tag:theconversation.com,2011:/id/topics/vaccinating-children-107790/articlesvaccinating children – The Conversation2021-12-09T16:53:37Ztag:theconversation.com,2011:article/1733242021-12-09T16:53:37Z2021-12-09T16:53:37ZChildren ages 5 to 11 are getting COVID-19 vaccinations: What this might mean for the holidays and the Omicron variant<figure><img src="https://images.theconversation.com/files/436447/original/file-20211208-140109-sdogbt.png?ixlib=rb-1.1.0&rect=0%2C0%2C973%2C785&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Young children are rolling up their sleeves to get vaccinated, protecting themselves against COVID-19 and helping to curb the pandemic.</span> <span class="attribution"><span class="source">(Dasantila Golemi-Kotra)</span>, <span class="license">Author provided</span></span></figcaption></figure><p><a href="https://www.thestar.com/news/canada/2021/11/18/health-canada-is-set-to-approve-the-pfizer-covid-vaccine-for-kids-heres-what-you-need-to-know.html">Public Health Canada</a> approved the use of <a href="https://www.canada.ca/en/health-canada/services/drugs-health-products/covid19-industry/drugs-vaccines-treatments/vaccines/pfizer-biontech.html">Pfizer/BioNTech</a> mRNA vaccine for children ages five to 11 on Nov. 19. The decision was highly anticipated as parents — including one of the authors — have been waiting to protect school-age children in the face of growing SARS-CoV-2 positive cases and spare them from another interruption of the school year. (Children ages five to 11 represent <a href="https://www.canada.ca/en/public-health/services/immunization/national-advisory-committee-on-immunization-naci/recommendations-use-covid-19-vaccines/pfizer-biontech-10-mcg-children-5-11-years-age.html">7.5 per cent</a> of all the cases in Canada, with potentially <a href="https://theconversation.com/im-an-infectious-disease-doctor-yes-im-vaccinating-our-5-year-old-against-covid-19-here-is-why-you-should-too-171001">life-threatening consequences</a>.)</p>
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<img alt="" src="https://images.theconversation.com/files/410911/original/file-20210712-19-geybnm.png?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/410911/original/file-20210712-19-geybnm.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=600&fit=crop&dpr=1 600w, https://images.theconversation.com/files/410911/original/file-20210712-19-geybnm.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=600&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/410911/original/file-20210712-19-geybnm.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=600&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/410911/original/file-20210712-19-geybnm.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=754&fit=crop&dpr=1 754w, https://images.theconversation.com/files/410911/original/file-20210712-19-geybnm.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=754&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/410911/original/file-20210712-19-geybnm.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=754&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="attribution"><a class="source" href="https://theconversation.com/ca/topics/vaccine-confidence-in-canada-107061">Click here for more articles in our series about vaccine confidence.</a></span>
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<p>As soon as the provincial online booking system became available on Nov. 23, Dasantila booked her daughter for an appointment over the weekend, not wanting her to miss any school days. Then she started planning how to offer comfort on the day of the vaccination: her daughter does not like needles — the sight of a needle on TV or in a magazine or even mentioning one makes her cringe, and she instinctively covers her left arm and says she is in pain.</p>
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Read more:
<a href="https://theconversation.com/if-your-child-is-afraid-of-or-refusing-a-medical-procedure-heres-how-to-help-170923">If your child is afraid of — or refusing — a medical procedure, here’s how to help</a>
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<p>The following day, however, she came home and asked whether her vaccination had been booked. When gently informed that it would be on the weekend, she inquired why not sooner? Dasantila was shocked that her little one, who usually had to be coaxed with chocolate to get her shots, was not happy that her vaccination was not booked sooner. Hiding her shock, Dasantila asked why she wanted it sooner, and her daughter said everyone in her class was getting it sooner.</p>
<p>It’s a reminder that children may be stronger than we imagine them to be, and may exceed our expectations. It’s also another reason to thank teachers who have been consistent in their message about the importance of public health measures to protect themselves and others.</p>
<h2>What is the vaccination coverage in Canada?</h2>
