More than 910 million covid-19 vaccine doses have been given and the number is climbing daily. So far, though, the vast majority of those given a shot and targeted by campaigns have one thing in common: they’re adults. That was the right place to start the world’s largest vaccination drive, but it’s not where we should stop.
Children have, it’s true, proven less susceptible to the coronavirus so far. It’s one of the pandemic’s few mercies, even if under-reporting plays a role. But not all have escaped unscathed, and we know infected youngsters have unwittingly passed the illness to others. As with shots for diseases like measles and rubella, covid-19 vaccinations for kids are about protecting them—and about shielding everyone else. Even if children aren’t “super” spreaders, but merely spreaders, the return to a normality of sorts remains a mirage without them.
Unfortunately, this is a corner of the global vaccination campaign where problems like access and hesitancy will be most sharply felt. Trials involving children are only just beginning and are by necessity slow, given safety concerns, which mean researchers work down the age ranges, and lower infection rates. We’ll need to wait to know which immunisations are safest and best at preventing transmission. The good news is that the gap before rollouts provides a vital few months to tackle head-on the misperception that these shots bring lower rewards.
Children made up about 8% of all covid-19 cases last year, according to World Health Organization figures, though they account for 29% of the global population. Fewer have ended up in intensive care and most have escaped with fever, fatigue and a cough. Under 0.2% of covid fatalities were people younger than 20, according to WHO numbers from September.
Crucially, this can change during periods when the disease is running wild. It’s alarming to note that Brazil’s devastating current wave is killing younger people. Pregnant women and children under 10 are falling ill, some of whom have different symptoms and so are misdiagnosed. Kirsty Short, a virologist at the University of Queensland, points out that there is a lot we don’t know around other factors at play, including social behaviours, or how children, in particular, respond to variants. But there are good reasons to be wary—not least because of the rare but potentially lethal multi-system inflammatory syndrome, which shares symptoms with toxic shock and Kawasaki disease, like rashes and vomiting, and appears a few weeks after infection. We also know little about the long-term consequences of covid-19.
Avoidable deaths and potential after-effects are reason enough to ensure shots get into the arms of the world’s children, but there’s more. For one, figures like Anthony Fauci, President Joe Biden’s medical adviser, point out that it will be tough to reach herd immunity levels—which he estimates requires 70% to 85% of people to be vaccinated or immune—without children, who make up about a quarter of the U.S. population. And while restrictions remain in place, youngsters suffer the most, bearing the burden of curtailed education, play and sport as advances in health and nutrition go backward. Many who have suffered such disruptions may never return to the classroom.
We’re getting closer to the point where children’s vaccines will become available. Moderna Inc., for example, began clinical trials with over-12s in December, and said last month that the first children had been dosed in a trial of its vaccine with younger kids. Pfizer Inc. and partner BioNTech SE want regulators to allow use of their vaccine in 12-to-15-year-olds, after a study found it was 100% effective in preventing illness during a final-stage trial with that age group. We know Israel has already vaccinated some 600 adolescents in at-risk groups with the BioNTech vaccine and saw no significant side effects.
The rub is that while vaccine hesitancy has varied causes and is spread globally, parents in general have more doubts. Pew research in 2017 found that Americans overwhelmingly backed measles, mumps and rubella vaccine requirements for public school pupils, but parents of young children saw lower benefits and higher risks. That’s the case with covid-19, too. Research carried out by leading U.S. universities published last month found that when it comes to the coronavirus, younger mothers are especially reluctant: Roughly two-fifths are somewhat or extremely unlikely to seek the vaccination for their children. Part of it, in the developed world, is the lingering, damaging legacy of misinformation around vaccines like MMR. In the developing world, there are also competing health priorities—even when shots are available.
Tackling that requires a concerted global effort focused on education, outreach, and, critically, communication around the risks and rewards, especially after blood-clotting incidents that suspended shots of some vaccines. Robust safety data from trials will help, given that most people simply have doubts, usually reasonable ones, and are not unconditionally opposed.
It’s an opportunity to build trust, particularly in communities and among parent groups that have been more vulnerable to covid-19 but are also skeptical of official pronouncements. Success with these campaigns percolates in a way that mandatory drives do not. Convincing families to protect themselves now may well improve their willingness to get other childhood vaccines. That’s a win, since immunisation programs have been battered in much of the world due to the broader disruptions of the past year.
The alternative to vaccinating children is to let covid linger, as measles has. The highly contagious illness was officially eliminated in 2000 in the United States. But in 2019, a total of 1,282 cases were reported, the most in more than a quarter-century, thanks to unvaccinated people. It’s an unpalatable prospect.