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Covid-19: JCVI opts not to recommend universal vaccination of 12-15 year olds

BMJ 2021; 374 doi: https://doi.org/10.1136/bmj.n2180 (Published 03 September 2021) Cite this as: BMJ 2021;374:n2180

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Re: Covid-19: JCVI opts not to recommend universal vaccination of 12-15 year olds

Dear Editor

JCVI has again opted (wisely) against mass Covid vaccinations for all children and teenagers; plan to offer jabs to vulnerable 12 to 15-year-olds. Let’s explore the issue (COVID in children), available data, and most importantly the risk-benefit analysis, to conclude whether mass-vaccinations in children are indicated?

As of September3rd, 2021, ~5 million children in the United States have been tested positive for COVID-19 (1). Only ~1% of those resulted in hospitalization (10-20 times less than in adults) and >70% of those children hospitalized had underlying comorbidities such as obesity (2). Case fatality rate in this group is also extremely low (0 - 0.03%; 100 times less than in elderly) (1).

Next we look at the risks associated with mass vaccinations which potentially include ~75 million children in the US alone. In the absence of long-term safety data, there is a potential for harm - both for known side effects as well as the long-term unknown and unintended consequences for children (given longer remaining lifespan) from COVID-19 vaccines. Besides local injection site reactions and systemic symptoms, the CDC has completed investigation of more serious side effects - myocarditis and pericarditis - now reported in over 1000 children and young adults and found a potential link (3); US FDA has issued a warning for the same (4). Europe's drug regulator has also found a possible link between heart inflammation and mRNA COVID-19 vaccines (5). Even if these reactions are rare, the absolute number of (healthy) children affected with this and other unknown side effects could potentially outnumber complications due to COVID-19 requiring hospitalizations.

Another important point to consider is possibility of unintended consequences related to differences in vaccine induced and infection induced immunity? There is a possibility that antibody-responses due to mRNA vaccines against SARS-CoV-2 might be similar to that of natural infection, but CD8 T cell responses generated could be less-broadly protective against future variants (6).

Proponents of covid-19 vaccine in children argue that children transmit viruses to vulnerable older adults. Data to back this argument does not exist. More so, the Covid vaccination rates for elderly in the United States (and in western countries) is relatively very high (~85% has received one shot and 75% has received 2 shots) which should provide adequate protection from Covid infection and complications (7).

We must vaccinate our (and global) vulnerable population (older individuals with risk factors and children with co-morbidities). However, utmost caution should be applied before embarking on any public policy suggesting/mandating mass-COVID-immunization of healthy children. Informed consent should also be “truly informed” for those parents who wish to vaccinate their children (8), and we must use our wisdom; the marginal benefits of mass vaccination should be considered in the larger overall context of available resources and potential harm (9).

References:
1. American Academy of Pediatrics. Children and COVID-19: state-level data report. Updated 7/1/2021
https://services.aap.org/en/pages/2019-novel-coronavirus-covid-19-infect...
2. Hospitalization of Adolescents Aged 12–17 Years with Laboratory-Confirmed COVID-19 — COVID-NET, 14 States, March 1, 2020–April 24, 2021 | MMWR (cdc.gov)
3. Myocarditis and Pericarditis Following mRNA COVID-19 Vaccination. https://www.cdc.gov/coronavirus/2019-ncov/vaccines/safety/myocarditis.html
4. https://www.fda.gov/news-events/press-announcements/coronavirus-covid-19...
5.. https://www.reuters.com/business/healthcare-pharmaceuticals/eu-regulator...
6. Ivanova EN et al. Discrete immune response signature to SARS-CoV-2 mRNA vaccination versus infection.
7. https://covid.cdc.gov/covid-data-tracker/#vaccinations
8. Emanuel EJ, Boyle CW. Assessment of Length and Readability of Informed Consent Documents for COVID-19 Vaccine Trials. JAMA Netw Open 2021
9. Think Twice Before Giving the COVID Vax to Healthy Kids | MedPage Today

Competing interests: No competing interests

05 September 2021
MANISH JOSHI
Physician
Thaddeus Bartter, MD; Anita Joshi, BDS, MPH
CAVHS
Little Rock, AR, USA