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<a href="https://images.theconversation.com/files/436451/original/file-20211208-25-1us6nae.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="A person out-of-frame holds a smartphone camera in the foreground as a girl gets vaccinated" src="https://images.theconversation.com/files/436451/original/file-20211208-25-1us6nae.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/436451/original/file-20211208-25-1us6nae.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=431&fit=crop&dpr=1 600w, https://images.theconversation.com/files/436451/original/file-20211208-25-1us6nae.JPG?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=431&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/436451/original/file-20211208-25-1us6nae.JPG?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=431&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/436451/original/file-20211208-25-1us6nae.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=542&fit=crop&dpr=1 754w, https://images.theconversation.com/files/436451/original/file-20211208-25-1us6nae.JPG?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=542&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/436451/original/file-20211208-25-1us6nae.JPG?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=542&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<span class="caption">A mother takes a picture of her daughter receiving a COVID-19 vaccine during the second day of vaccination for children aged five to 11 years old in Montréal.</span>
<span class="attribution"><span class="source">THE CANADIAN PRESS/Paul Chiasson</span></span>
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<p>The approval of vaccination for children ages five to 11 years comes at a <a href="https://health-infobase.canada.ca/covid-19/epidemiological-summary-covid-19-cases.html">critical point in the pandemic here in Canada</a>. In <a href="https://www.publichealthontario.ca/-/media/documents/ncov/epi/covid-19-vaccine-uptake-ontario-epi-summary.pdf?la=en">Ontario</a>, where we live, cases are <a href="https://globalnews.ca/news/8404305/ontario-covid-cases-november-26-coronavirus/">slowly creeping up</a> (the <a href="https://health-infobase.canada.ca/covid-19/epidemiological-summary-covid-19-cases.html">positivity rate</a> — the percentage of people tested who get a positive result — is fluctuating around three per cent), and <a href="https://www.ontario.ca/page/covid-19-cases-schools#section-1">outbreaks in the province’s elementary schools</a> are at their <a href="https://www.cbc.ca/news/canada/toronto/covid-19-ontario-dec-8-2021-school-outbreaks-rapid-tests-1.6277720">highest level since the pandemic began</a>.</p>
<p>A slow increase in positive cases was expected as people gather more indoors due to the cold weather, more venues opened to full capacities and travel bans were lifted. But we don’t know at what rate this trend will continue, so public health measures and vaccines are the thread we must hold on to. </p>
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Read more:
<a href="https://theconversation.com/needle-fears-can-cause-covid-19-vaccine-hesitancy-but-these-strategies-can-manage-pain-and-fear-165009">Needle fears can cause COVID-19 vaccine hesitancy, but these strategies can manage pain and fear</a>
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<p>The participation of five-to-11-year-old children in vaccination programs will make 90 per cent of the population eligible to get vaccinated (this age groups accounts for as many as <a href="https://www.statista.com/statistics/444868/canada-resident-population-by-age-group/">three million</a> children). This level of vaccination can make a substantial difference in “making it or breaking it” for the health-care system in Canada, which has been strained and not at a full capacity when it comes to <a href="https://theconversation.com/collateral-damage-the-unmet-health-care-needs-of-non-covid-19-patients-145934">serving non-COVID-19 patients</a>. </p>
<p>Currently, in Canada, <a href="https://health-infobase.canada.ca/covid-19/vaccination-coverage/">76 per cent of the total population is fully vaccinated</a> (86 per cent of people 12 and older). In Ontario, <a href="https://www.publichealthontario.ca/-/media/documents/ncov/epi/covid-19-vaccine-uptake-ontario-epi-summary.pdf?la=en">77 per cent of total population is fully vaccinated</a> (87 per cent of people 12 and older). Partial vaccination coverage (single dose) among children ages five to 11 is 5.8 per cent in <a href="https://health-infobase.canada.ca/covid-19/vaccination-coverage/">Canada</a> and 22 per cent in <a href="https://covid-19.ontario.ca/data">Ontario</a>.</p>
<h2>Where we are heading?</h2>
<p>A study by the Laboratory for Industrial and Applied Mathematics at York University shows that, with the current Ontario level of full vaccination in the population of 12 and older and in the absence of vaccination for children under 12, the COVID-19 attack ratio (defined as the proportion of infected individuals in the population during an outbreak) among kids <a href="https://doi.org/10.1101/2021.09.25.21263542">under age 12 can reach 18 per cent</a> (the study is not yet peer reviewed).</p>
