Covid-19 Vaccination for 12- to 15-years old: A Recent Shift in British Vaccines Policy
On 13 September 2021, the UK’s Department of Health and Social Care announced that all 12- to 15-year-olds in England would shortly be offered a first dose of the Pfizer-BioNTech COVID-19 vaccine. The decision to immunise around three million eligible teenagers was unanimously supported by all four Chief Medical Officers (CMOs), representing all four constituent nations of the UK, and replaced earlier plans to delay the universal roll-out of vaccines in this particular age group. A second dose of vaccine would, however, only be considered after the spring term of 2022. It is anticipated that this roll-out of vaccine will soon be extended to Scotland, Wales, and Northern Ireland.
The British government seeks to reduce the risk of transmission of SARS-Cov-2, especially of the dominant and more contagious Delta variant, within the potential breeding grounds of the nation’s schools. The immunisation of adolescents will hopefully reduce the likelihood of localised outbreaks, and possibly even school closures, and also further limit community spread of the virus by younger people, thereby averting a potential lockdown in the coming winter months
According to the original plans, vaccination was to have been restricted to high-risk 16- to 17-year-olds with pre-specified health conditions, as well as those living in the same household with vulnerable (immunosuppressed) adults. On 3 September 2021, the Joint Committee on Vaccination and Immunisation (JCVI), an advisory group of independent experts, issued an updated statement on the COVID-19 vaccination of children aged 12 to 15 years. According to the experts, the individual health benefits from COVID-19 vaccination were “small” in this age group and only “marginally greater than the potential known harms”. At the time, the JCVI’s advice was to restrict vaccination to a smaller group of around 200,000 at-risk 12-to 15-year-olds. Their advice has since been superseded by the CMOs.
As with all other aspects of the global response to the coronavirus pandemic, there is considerable variation between the vaccination policies of individual nations. The possible options for 12- to 15-year-olds thus include no vaccination at all, selective vaccination of at-risk groups, or vaccination for all those eligible, using either a single dose or two doses. China was the first country in the world to immunise some children, three years and older, from June 2021 onwards. Earlier, in May 2021, the European Medicines Agency (EMA) and the US Food and Drug Administration (FDA) both approved the Pfizer-BioNTech vaccine for use in adolescents. The US, Canada, Israel, France, Germany, Denmark, and Spain are among the first in a growing list of high-income countries that have started to administer the Pfizer-BioNTech vaccine to 12 – to 15-year-olds. Cuba then began to offer two doses of its own Soberana-2 vaccine to children aged between 2 and 18, from 3 September onwards. Despite this extension of vaccination to younger age groups in some countries, most vulnerable adults, who according to some should be prioritised, have yet to receive their first dose in many poorer parts of the world.
In England, vaccination is being “offered” to adolescents rather than being mandated. Administration of vaccine will require consent from a parent or an adult with parental responsibility, such as a carer or a guardian. Those aged 16 or under can choose to override parental refusal of vaccination, which may be an issue in the families of “anti-vaxxers”, but only if deemed competent to do so by those responsible for vaccination. Vaccines will be administered mostly on school premises, by immunisation teams from the School Age Immunisation Service, and the schools themselves will not be directly involved in vaccination procedures. This service has considerable experience in delivering HPV (Human Papillomavirus) and DTP (Diphtheria, Tetanus and Polio) vaccines on school premises and is ideally equipped for the task of on-site COVID-19 vaccination.
The question then arises of the health benefits of vaccination versus any potential risks. Most children only develop mild symptoms or remain asymptomatic following infection with SRAS-Cov-2, although severe complications, occasionally leading to either death (25 deaths in under-18s in England during the first 12 months of the pandemic) or ‘long Covid’ symptoms, have been described in younger people. Vaccination can not only prevent the serious outcomes of coronavirus infection in children but also reduce the risk of serious complications in adults who are infected by them.
The side effects of vaccination are also mostly mild and should not require the taking of time off school. One particular concern is that cases of myocarditis and pericarditis, complications affecting the muscle of the heart or its outer covering respectively, have been reported after the second dose of mRNA vaccines, such as Pfizer BioNTech and Moderna, in teenagers and young adults. These complications have been reported to be mild and self-limiting, although it is not yet known if they are followed by any long-term effects.
This latest shift in British vaccine policy can be seen as primarily as a public health measure, driven by the threat of increased transmissibility of the Delta variant and focused on preventing yet another crisis over the coming winter. Although there have been allegations of mixed messaging from official sources, the JCVI advice referred to individual health benefits, while the CMOs considered the wider societal benefits of vaccination in arriving at their collective decision. Only time, and a careful analysis of the emerging data, will tell whether this was the best choice.
Ashis Banerjee