All over-12s are likely to be offered coronavirus vaccines later this year as scientific advisers become increasingly confident about the safety of the jabs.
Vaccination of more than a million healthy 16 and 17-year-olds will begin this month, with a decision on second doses put back while scientists consider whether to mix and match jabs or treat boys differently to girls.
The decision to vaccinate children is a U-turn from the Joint Committee on Vaccination and Immunisation’s (JCVI) ruling, little more than two weeks ago, against jabs for healthy under-18s. Senior children’s doctors attacked the “shambolic” handling of the matter.
Last month the committee feared the risk of heart inflammation after inoculation could outweigh the benefits of preventing a disease which is usually mild in children.
The JCVI is now much more confident that these side effects are extremely rare and usually mild, with a rate of about 60 per million in boys. Children’s risk of dying from Covid is about two in a million.
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However, the side effects are about seven times more common after a second dose and the JCVI has given itself 12 weeks to decide what do about second doses.
Adam Finn, a member of the committee, said the “clarity” of the evidence was clearer than it had been last month. “The fact that it’s crystallised much more clearly that it’s a second dose risk has given us the boldness to go forward with a first dose in this older group where there is a bigger disease risk than in the younger healthy kids,” he said.
Although Pfizer-BioNTech is the only jab approved for children, others are being studied and the committee is looking at whether a second dose of a different vaccine would reduce the risk of side effects. Different advice for boys given their higher risk is “theoretically on the cards”, Finn said.
Professor Wei Shen Lim, head of the JCVI, said that just as older adults were at higher risk from Covid “the benefits of vaccination are typically greater for older children, compared to younger children”.
Jonathan Van Tam, the deputy chief medical officer for England, said the government had “a plentiful supply” of doses to vaccinate teenagers without disrupting the autumn booster programme. “There is no time to waste in getting on with this,” he said.
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Ministers hope the programme will be well advanced by the time pupils return to school next month, with doses administered through GPs and vaccination centres in the same way as adult doses were. Sajid Javid, the health secretary, said he had “asked the NHS to prepare to vaccinate those eligible as soon as possible”.
Over-16s are usually deemed capable of consenting to treatment so would be able to choose to have the vaccine even if parents do not want them to have it.
June Raine, head of the Medicines and Healthcare Products Regulatory Agency, which approved the Pfizer vaccine for over-12s, said its conclusion “has robustly been that the benefits outweigh any risks” for adolescents.
But Camilla Kingdon, president of the Royal College of Paediatrics and Child Health, said the vaccine programme for adults “has been incredibly impressive but for children and young people it has been frankly shambolic”, adding: “This is the second announcement around vaccinations for children or young people in the last three weeks but we still haven’t seen detailed plans for the first.”
Case study
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Neha Azmat, a 17-year-old sixth-form student from London, plans to get her Covid-19 vaccine as soon as possible. She has seen how the vaccination rollout has reduced cases and wants protection for herself and her family (Kate Gibbons writes).
“I’ve had Covid and the symptoms lasted for more than a month. During all that time I felt awful. I just felt helpless and frustrated,” she said.
“So now, if I could do anything I can to prevent it happening again, I would. I also want to protect the vulnerable people around me, as compared to them I’ve had much more exposure to the public from going into school and commuting — I want to keep my loved ones safe. I’ve had other vaccinations such as MMR so having the Covid vaccine wouldn’t be all that different.”
Neha said she has felt some pressure from relatives “to get it as soon as it is available”, driven by their worry for her to be safe.
She added: “I don’t feel there has been enough public information. Unless I go and actively research it, the information is not presented to the public on a day-to-day basis. So I have done my own research about the Covid vaccination.
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“I have closely followed the vaccination details from the beginning, and the statistics regarding the dip in Covid cases after the vaccination speak for themselves.”
Despite a disruptive school year, Neha plans to apply for university next year but will make sure she “takes breaks along the way” to help her cope.
I thought the JCVI had ruled against vaccinating children?
Yes, two weeks ago it concluded that only for children with severe immune problems would the benefit clearly outweigh risks.
Why the sudden change?
The JCVI said it would keep the data under “very close review” amid the vaccination of teenagers in other countries. The chief medical officers of the four home nations asked it to accelerate that review.
What has changed in two weeks?
There has been no big study prompting the change, but the JCVI says that it is now clearer about how common side effects are and that they mainly occur after second doses, making it more confident to go ahead with first doses.
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Why is the cut-off 16?
The vaccine was originally approved for over-16s last year and eligibility was already much wider in those aged 16 and 17. Given older children are more at risk from Covid, there is more clearly a benefit for this age group.
Could second doses be from different makers or boys be treated differently from girls?
Only Pfizer-BioNTech is approved for under-18s but if other jabs become available, mixing them will be considered. Side effects appear more common after the second dose in boys and there is precedent with vaccines such as HPV for treating the sexes differently.
What is the difference between regulatory approval and JCVI advice?
The Medicines and Healthcare Products Regulatory Agency has said the Pfizer vaccine for over-12s passes essential standards. But the JCVI is trying to answer whether the benefits of giving it to healthy children is worth the risk.
What does this mean for younger children?
It raises the likelihood that the JCVI will later widen access to vaccination. The jabs are not licensed for under-12s, however.
What are other countries doing?
Britain is looking like an outlier. Ireland advised last week the routine vaccination of over-12s.