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<a href="https://images.theconversation.com/files/436453/original/file-20211208-136652-fayxzx.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="A boy wearing glasses and a mask gets vaccinated by a health-care worker wearing PPE" src="https://images.theconversation.com/files/436453/original/file-20211208-136652-fayxzx.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/436453/original/file-20211208-136652-fayxzx.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=447&fit=crop&dpr=1 600w, https://images.theconversation.com/files/436453/original/file-20211208-136652-fayxzx.JPG?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=447&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/436453/original/file-20211208-136652-fayxzx.JPG?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=447&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/436453/original/file-20211208-136652-fayxzx.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=562&fit=crop&dpr=1 754w, https://images.theconversation.com/files/436453/original/file-20211208-136652-fayxzx.JPG?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=562&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/436453/original/file-20211208-136652-fayxzx.JPG?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=562&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<span class="caption">The approval of vaccination for children ages five to 11 years comes at a critical point in the pandemic.</span>
<span class="attribution"><span class="source">THE CANADIAN PRESS/Ryan Remiorz</span></span>
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<p>This level of infection in this age group can persist even if the social activity of the populations aged 12 and above remains below 75 per cent of the pre-pandemic level. An effective vaccination among kids five to 11 years old, fortunately, can reduce this attack ratio to under 0.2 per cent. </p>
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Read more:
<a href="https://theconversation.com/im-an-infectious-disease-doctor-yes-im-vaccinating-our-5-year-old-against-covid-19-here-is-why-you-should-too-171001">I'm an infectious disease doctor. Yes, I'm vaccinating our 5-year-old against COVID-19. Here is why you should too.</a>
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<p>A recent report by the same group, published in the PHAC modelling group <a href="https://nccid.ca/covid-19-phac-modelling-group/">Weekly Report</a> (October Report) shows that the attack ratio among all kids under 12 can be lowered to below two per cent if half of kids in this age group are fully vaccinated, and to 0.17 per cent with a 90 per cent vaccination rate in this age group. A game changer!</p>
<h2>Omicron and the holidays</h2>
<p>The emergence of Omicron, a variant that is considered to be <a href="https://www.macleans.ca/news/omicron-variant-will-likely-be-worse-than-delta-according-to-early-research/">more transmissible than Delta</a>, adds more urgency to getting younger ones vaccinated to curb circulation in the community and protect those that remain vulnerable even after being fully vaccinated (including the booster shots). Numerous studies show that <a href="https://theconversation.com/covid-19-vaccine-faqs-efficacy-immunity-to-illness-vs-infection-yes-theyre-different-new-variants-and-the-likelihood-of-eradication-154569">vaccines protect against severe cases of COVID-19 disease</a>, and reduce infection and transmission. </p>
<p>So as the holidays approach, encourage and support those who remain on the fence when it comes to the vaccines, and continue to embrace public health measures: face masks, physical distancing, limited gatherings and hand hygiene. The holidays may seem a bit brighter this way!</p>
<p><em>Do you have a question about COVID-19 vaccines? Email us at <a href="mailto:ca-vaccination@theconversation.com">ca-vaccination@theconversation.com</a> and vaccine experts will answer questions in upcoming articles.</em></p><img src="https://counter.theconversation.com/content/173324/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Jianhong Wu receives funding from the Natural Sciences and Engineering Research Council of Canada (NSRRC) and from the Canadian Institute of Health Research. NSERC has also joined force with Sanofi Pasteur Canada in funding his Industrial Research Chair program in Vaccine Mathematics, Modelling and Manufacturing.</span></em></p><p class="fine-print"><em><span>Dasantila Golemi-Kotra does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>The participation of five-to-11-year-old children in vaccination programs will make 90 per cent of the population eligible to get vaccinated against COVID-19.Dasantila Golemi-Kotra, Professor, Biology, York University, CanadaJianhong Wu, Professor and Canada Research Chair in Industrial and Applied Mathematics, York University, CanadaLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1710012021-11-05T15:00:55Z2021-11-05T15:00:55ZI’m an infectious disease doctor. Yes, I’m vaccinating our 5-year-old against COVID-19. Here is why you should too.<figure><img src="https://images.theconversation.com/files/430390/original/file-20211104-25-12ufquc.jpg?ixlib=rb-1.1.0&rect=684%2C14%2C3414%2C2195&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Carter Giglio, 8, joined by service dog Barney of Hero Dogs, shows off the bandage over his injection site after being vaccinated at Children's National Hospital in Washington.
