Intended for healthcare professionals

Letters Vaccinating vulnerable children

Inviting adolescents aged 12-17 for covid-19 vaccination: the need for patience

BMJ 2021; 374 doi: (Published 09 September 2021) Cite this as: BMJ 2021;374:n2172
  1. Peter A M de Beer, specialist physician and adviser in global health and tropical medicine1,
  2. Koenraad Van den Abbeele, consultant physician2
  1. 1Medical Services for the Tropics/Dr de Beer Travel Clinic, Maastricht, Netherlands
  2. 2Department of Medicine, Wexham Park Hospital, Frimley Health NHS Foundation Trust, UK
  1. mstropics{at}

The UK shows restraint in rolling out covid-19 vaccination for adolescents by reserving it for vulnerable children.1 We commend such prudence.2

The European Medicines Agency (EMA) recently accepted the Pfizer-BioNTech and Moderna covid-19 vaccines for use from 12 years old. Expected direct benefits are reductions in multisystem inflammatory syndrome in children and long covid; indirect benefits are less virus circulation and herd immunity because too many adults are refusing. EMA is reviewing vaccine side effects such as myocarditis and pericarditis.

The Dutch Health Council advised vaccination of vulnerable 12-17 year olds.3 But on 29 June, the Dutch National Institute of Public Health and the Environment decided to offer vaccination to the whole age group.4 Belgium, Denmark, Finland, Austria, and Portugal offer only to 16 and 17 year olds. The effects of covid-19 on teenagers’ health have not been a priority, but Park et al showed that household transmission of SARS-CoV-2 was high if the index patient was 10-19 years old.5

Parents and caregivers are contacting experts in travel medicine, infectious diseases, global health, and tropical medicine for answers. While awaiting trial results, we need to err on the side of caution, watch out for virus virulence related pathology from new variants, follow genomic surveillance data, and respond quickly, as William Hanage advocates.6 Junior doses of hepatitis A and B vaccines induce better antibody responses than adult doses, so covid-19 vaccine trials with lower doses and vaccines considered “too weak” for adults could be conducted.

The European Centre for Disease Prevention and Control, Dutch National Institute of Public Health and the Environment, and others consider the IgG immune response after one vaccination in previously infected people equal to that after two.78 We could offer IgG antibody testing to adolescent contacts of confirmed SARS-CoV-2 cases and save vaccine doses. This strategy is not in the guidelines; opponents argued that it was too costly. But some covid-19 vaccines are more expensive than IgG tests. We could donate saved vaccines to countries with vaccine coverage <2%.910 Expeditious global vaccine rollout would be in everyone's interest by avoiding vaccine resistant mutant reservoirs.


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