It is not acceptable to expose any particular age group to transmission with a virus we still don’t know much about, without regard for long-COVID, virus adaptation, and illness.
First published in May 2021.
This framing is false – it isn’t vaccinate children vs vaccinate people in other countries. I support equitable vaccine supply, but let’s look at the scientific and ethical arguments here, which present a false dichotomy that really doesn’t exist and is based in ideology rather than science.
Yes, we need to ensure equitable vaccine supply across the globe. This is a global pandemic and it is important that there is global equitable vaccine supply. So, what can we do?
We can donate our current supply of vaccines to other countries, while pivoting to elimination.
This is something I would support. Elimination would mean that there isn’t the urgency to vaccinate that there is now, and it wouldn’t put young people who are unvaccinated at risk.
How is this different from the argument being made here?
The argument suggests that it is less important to vaccinate children compared to say 20 or 30 somethings, because the argument isn’t donating the rest of our supply to other countries, but specifically supplies that would be for children. Does this make sense?
No, there is good evidence now to show that at sustained levels of community transmission it is better to vaccinate the ‘mixers’ rather than the ‘vulnerable’ groups, as overall this actually leads to rapid lowering of transmission and lower mortality even among vulnerable people.
This may seem counter-intuitive, but it essentially works by driving transmission into vulnerable populations down by targeting those who spread into the community more. This has a more rapid impact than targeting the vulnerable – even on the vulnerable.
Vaccine escape in a heterogeneous population: insights for SARS-CoV-2 from a simple model. | Medrxiv
By this argument, vaccinating children should actually be a higher priority than vaccinating older groups, so why then is this argument being presented as a dichotomy between vaccinating children vs vaccinating adults in other countries?
Either we are prioritising containing transmission through vaccination, in which case there are strong arguments for prioritising vaccination among children now, or we are saying ‘let’s donate all vaccine supplies’, in which case the dichotomy isn’t children here vs adults elsewhere.
The reason I am concerned by this specific argument is that it is being made by several groups, including Professor Pollard on the basis that children generally don’t need to be vaccinated, because they don’t suffer much from harms and it is OK for them to be exposed to the virus.
This view isn’t based in evidence:
- Severe impact on children – death and hospitalisations are rare, as with flue and polio, but we don’t expose children to these, we vaccinate them;
- Long COVID: 7-8% of children have symptoms lasting 12 weeks or more – we don’t know yet what this means;
- This is a virus we know persists neurologically, in the gut and in other tissues for months. Many children report persistent neuro-cognitive symptoms after infection;
- Parents are more likely to get hospitalised with COVID-19;
- There is a significant impact on children of bereavement from loss of parents and grandparents. This has not been quantified here in the UK, but reports from the US and other countries are very concerning;
- Impact on educational disruption due to school closure, or repeated need for isolation.
So yes, let’s talk about equitable vaccine sharing, but let’s not make this a false choice between vaccinating children here vs vaccinating adults elsewhere – an argument that has no basis in science.
Let’s talk about moving to elimination, and sharing remaining supplies with other countries. This is far more fair and grounded in evidence.
There is absolutely no scientific grounds for prioritising vaccination of 20 and 30 years old over children, given that current evidence suggests that vaccinating children would have a much greater impact on transmission and deaths in all age groups.
And I do hope that scientists supporting this will also support pivoting to elimination – as it would be entirely unethical not to vaccinate particular age groups and tolerate infections in them without regard for long-COVID, virus adaptation, and illness among these.
To put it another way, it is not acceptable to expose any group to transmission with a virus we still don’t know much about, that causes not just acute but chronic debilitating disease we barely understand, and has adapted rapidly to increase in fitness.
So if we are talking about moral and ethical responsibility, let’s also talk about the negligence of considering spread of this virus through children – and ensure we take the right steps to prevent this – irrespective of whether we decide to share vaccines or not.
- Vaccine escape in a heterogeneous population: insights for SARS-CoV-2 from a simple model | Medrxiv
- Long-COVID Kids
▫ Dr Deepti Gurdasani, Senior Lecturer in Epidemiology, Statistical Genetics, Machine Learning, Queen Mary University of London.
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[This piece was first published as a Twitter thread and turned into the above article on 20 May 2021 with the purpose of reaching a larger audience. It has been minorly edited and corrected, and published with the author’s consent. | The author of the tweets writes in a personal capacity.]
(Cover: Pixabay. / Licensed under a Creative Commons Attribution-ShareAlike 4.0 International License.)