</span> <span class="attribution"><span class="source">(AP Photo/Carolyn Kaster)</span></span></figcaption></figure><iframe style="width: 100%; height: 175px; border: none; position: relative; z-index: 1;" allowtransparency="" src="https://narrations.ad-auris.com/widget/the-conversation-canada/i-m-an-infectious-disease-doctor--yes--i-m-vaccinating-our-5-year-old-against-covid-19--here-is-why-you-should-too-" width="100%" height="400"></iframe>
<p>I am an infectious disease physician. When it is our turn to vaccinate our five-year-old son against COVID-19, I will do so with confidence and without hesitation. I am encouraging every parent with eligible children between ages five and 11 to do the same. Here is why.</p>
<p>The U.S. Food and Drug Administration (FDA) <a href="https://www.cbc.ca/news/world/fda-approves-pfizer-children-1.6229798">recently authorized the Pfizer-BioNTech vaccine for children between five and 11 years of age</a>. Subsequently, <a href="https://www.cbc.ca/news/health/children-covid-19-vaccine-pfizer-cdc-advisory-panel-1.6234568">members of the Centers for Disease Control and Prevention’s Advisory Committee on Immunization Practices voted unanimously to recommend vaccination for all children ages five to 11</a>, a recommendation quickly endorsed by CDC director Dr. Rochelle Walensky. </p>
<p>The rush to vaccinate children in this age group in the United States has now begun.</p>
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<img alt="" src="https://images.theconversation.com/files/410911/original/file-20210712-19-geybnm.png?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/410911/original/file-20210712-19-geybnm.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=600&fit=crop&dpr=1 600w, https://images.theconversation.com/files/410911/original/file-20210712-19-geybnm.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=600&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/410911/original/file-20210712-19-geybnm.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=600&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/410911/original/file-20210712-19-geybnm.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=754&fit=crop&dpr=1 754w, https://images.theconversation.com/files/410911/original/file-20210712-19-geybnm.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=754&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/410911/original/file-20210712-19-geybnm.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=754&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="attribution"><a class="source" href="https://theconversation.com/ca/topics/vaccine-confidence-in-canada-107061">Click here for more articles in our series about vaccine confidence.</a></span>
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<p><a href="https://www.cbc.ca/news/health/pfizer-seeks-kids-covid-vaccine-approval-health-canada-1.6215547">Health Canada</a> is reviewing a similar submission from Pfizer to allow its vaccine to be used in children aged five to 11. Approval is expected in the coming weeks. The National Advisory Committee on Immunization (NACI) will then provide guidance for its use in Canada, after which we expect to have the vaccine authorized for all children in Canada in this age group.</p>
<h2>Reviewing the evidence</h2>
<p><a href="https://www.theglobeandmail.com/canada/article-parents-more-hesitant-to-vaccinate-kids-than-themselves-researcher/">Many parents in Canada have indicated hesitancy to vaccinate their children</a>, and understandably all parents have questions about weighing the risks and benefits. Let’s review the evidence.</p>
<p>Pfizer’s clinical trial conducted in the United States in kids aged five to 11 began early in 2021, and a significant surge of COVID-19 occurred soon after as the highly contagious Delta variant swept across the country. The data reported from the clinical trial thus far is encouraging. </p>
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Read more:
<a href="https://theconversation.com/ethical-decisions-weighing-risks-and-benefits-of-approving-covid-19-vaccination-in-children-ages-5-11-169820">Ethical decisions: Weighing risks and benefits of approving COVID-19 vaccination in children ages 5-11</a>
