LONDON — It was a relatively easy call to vaccinate the elderly against the coronavirus and keep them from getting seriously sick. But as rich countries rapidly work their way through the age groups, the vaccination of children is proving highly emotive and contentious.
The new guidance represents a confusing 90-degree turn that British teens and their families must navigate. Even pro-vaccine parents would be forgiven if their heads were spinning.
Britain’s Joint Committee on Vaccination and Immunization said its revised recommendation reflected both the state of the virus in Britain and additional safety data.
“In the last few weeks, there have been large changes in the way COVID-19 has been spreading in the UK, particularly in younger age groups,” the committee said in a statement Wednesday.
It did not specify what about the spread had influenced the shift in thinking, but Britain was hit early and hard by the highly contagious delta variant of the virus, and because so many older people are vaccinated, many of those getting infected now are young.
The vaccination committee had previously noted concern about serious vaccine side effects involving inflammation of the heart muscle or the membrane around the heart, but on Wednesday it offered further assurance that those were “extremely rare” and more of an issue after a second dose. The committee also cited data suggesting that one dose would provide young people with 80 percent protection against hospitalization.
At a Downing Street news conference, government officials were repeatedly pressed on how much had actually changed in just two weeks. “I think people are a bit confused about this changing advice,” said one reporter.
Wei Shen Lim, chair of the vaccination committee, said the advisers now had a greater certainty of data that has influenced their recommendations.
“There is no time to waste in getting on with this,” said Jonathan Van-Tam, England’s deputy chief medical officer, noting that children will start returning to school within weeks. “I want us to proceed as fast as is practically possible.”
But health policy experts who have been critical of the government’s hesitancy to inoculate teenagers said officials have been wasting time while getting to even this halfway conclusion, undermining what is otherwise one of the world’s most successful vaccination programs.
“The idea of allowing a pretty much uncharacterized virus tear through our children is utterly reckless and irresponsible, especially because it’s a vaccine-preventable disease,” said Stephen Griffin, a virologist at the University of Leeds.
“I’m very pleased that they are doing this U-turn,” Griffin said. “I hope once the safety data is in they go even younger.”
Educators welcomed Wednesday’s decision to extend vaccinations to more teens.
“No one wants thousands of pupils to miss out on school,” the National Education Union, the biggest teachers union in Britain, said in a statement.
More than 1 million students in England were out of school for covid-19-related reasons in a single week in July, before classes let out for the summer.
But Peter Kyle, the opposition Labour Party’s point person on schools, tweeted that the government reversal on vaccines for older teens “is too late to make a difference to education when terms starts next month. Government have squandered the opportunity summer offered.”
Britain’s resistance to jabbing the young has made it an outlier in the developed world, where most rich countries are trying to get a needle into the arms of those under 18 as quickly as possible.
The United States and Canada have been vaccinating 12- to 17-year-olds since May. France, Italy and other countries in Europe began in June. Germany was something of a holdout, but this week it decided to move forward on vaccinations for that age group.
Trials are underway to test the vaccines in even younger subjects. Last week, President Biden expressed optimism that children under 12 would become eligible for inoculations in the United States “soon.”
In Britain, regulators authorized use of the Pfizer-BioNTech mRNA vaccine in June for those as young as 12. But when the experts on the government advisory panel delivered their assessment two weeks ago, they concluded: “Until more safety data is available and has been evaluated, a precautionary approach is preferred.”
They approved vaccinations only for the most medically vulnerable 12-to-17-year-olds and those living with immunocompromised adults.
Some commentators in Britain have wondered aloud if the reluctance to inoculate younger people has been driven by concerns about vaccine supply. The government has declined to release numbers of available jabs. But health officials insist that supply is not a limiting factor.
Government advisers have emphasized the benefits and risks of vaccination for individual teens. With the new advice on Wednesday, Lim said: “While covid-19 is typically mild or asymptomatic in most young people, it can be very unpleasant for some and for this particular age group, we expect one dose of the vaccine to provide good protection against severe illness and hospitalization.”
Other public health experts say it’s not just a question of risk to the individual but risk for the whole society. Teens can readily become infected and spread the virus to other children and to adults, including those who cannot be vaccinated for medical reasons.
Lawrence Young, a virologist at Warwick Medical School, warned that Britain may never reach population immunity or herd immunity if children are not vaccinated. Some estimates suggest 85 percent of a population must be vaccinated or have had a previous infection to stop the pandemic, and people under 18 make up about 20 percent of the British population. This pool of unvaccinated people could keep the pandemic going on and on, increasing the potential for new variants of concern.
From a societal standpoint, Young said, “the benefits of vaccination for the young strongly outweigh any risks.”
Griffin, of the University of Leeds, noted that teens tends to have a lot of social contact as they move through their days. “So, in terms of achieving population immunity, you need to target them,” he said.
But Anthony Harnden, an Oxford University professor and deputy chair of the vaccine advisory panel, stressed that “the primary aim of the vaccination program has always been to prevent hospitalizations and deaths.”
Meaning: the point of vaccines is not ending the pandemic, which many might argue with.
“The benefits of reducing transmission to the wider population from children are also highly uncertain, especially as vaccine uptake is very high in older people who are at highest risk from serious covid-19 infection,” Harnden said in a statement.
Others have argued that the morally responsible move would be to focus on vulnerable people worldwide — not kids in Britain or America.
Andrew Pollard, a leader of the team that developed the Oxford-AstraZeneca vaccine, told lawmakers in May that “it feels completely wrong” to prioritize children in rich countries over older populations in poor countries that don’t have access to vaccines.
Some of the most comprehensive studies on the effects of the coronavirus on children and teens have come out of Britain, and so there is global interest in what Britain is seeing.
Those studies have shown it is very rare for children to get severe covid.
Within England, from the beginning of the pandemic through February of this year, studies calculated that there were about 4 million cases of covid identified in children, with fewer than 6,000 hospitalizations and 25 deaths.
And while the delta variant is more contagious, it hasn’t clearly changed how the virus affects kids. Some hospital workers in the United States report anecdotal evidence that the variant makes for “younger, sicker, quicker” patients. In Britain, scientists want to see more evidence.
A preliminary study by Aziz Sheikh and colleagues at Public Health Scotland suggested the risk of hospitalization was doubled for those infected by the delta variant, compared with the alpha strain, first detected in England. But when the alpha version of the virus was rampaging, vaccines were just beginning to be deployed, so comparisons are tricky.
Children can suffer from “long covid,” but a review in the journal Nature reported that estimates of how common it is in children “vary wildly.”
A new study published Tuesday by researchers at King’s College London followed 1,734 children, aged 5 to 17, who developed symptoms and tested positive for the coronavirus between September 2020 and February 2021, before the delta variant became dominant. The researchers report that one in 50 children with had symptoms that lasted for more than eight weeks. Two percent — of millions of cases — could be worrisome.
Wednesday’s new guidance in Britain prompted an anti-vaccine campaign on Twitter, under the hashtag #leaveourkidsalone. But teens re-appropriated the tag, declaring they were eager for the vaccine.
“maybe the anti-vaxers in #LeaveOurKidsAlone should listen to their own advice and leave us alone??,” wrote one user. “i’ve been waiting for this vaccine to help protect my high risk parents for ages and i’m excited to get it over and done with.”