The Joint Committee on Vaccination and Immunisation (JCVI), the UK’s top body of independent experts, has advised its government to defer vaccinating all children aged 12-17, saying only children at increased risk of serious COVID-19 disease should be offered the Pfizer-BioNTech vaccine.
The JCVI, which is the equivalent of India's National Technical Advisory Group on Immunisation, examined the risks of COVID-19 to children and young people and issued an advisory early this week. It said only those aged 12 and above with specific underlying health conditions that put them at risk of serious COVID-19 should be vaccinated. The committee said it will review its decision in the future based on more data.
The decision comes as experts remain divided on whether a third wave of the pandemic will impact children. While children and teens are not spared by COVID-19, they rarely develop severe forms of the disease and deaths are even rarer.
The JCVI’s decision could have a bearing on other countries as well.
In the UK, the Pfizer-BioNTech vaccine is authorised for those less than 18 years old (up to 12 years).
Indian vaccine makers Bharat Biotech, Serum Institute of India and Zydus Cadila have either initiated clinical trials their COVID-19 vaccines for children or are doing so.
Here is an explainer on why the UK panel advised against vaccinating all children aged 12-17.
Benefits don’t outweigh risks
The JCVI said the evidence strongly indicates that almost all children and young people are at very low risk from COVID-19. The symptoms seen in children and young people are typically mild, and not different from other mild respiratory viral infections that circulate each year.
“In England, between February 2020 and March 2021 inclusive, fewer than 30 persons aged less than 18 years died because of COVID-19, corresponding to a mortality rate of 2 deaths per million. During the second wave of the pandemic in the UK, the hospitalisation rate in children and young people was 100 to 400 per million. Most of those hospitalised had severe underlying health conditions,” the JCVI said.
While vaccination of younger cohorts could reduce the risk of outbreaks of COVID-19 in school settings, the vast majority of those infected in any outbreak will either be asymptomatic or have mild disease, the panel said.
“Currently, less data are available on the safety of COVID-19 vaccines in children and young people compared to adults, and JCVI carefully considered reports of myocarditis following the use of the Pfizer and Moderna vaccines in younger adults. At this time, JCVI does not consider that the benefits of vaccination outweigh the potential risks,” the JCVI said.
Myocarditis is an inflammation of the heart muscle.
The JCVI said until more safety data have accrued and their significance for children and young people has been more thoroughly evaluated, a precautionary approach is preferred.
What about multisystem inflammatory syndrome and long COVID in some children?
The JCVI said Paediatric Inflammatory Multisystem Syndrome (PIMS) associated with the SARS-COV2 infection in some children was “rare” and there was insufficient data to advise on how COVID-19 vaccination would affect PIMS.
“During the second wave, PIMS was estimated to occur in 5 per 10,000 children infected with SARS-CoV2 in the UK, with a case fatality ratio of 1 percent. The underlying cause for PIMS is not properly understood,” the committee said. “Specifically, it is not known how COVID-19 vaccination might influence the occurrence or severity of PIMS.”
The panel said the risk of post-acute COVID-19 syndrome or long COVID in children is very low in comparison with adults.
Does vaccinating children shield the elderly from COVID?
Not necessarily, the JCVI said. The committee acknowledged modelling from the University of Warwick and Public Health England, which indicated that vaccinating children and young people could have some impact on hospitalisation and deaths in older adults. But it said the extent of such indirect benefit is highly uncertain.
“… the extent of such benefits are considered highly uncertain, and by autumn 2021, all eligible adults should have been offered two doses of COVID-19 vaccine. A successful adult COVID-19 immunisation programme would mean that education staff and adult household members of students should have been vaccinated, reducing the risk of onward transmission from children to adults in school or at home, respectively,” the JCVI said.
Who among children should get preference for vaccination?
The JCVI advised that children and teens with specific underlying health conditions that put them at risk of serious COVID-19 should be offered COVID-19 vaccination. These conditions include severe neuro-disabilities, Down’s syndrome, children having immunosuppression, and those with profound and multiple learning disabilities. Also, children and teens who are household contacts of persons who are immunosuppressed should be offered COVID-19 vaccination.
Go for non-COVID immunisation
The committee advised on getting non-COVID-19 school immunisations such as human papillomavirus and meningitis vaccinations and routine vaccines such as mumps, measles and rubella in school settings as part of the overall recovery, in addition to extension of the childhood influenza programme. The committee said most non-COVID-19 childhood immunisations are likely to offer more benefits to children and young people than a COVID-19 immunisation programme.