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<p>The antibody responses <a href="https://www.pfizer.com/news/press-release/press-release-detail/pfizer-and-biontech-announce-positive-topline-results">in children aged five to 11 with two 10-microgram doses, given three weeks apart, were comparable to those in persons aged 16 to 25 who were given two 30-microgram doses three weeks apart</a>. Being fully vaccinated <a href="https://www.npr.org/sections/health-shots/2021/10/22/1048334791/pfizer-biontech-covid-vaccine-appears-more-than-90-effective-in-kids-5-to-11">reduced the chances of being infected with COVID-19 by over 90 per cent, an impressive number especially amidst the Delta surge</a>. </p>
<p>No concerning safety events were identified in over 3,000 children who received the vaccine, although followup intervals were short.</p>
<h2>Why vaccinate kids against COVID-19?</h2>
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<a href="https://images.theconversation.com/files/430173/original/file-20211104-17-3uuo0i.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="A vial of Pfizer-BioNTech COVID-19 vaccine for children, with a tag indicating it is for ages five to 11" src="https://images.theconversation.com/files/430173/original/file-20211104-17-3uuo0i.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/430173/original/file-20211104-17-3uuo0i.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/430173/original/file-20211104-17-3uuo0i.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/430173/original/file-20211104-17-3uuo0i.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/430173/original/file-20211104-17-3uuo0i.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/430173/original/file-20211104-17-3uuo0i.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/430173/original/file-20211104-17-3uuo0i.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<span class="caption">Data from Pfizer’s clinical trial in children, conducted in the U.S., is encouraging.</span>
<span class="attribution"><span class="source">(AP Photo/Mary Altaffer)</span></span>
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<p>A question commonly asked by parents is this: “Kids don’t generally get very sick or die from COVID-19 compared to adults, right? So why vaccinate them if their risk is so low?”</p>
<p>Yes, the risk of children getting very sick or dying with COVID-19 is low, but the relative risk of severe outcomes and death that kids face when they acquire COVID-19 is extremely high. <a href="https://www.fda.gov/media/153508/download">COVID-19 was the sixth highest cause of death from disease in children ages five to 11 in the U.S. in 2020, comparable to rates of death seen in children with heart or lung disease</a>. If there were a way to prevent death in children with heart or lung disease as simple as a safe two-dose vaccine, there would be very little hesitation from parents to take advantage of it.</p>
<p>Besides hospitalization and death, COVID-19 infection poses other significant risks for children, including the risk of multisystem inflammatory syndrome in children (MIS-C) and longer-term post-COVID-19 complications (“long COVID”) similar to adults. <a href="http://doi.org/10.1001/jama.2021.2091">MIS-C can occur two to six weeks after COVID-19 infection, nearly two-thirds of affected children will require critical care support, and between one and two per cent of affected children will die</a>.</p>
<p><a href="https://www.ons.gov.uk/peoplepopulationandcommunity/healthandsocialcare/conditionsanddiseases/bulletins/prevalenceofongoingsymptomsfollowingcoronaviruscovid19infectionintheuk/1april2021">About seven per cent of children in the United Kingdom who recovered from COVID-19 infection reported ongoing symptoms 12 weeks after being diagnosed</a>, which affected various aspects of their quality of life: missing school, being less able to perform physical activity and mental health concerns.</p>
<p>MIS-C and long COVID in children are best avoided through prevention of COVID-19 infection by being fully vaccinated.</p>
<h2>Concerns about side-effects</h2>
<p>The primary side-effect of concern in young children receiving the COVID-19 vaccine is myocarditis, or inflammation of the heart muscle. <a href="https://doi.org/10.1056/NEJMoa2110737">In one recent Israeli study</a>, the risk of myocarditis was highest in male patients between ages 16 and 29 after a second dose of an mRNA vaccine, at roughly 11 out of every 100,000 males. <a href="https://doi.org/10.1056/NEJMoa2109730">A second Israeli study identified males between ages 16 and 19 as being at greatest risk</a>. The risk of myocarditis in females across all age groups was negligible in both studies. Deaths due to vaccine-induced myocarditis are extremely rare, and nearly all cases recover fully.</p>
