Should the UK vaccinate children and adolescents against covid-19?

Benefits and risks

Extending covid-19 vaccination to protect adolescents aged 12 to 15 years with medical conditions such as Down’s syndrome seems justified, given their increased risk of severe infection.8 However, the vaccine offers less benefit for healthy adolescents, who tend to have a relatively mild illness. Their risk of death or hospital admission from covid-19 is very low; one study estimated the risk of catching and dying of covid-19 for all children in England as two in a million.9 Complications of covid-19 infection, including paediatric multisystem inflammatory syndrome, are also rare.10

Although most healthy adolescents recover after covid-19, some have reported persistent symptoms such as fatigue and headaches lasting 3-6 months.1112 Prevalence estimates for long covid vary, partly because symptoms are hard to separate from the wider effects of isolation and lockdowns on adolescents, but vaccination could reduce the health burden from long covid. Covid-19 vaccines reduce the risk of new variants emerging, and even a single dose can halve transmission rates.13 Thus vaccinating healthy adolescents could afford them better health while reducing disruption to their education and protecting social contacts.

Parents’ concerns centre around vaccine safety.14 Only half of parents of secondary school children say they would definitely want them to receive a covid-19 vaccination.5 The Pfizer-BioNTech vaccine trial in adolescents reported 100% efficacy at preventing covid-19 infection, without serious side effects.15 Regulatory agencies globally say vaccine benefits outweigh infection risks, and millions of over 12s have been vaccinated safely.316 A few vaccinated adolescents in the US and Israel have experienced heart inflammation (pericarditis and myocarditis).1718 The US Centers for Disease Control and Prevention confirmed 633 cases among the millions vaccinated to date.19 Most of the cases were mild and the young people recovered quickly.20

Even rare side effects among adolescents could undermine public trust in other lifesaving programmes such as human papillomavirus vaccination, which has reduced deaths from cervical cancer. Parents and teenagers should be reassured that any new vaccination programme is closely monitored and reports of side effects are quickly investigated. Parents should also be informed there are no plans to vaccinate children under 12 in the UK as there is currently insufficient evidence that vaccinating this age group is safe, effective, or acceptable to parents. However, trials are under way.

Unheard voices

Young people have sacrificed their freedom in order to protect elderly relatives and family members. Yet from the start of the pandemic, 9 in 10 young people felt excluded from the covid-19 conversation by scientists and policy makers.21 Most young people aged 16-29 express willingness to be vaccinated against covid-19 if offered,5 though in the UK those aged 16 and 17 seem more cautious than people aged 18-24.22

Involving patients and the public in decisions about their health is an embedded core principle for health professionals. However, patient and public involvement has been largely missing from the pandemic response so far. Consulting young people and parents to understand their perspectives about getting the vaccine must now be a priority for a sustainable vaccination programme. This would also send a positive signal to the next generation that they are an integral part of society’s efforts to control the virus. By getting vaccinated, adolescents could protect themselves against the risk of long covid and help the UK’s control efforts. But they may prefer to wait their turn behind adults in other countries that have greater need.

Last week’s announcement for selective vaccination of adolescents seems justifiable given the benefits to adolescents and households at high risk of severe covid-19 infection, although it leaves the UK an outlier among rich countries. For now, decisions about mass vaccination of healthy adolescents will be guided by the pandemic’s impacts, and new data about the safety and effectiveness of vaccinating this age group. The effectiveness of any vaccine programme depends on uptake, so young people’s voices should be part of ongoing reviews of covid-19 policy. Today’s adolescents will make decisions about our health in years to come. We need to listen to them.