it is for their own safety. It is because adults think it is okay to ask children to take a medicine which may cause them harm to protect us. Yet the adults clamouring for this have all been vaccinated already.
Two weeks ago, 40 UK doctors wrote to the Medicines and Healthcare products Regulatory Agency (MHRA) and the Joint Committee on Vaccination and Immunisation (JCVI) calling for a halt to any proposals to widen the temporary emergency authorisation for COVID-19 vaccines to include children on the grounds of major safety concerns. We now learn that this is such a complex ethical question that the JCVI will pass the responsibility to the Prime Minister. The entire management of the pandemic has been politicised to the detriment of open scientific and ethical debate and it is totally inappropriate for child health to become a potential political football. The urgency for such debate has increased by the approval, first in North America and now Europe, for vaccination of 12-to-17-year-olds, and Pfizer’s application is currently lodged with the MHRA. So what is the medical, ethical and legal basis for such a move?
The medical case for children
Children are mercifully at incredibly low risk for COVID-19, with the vast majority having mild to no symptoms, few hospital admissions and even fewer requiring intensive care. There were nine Covid-associated deaths in under-15s in the whole of 2020, all with prior life-limiting conditions and accounting for 0.3% of all cause deaths in this age group. Any adolescent at extremely high risk may already receive a vaccine and this should not inform policy for an entire age group. Long Covid has also been raised as a concern, but in children it is milder and shorter-lived than in adults, with studies reporting complete recovery.
So if the disease is extremely mild for children, what of potential adverse effects of vaccination? Tragically, in recent weeks we have seen reports of thrombotic thrombocytopenia (VITT), an extremely rare condition, occurring in a significant number of young adults following vaccination, with cerebral venous strokes, some fatal. VITT was not detected in any of the trials but the MHRA now quotes the incidence following AstraZeneca vaccination as 1 in 77,000, stating ‘the data shows there is a higher reported incidence rate in younger adult age groups compared with older groups’. Doctors advising an individual on benefits and risks are left to guess how much higher but AstraZeneca vaccine was withdrawn for under 30s and latterly under 40s, and the Oxford children’s trial was suspended. Pfizer appears to have similar thrombotic problems though possibly at a lower rate and this is likely to be a class effect involving the spike protein. With Pfizer, the Israel Health Ministry have confirmed that myocarditis is occurring at a rate of 1 in 41,730 for the 2nd dose in young men aged 16-30s, but highest in 16-19s. These are not trivial side-effects: they are potentially fatal or life-changing and appear to be occurring at a rate which is higher than that of severe outcomes for childhood Covid infections. This is without considering any as yet unknown longer-term adverse effects and bearing in mind that only 1,134 children were vaccinated in the Pfizer trials. Following the tenet “First do no harm”, routine vaccination of children against COVID-19 is contra-indicated.