<figure class="align-center ">
<img alt="A Black woman in a face mask holds her son's hand as a health-care worker gives him an injection" src="https://images.theconversation.com/files/430165/original/file-20211104-19-1wgjf9f.jpg?ixlib=rb-1.1.0&rect=216%2C86%2C5483%2C3529&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/430165/original/file-20211104-19-1wgjf9f.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/430165/original/file-20211104-19-1wgjf9f.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/430165/original/file-20211104-19-1wgjf9f.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/430165/original/file-20211104-19-1wgjf9f.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/430165/original/file-20211104-19-1wgjf9f.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/430165/original/file-20211104-19-1wgjf9f.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">A seven-year-old gets the Pfizer-BioNTech COVID-19 vaccine in Bronx, N.Y. The United States has approved the vaccine in children ages five to 11, and Canada is expected to follow suit.</span>
<span class="attribution"><span class="source">(AP Photo/Mary Altaffer)</span></span>
</figcaption>
</figure>
<p>In Pfizer’s clinical trial of children between ages five and 11, no cases of myocarditis have been detected, but ongoing surveillance will be necessary as cases of myocarditis in children of this age group are expected to be extremely rare, given that myocarditis is typically a post-pubertal phenomenon. Also, since the vaccine dose being given to children aged five to 11 is one-third the dose given to persons over 12, an even greater reduction in vaccine-induced myocarditis is likely in this younger age group.</p>
<p>The risk of <a href="http://doi.org/10.1001/jama.2021.0107">damage to the heart from infection with SARS-CoV-2</a> is statistically much higher than the risk of vaccine-induced myocarditis. COVID-19 infection can lead to a variety of complications of the heart, some serious. Such complications include damage to heart muscle from myocarditis itself, as well as inflammation of blood vessels supplying the heart muscle caused by the virus. </p>
<p>Many parents worry about the possible effects of COVID-19 vaccine on fertility and future pregnancies. No evidence exists right now to demonstrate any concerns with COVID-19 vaccine and fertility, pregnancy or breast-feeding. <a href="https://doi.org/10.1056/NEJMoa2104983">Tens of thousands of women have received vaccine while being pregnant, and no safety signals have been identified</a>. </p>
<p>Parents are concerned about the lack of long-term safety data available for the mRNA vaccines. No reasonable scientific basis exists to indicate that long-term side effects of mRNA vaccination will occur. mRNA is <a href="https://www.nebraskamed.com/COVID/where-mrna-vaccines-and-spike-proteins-go">degraded in the body very quickly</a>, which is why we would typically expect to see vaccine side effects like myocarditis within the first two months of vaccine administration, or not at all. Billions of doses of COVID-19 vaccine have been administered worldwide with no long-term side effects identified, providing further evidence for the long-term safety of mRNA vaccines.</p>
<h2>Benefits of vaccination far exceed potential risks</h2>
<p>Unfortunately, SARS-CoV-2 is not going to ever go away. Our best-case scenario is <a href="https://ottawacitizen.com/news/local-news/what-does-it-mean-if">endemicity</a>, and even that reality is unpredictable given the potential emergence of new viral variants. We cannot expect our children to live in “bubbles” forever. We must prepare them as best as we can to safely navigate this new reality.</p>
<figure class="align-center ">
