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Should we delay covid-19 vaccination in children?

BMJ 2021; 374 doi: https://doi.org/10.1136/bmj.n1687 (Published 09 July 2021) Cite this as: BMJ 2021;374:n1687

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  1. Dominic Wilkinson, professor of medical ethics1 2 3,
  2. Ilora Finlay, professor of palliative medicine4,
  3. Andrew J Pollard, professor of paediatric infection and immunity2 5 6,
  4. Lisa Forsberg, British Academy postdoctoral fellow in philosophy and law1 7,
  5. Anthony Skelton, associate professor of philosophy8
  1. 1Oxford Uehiro Centre for Practical Ethics, Faculty of Philosophy, University of Oxford, UK
  2. 2John Radcliffe Hospital, Oxford, UK
  3. 3Murdoch Children’s Research Institute, Melbourne, Australia
  4. 4Cardiff University, UK
  5. 5Oxford Vaccine Group, Department of Paediatrics, University of Oxford, UK
  6. 6NIHR Oxford Biomedical Research Centre, Oxford, UK
  7. 7Faculty of Law, University of Oxford, UK
  8. 8Department of Philosophy, University of Western Ontario, Canada
  1. Correspondence to: D Wilkinson dominic.wilkinson{at}philosophy.ox.ac.uk, A Skelton askelto4{at}uwo.ca

The net benefit of vaccinating children is unclear, and vulnerable people worldwide should be prioritised instead, say Dominic Wilkinson, Ilora Finlay, and Andrew J Pollard. But Lisa Forsberg and Anthony Skelton argue that covid-19 vaccines have been approved for some children and that children should not be disadvantaged because of policy choices that impede global vaccination

Yes—Dominic Wilkinson, Ilora Finlay, and Andrew J Pollard

For a health system to offer any vaccine to a child, two key ethical questions must be asked. First, do the benefits outweigh the risks? Second, if the vaccine is in short supply, does someone else need it more? Careful attention to both questions suggests that we should not yet roll out covid-19 vaccination to otherwise healthy children.

Covid-19 vaccines in adults have been remarkably effective. There is good reason to expect that the same will be true in children. Preliminary studies in adolescents indicate high levels of antibody production and 93-100% effectiveness in preventing covid-19.12 This has led to licensing decisions in the UK, the US, and elsewhere.

Less benefit

In older adults, the benefits of covid vaccines clearly outweigh the rare side effects. But in children there are some key differences.

First, we know less about the risks. Randomised trials to date have given vaccines to only about 3500 adolescents. These trials are not designed to identify rare side effects.3 For example, the US government’s Centers for Disease Control and Prevention has recently identified a risk of myocarditis in adolescents who have received mRNA based covid-19 vaccines (an estimated 56-69 cases per million vaccine doses).4 We do not know whether other complications will emerge.

Second, the potential benefit in children is much smaller. Most children who get covid-19 have mild illness. There are low risks of hospital admission and death (around two per million children in the …

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