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Should a Covid-19 vaccine be mandatory for children? Health professionals try to decide

City council members, parents and students participate in an outdoor learning demonstration outside a public school in Red Hook, Brooklyn, New York on September 2, 2020.

City council members, parents, and students participate in an outdoor learning demonstration outside a public school in Red Hook, Brooklyn, New York on September 2, 2020.
photo:: Spencer Platt (Getty Images)

As the race to develop a vaccine against the coronavirus, which causes Covid-19, continues, a crucial question is on the horizon: should a successful vaccine be mandatory for children who go to school? In a new article from Monday, a group of experts argue that it is too early to definitively answer the question, but they outline several important criteria that are required for a Covid-19 vaccine for children to be deemed necessary.

Although a discussion about making an approved Covid-19 vaccine mandatory has not yet been in the foreground among public health experts, according to Julie Swann, a systems engineer at North Carolina State University, it is the Obama administration during their vaccination initiated a vaccination campaign against the swine flu pandemic in 2009. And there are already several mandatory vaccination programs for children attending public schools in the US and elsewhere.

“Logistically, it is relatively easy to prescribe vaccines for children because you can prescribe them before school starts.” said Swann, unrelated to this new paper, “But it will also depend on how effective the vaccine is, what the side effects are, and what the costs and benefits are.”

The new Paper, released JAMA Pediatrics describes nine criteria for obliging a Covid-19 vaccine for children based on existing guidelines and previous research by the authors. According to the authors, however, the most important details are still missing to know whether these criteria are met or not.

For example, while half a dozen vaccine candidates are in late-stage clinical trials, we don’t know how effective any of them are in preventing infection. Many vaccines are highly effective, preventing over 90 percent of infections, while others, like the annual flu vaccine, are much less effective, being anywhere from 30% to 60% effective depending on the year. However, even a relatively less effective vaccine would be valuable if it could reduce the risk of serious illness.

The potential safety of the vaccines is less in doubt, as few to no reports of serious adverse events related to these candidates were found in early clinical trials. But it was just last week The pharmaceutical company AstraZeneca halted its Phase III trials following a report by a participant who developed severe neurological symptoms at some point after receiving the vaccine. However, it is not clear whether the woman’s disease was actually related to the fact that she received the vaccine. The company has since then partially resumed its trials in the UK following a decision by an independent body that oversees them. AstraZeneca is one of the few companies Swann noted that it can be a long time before we have relevant data on the safety of children taking any of these vaccines.

“The criterion that should take precedence over all others is the first: There must be evidence that a COVID-19 vaccine is safe for children at an acceptable risk,” the authors of the new paper wrote.

In addition, we also don’t have a clear overview of how Covid-19 affects children. The vaccines currently prescribed for public school children tend to protect against infectious diseases that are more serious to children than adults, such as measles, or that become more serious in adolescence, such as chickenpox. However, we do know that children generally suffer less from Covid-19 than adults, which could speak against obliging a vaccine for them. Only a handful of states mandate flu shots for children, and none mandate them to go to elementary school – the flu may be the closest analog of Covid-19 as it is a very common but preventable respiratory infection, which tends to be more serious for older people. At the same time, children are not invulnerable to covid-19, and some develop serious complications that can be life-threatening.

In addition to personal risk, another potentially compelling argument for requiring a vaccine against Covid-19 children is the concern that children can easily pass their infection on to others, especially their teachers and older family members. But here too, the evidence of widespread transmission of Covid-19 from children is still in flux. There have been reports of outbreaks predominantly children, and children can pass the coronavirus on to others. But we Do not know How likely is it that children in schools and elsewhere will begin and trigger the Covid-19 outbreak, as opposed to transmission that occurs primarily from adult to child.

“While children are not at the greatest immediate risk of serious consequences from Covid-19, they can have serious consequences and pass it on to others,” noted Swann.

Assuming there is a real benefit in stopping child transmission, a vaccine would need to be readily available to children and their families before it becomes mandatory, according to the authors.

The criteria proposed by the authors for deciding whether a Covid-19 vaccine should be mandatory for children attending a public school.

The criteria proposed by the authors for deciding whether to have a Covid-19 vaccine for children attending public school.
graphic:: Opel et al. / JAMA Pediatrics

“Since the benefits of a Covid-19 vaccine are more likely to benefit adults at high risk than children, it shouldn’t be burdensome for a child, or more precisely for a child’s parents or guardians, to keep the vaccine mandate.” They write. “This means that a prescribed vaccine must be widely available, easily accessible and affordable for all.”

Right now the most important thing is to find a vaccine against Covid-19 that works at all. However, this is exactly the right time to start thinking about who needs and will benefit from vaccination most urgently. By setting these criteria, the authors hope to provide a framework for other experts to decide what is best for everyone, including children.

“The only logical conclusion is that we currently know too little about the performance of any of the COVID-19 vaccine candidates or the epidemiology of SARS-CoV-2 in children to be able to make a firm decision about whether or not to have COVID-19. Vaccine should be mandatory in children, ”they wrote. “However, it is not too early to incorporate these criteria into our planning to ensure that we are making the right decision. The children of our nation deserve it too. “

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