Vulnerable children to get Covid vaccine – but no universal rollout for under-18s

Clinically vulnerable children who face an increased risk from Covid-19 are to be vaccinated, the government has confirmed – though health officials have decided against a universal rollout for all under-18s.

The Joint Committee on Vaccination and Immunisation (JCVI) has advised that children aged 12 to 15 with severe neurological conditions, Down’s syndrome, immunosuppression or multiple or severe learning disabilities should receive two doses of the Pfizer vaccine.

This recommendation extends to 17-year-olds who are within three months of their 18th birthday, and children as young as 12 who live with an immunosuppressed individual.

The UK’s Medicines and Healthcare products Regulatory Agency (MHRA) last month authorised use of the Pfizer vaccine in children aged 12-15, concluding that it is safe and effective to use in this age group. Israel, France and the US have also begun rolling out the Pfizer vaccine in children.

Despite this, the JCVI has recommended that the vaccine should not be administered to all under-18s due to limited data on the safety profile of the jab in children.

Although some experts have welcomed the latest guidance, others have warned that it is “entirely irresponsible” to leave young children unvaccinated and “exposed to the virus”.

The vaccines watchdog, which offers advice to Downing Street, is taking a cautious approach as it waits for more clarity on links between the jab and the rare cases of heart inflammation that have been reported among younger, typically male recipients.

The incidence of this side effect is around one in 20,000 people, though this is a broad estimate.

Until more data on the short-term and long-term outcomes of vaccine-induced heart inflammation is available and has been evaluated, a precautionary approach is preferred, the JCVI said on Monday, adding that the benefits of vaccinating fit and healthy children are “small” given their low risk from Covid-19.

Evidence shows that the virus rarely causes severe disease in children who do not have underlying health conditions. Fewer than 30 children have died from the disease as of March 2021.

A recent study found that some 5,830 children and young people have also been admitted to hospital since the beginning of the pandemic.

The researchers said children under 18 face an approximately one in 50,000 chance of being admitted to intensive care with Covid-19.

It’s expected that hundreds of thousands of vulnerable children aged as young as 12 will now be vaccinated in the “next few weeks”.

Under current JCVI guidance, those aged 16 to 18 can already receive a vaccine if they are clinically vulnerable or at high risk of Covid-19 due to underlying health conditions.

The decision to vaccinate 12- to 17-year-olds living with immunosuppressed individuals has been taken to offer greater protection to those people who may not be able to generate a sufficient response from the vaccines.

The JCVI is keeping its guidance under review and will adjust it accordingly to the data it receives over the coming weeks.

Professor Anthony Harnden, deputy chair of the JCVI, said: “The primary aim of the vaccination programme has always been to prevent hospitalisations and deaths. Based on the fact that previously well children, if they do get Covid-19, are likely to have a very mild form of the disease, the health benefits of vaccinating them are small.

“The benefits of reducing transmission to the wider population from children are also highly uncertain, especially as vaccine uptake is very high in older people, who are at highest risk from serious Covid-19 infection.”

It’s understood that supply constraints have not been factored into the JCVI’s decision-making, with an “abundance” of doses available for the UK’s ongoing rollout.

Helen Bedford, a professor of children’s health at University College London, said that “we need to be very clear about the safety of the vaccines” in 12- to 17-year-olds before rolling them out among this age cohort.

“More information is needed from trials and experience of using these vaccines in young people and children before the programme is rolled out further,” she said.

However, Dr Stephen Griffin, a virologist at the University of Leeds, said he was “dumbfounded” by the JCVI’s guidance, arguing that it was vital to vaccinate children in order to cut community transmission and increase the likelihood of reaching the population immunity threshold.

“If we’re ever going to get through this, we’re going to need to generate some approach to population immunity otherwise we’ll continue to have these waves of infection,” he said.

Professor Lawrence Young, a virologist at the University of Warwick, said that immunising children “will also protect them from developing long Covid, as well as help stem the spread of the virus in the population and thus the further generation of variants”.

Data from the Office for National Statistics has shown that 9.8 per cent of children aged 2-11 years, and 13 per cent of those aged 12-16 years, have reported at least one lingering symptom five weeks after a positive diagnosis.

Dr Griffin meanwhile challenged the JCVI’s insistence that there is not enough real-world evidence on the safety of the vaccines in children.

“America, Israel and elsewhere – millions of doses have gone into kids,” he said. “I don’t get that. Yes it’s right to be concerned about myocarditis and pericarditis [heart inflammation] – of course it is – but it’s such a low incidence.

“If they’re going to leave young children exposed to this virus, I think that’s entirely irresponsible. It is not a benign virus.”