Should children be vaccinated against COVID-19?

Abstract

Whether all children under 12 years of age should be vaccinated against COVID-19 remains an ongoing debate. The relatively low risk posed by acute COVID-19 in children, and uncertainty about the relative harms from vaccination and disease mean that the balance of risk and benefit of vaccination in this age group is more complex. One of the key arguments for vaccinating healthy children is to protect them from long-term consequences. Other considerations include population-level factors, such as reducing community transmission, vaccine supply, cost, and the avoidance of quarantine, school closures and other lockdown measures. The emergence of new variants of concern necessitates continual re-evaluation of the risks and benefits. In this review, we do not argue for or against vaccinating children against COVID-19 but rather outline the points to consider and highlight the complexity of policy decisions on COVID-19 vaccination in this age group.

Pediatric vaccination against COVID-19 and despite COVID-19

“…The infection is asymptomatic or mild in most paediatric cases, and fewer than 2% of symptomatic paediatric patients require hospital admission, many of which happen to have COVID-19 but are admitted for other reasons. 3 Although the infection, like any other, is not absolutely without risk, most severe cases of COVID-19 in the paediatric population occur in children with other risk factors and comorbidities, as is the case in adults. 3 Therefore, the vaccination against COVID-19 of children with risk factors or comorbidities is not up for debate, as their risk status places them in the same level of priority as other risk groups, independently of age.…”

“… 3 Although the infection, like any other, is not absolutely without risk, most severe cases of COVID-19 in the paediatric population occur in children with other risk factors and comorbidities, as is the case in adults. 3 Therefore, the vaccination against COVID-19 of children with risk factors or comorbidities is not up for debate, as their risk status places them in the same level of priority as other risk groups, independently of age. 1 As soon as the vaccines are approved for use in the paediatric age group, an active search should be performed to identify children at risk and offer them vaccination.…”

“…Children with cancer, immunosuppression, obesity, Down syndrome or severe neurologic disease are some of the established priority groups, but not all high-risk conditions have been identified in children as clearly as in adults. 3 For this reason, in any case in which there is uncertainty about the specific condition and the associated risk, the most prudent and advisable course of action after an individualised evaluation of its indication is to vaccinate. Similarly, it would be reasonable to consider children and adolescents that live with individuals who are immunosuppressed or at high-risk of severe COVID-19 a high-priority group for vaccination.…”

“…On the other hand, the direct benefits of universal vaccination of healthy children are marginal compared to universal vaccination of adults. 1 , 3 , 4 The burden of disease is low and mild, with the exception of multisystem inflammatory syndrome in children temporally associated with SARS-COV-2 which, while rare, is associated with a high mortality (1%–2%) and develops in paediatric patients without identifiable risk factors, and it is not currently known how effective vaccines may be at preventing this form of disease. 3 Furthermore, children do not seem to be a major reservoir of the infection, and the observed pattern of transmission is from adults to children, and not the other way around.…”

“…1 , 3 , 4 The burden of disease is low and mild, with the exception of multisystem inflammatory syndrome in children temporally associated with SARS-COV-2 which, while rare, is associated with a high mortality (1%–2%) and develops in paediatric patients without identifiable risk factors, and it is not currently known how effective vaccines may be at preventing this form of disease. 3 Furthermore, children do not seem to be a major reservoir of the infection, and the observed pattern of transmission is from adults to children, and not the other way around. 1 The actual contribution of children to the herd immunity against SARS-COV-2 eagerly pursued through vaccination remains unknown, although in the case of adolescents, it should not be any lesser than that of young adults.…”