Is there a role for childhood vaccination against COVID‐19?

Abstract

More than 30 million cases of COVID-19 have already been reported worldwide in the last 9 months, and their continuous rise reflects the need to control disease spread. COVID-19 is caused by SARS-coronavirus 2 (CoV) and mainly characterized by respiratory symptoms and fever. Complications such as acute respiratory distress syndrome (ARDS) and death are primarily seen in the elderly and in individuals with co-morbidities, for example, obesity, arterial hypertension, or chronic kidney disease. 1-3 Children are more often pauci-symptomatic, 4-6 and a considerable proportion might even be co-infected with other respiratory viruses. 7 In rare cases, a postinfectious disease, characterized by multisystemic inflammation, Kawasaki-like symptoms, and acute heart failure, can occur, 8-10 but in general children have a very low risk of death. 4-6,11 Additionally, the incidence of COVID-19 disease is strikingly lower in children. Initial data from China showed that only around 1% of SARS-CoV-2 cases occurred in the pediatric population 12 and an Icelandic population screening could not evidence PCR-positive cases in children under the age of 10. 13 In the United States, PCR-positive cases in children aged 5-11 years were half as frequent as in adolescence, 14 a finding that was confirmed in a Swiss seroprevalence study. 15 The role of children in disease transmission is still controversial. Infectious virus can be detected in nasopharyngeal swab of children of all age 16 and at similar or even higher concentrations than in adults. 17-19 There is evidence that children might have an insignificant role in disease transmission but rather get infected by adults or by household contacts. 20-24 However, schools were closed to help confine the pandemic, yet it still needs to be proven whether this specific measure (or the many others which were associated) was efficacious in slowing virus spread. 25-27 Given the substantial impact of the COVID-19 outbreak on health systems and the socioeconomic burden following complete shutdowns of states in order to control the pandemic, a race for vaccines has started as soon as the first sequencing data of the virus became publicly available on January 12, 2020. 28 This was

An ethical analysis of vaccinating children against COVID-19: benefits, risks, and issues of global health equity

“…Although long-term harms related to vaccines are rare, there should ideally be prolonged follow-up of pediatric trial participants before routine COVID-19 childhood vaccination, especially given the minimal expected direct benefits vaccination would provide for children 20 . Pfizer released the topline adolescent (12-15 years old) data 21 , which might at least rule out common adverse events occurring less than eight months post-vaccination.…”

“…Perhaps the strongest case against child COVID-19 vaccination is the fact that COVID-19 vaccines are safe and effective in higher-risk groups, including older adults and the immunocompromised 20,39 . Ethical arguments in favor of vaccinating healthy, young people for the benefit of others in the context of other diseases generally emphasize that the generation of population ("herd") immunity is one of the only ways to protect vulnerable risk groups 40 .…”

An Updated Review of SARS-CoV-2 Vaccines and the Importance of Effective Vaccination Programs in Pandemic Times

“…The last two groups are expected to be the last groups to be vaccinated globally. It is true that, generally, children and adolescents are less affected by SARS-CoV-2, and vaccines should demonstrate strong safety and efficacy before initiating global vaccination in this group [ 76 ]. Nevertheless, a vaccine targeting this population will be crucial for preventing SARS-CoV-2 transmission in the whole of society, while also avoiding possible severe COVID-19 presentations in both children and adolescents [ 77 , 78 , 79 ].…”

COVID-19 adaptive evolution during the pandemic – Implications of new SARS-CoV-2 variants on public health policies

“…As such, this unvaccinated part of the population puts more vulnerable groups at increased risk because of 1) elevated transmission rates and 2) continued evolution of the virus. The low level of morbidity associated with COVID-19 in most children argues against vaccinating this age group, as the vaccination of children could be considered unethical if it protects against a disease that carries only a small risk to a child’s health [ 14 ]. However, as soon as SARS-CoV-2 variants evolve with significant virulence in this age group, child vaccination may be needed to control antigenic drift.…”