<img alt="A syringe with a label reading 'PEDIATRIC Pfizer' in the foreground, held by a person in a mask, out of focus in the background" src="https://images.theconversation.com/files/430353/original/file-20211104-21-1egyto7.jpg?ixlib=rb-1.1.0&rect=176%2C109%2C4808%2C3623&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/430353/original/file-20211104-21-1egyto7.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/430353/original/file-20211104-21-1egyto7.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/430353/original/file-20211104-21-1egyto7.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/430353/original/file-20211104-21-1egyto7.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/430353/original/file-20211104-21-1egyto7.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/430353/original/file-20211104-21-1egyto7.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Based on the scientific evidence at hand, the benefits of vaccination for five-to-11-year-olds far exceed any potential risk.</span>
<span class="attribution"><span class="source">(AP Photo/David Zalubowski)</span></span>
</figcaption>
</figure>
<p>Based on the scientific evidence at hand, the benefits of vaccination for my five-year-old son far exceeds any potential risk. That is why he will be vaccinated as soon as he is eligible, and also why practically every expert group on child health across the world has come out in favour of universal vaccination of children, including the <a href="https://www.aappublications.org/news/2021/10/26/fda-pfizer-covid-vaccine-children-102621">American Academy of Pediatrics</a>. We have not even brought up the significant societal benefit of moving closer toward herd immunity through universal vaccination of eligible children.</p>
<p>Navigating the COVID-19 pandemic has been difficult and disruptive for children and their families. We now give routine childhood vaccines to our kids without hesitation, and they have dramatically improved the quality of life and life expectancy of children worldwide. Getting every child between ages five and 11 fully vaccinated against COVID-19 helps bring us all one step closer towards normalcy and protects our children from severe outcomes of COVID-19 infection. </p>
<p>That is why I am going to vaccinate our five-year-old son with confidence, and why I will strongly encourage all parents to do the same.</p>
<p><em>Do you have a question about COVID-19 vaccines? Email us at <a href="mailto:ca-vaccination@theconversation.com">ca-vaccination@theconversation.com</a> and vaccine experts will answer questions in upcoming articles.</em></p><img src="https://counter.theconversation.com/content/171001/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Dr. Alexander Wong has previously consulted for Pfizer with regards to its vaccines to prevent pneumococcal infection, and received honoraria from Pfizer for leading scientific discussions for healthcare professionals on pneumococcal vaccines.</span></em></p>An infectious diseases doctor reviews the evidence, discusses hesitancy and concerns about side-effects and explains the overwhelming case for vaccinating five-to-11-year-olds, including his own son.Alexander Wong, Associate Professor, Infectious Diseases, University of SaskatchewanLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1698202021-11-01T16:26:59Z2021-11-01T16:26:59ZEthical decisions: Weighing risks and benefits of approving COVID-19 vaccination in children ages 5-11<figure><img src="https://images.theconversation.com/files/429411/original/file-20211029-23-1u7vp0d.jpg?ixlib=rb-1.1.0&rect=257%2C74%2C4082%2C2809&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Ethics are important to vaccination decisions because while science can clarify some of the costs and benefits, it cannot tell us which costs and benefits matter most to us.</span> <span class="attribution"><span class="source">THE CANADIAN PRESS/Frank Gunn </span></span></figcaption></figure><iframe style="width: 100%; height: 175px; border: none; position: relative; z-index: 1;" allowtransparency="" src="https://narrations.ad-auris.com/widget/the-conversation-canada/ethical-decisions--weighing-risks-and-benefits-of-approving-covid-19-vaccination-in-children-ages-5-11" width="100%" height="400"></iframe>
<p>The U.S. Food and Drug Administration has approved <a href="https://www.cbc.ca/news/world/fda-approves-pfizer-children-1.6229798">Pfizer’s COVID-19 vaccine for use in children ages five to 11</a>. Pfizer’s <a href="https://www.pfizer.com/news/press-release/press-release-detail/pfizer-and-biontech-announce-positive-topline-results">clinical trial results</a> indicate the vaccine is safe and effective in this age group. </p>
<p>This is an important development. <a href="https://globalnews.ca/news/8250271/covid-19-bc-modelling-data-children/">COVID-19 infections</a> <a href="https://www.cbc.ca/news/canada/calgary/covid-alberta-kids-1.6208827">are on the rise</a> <a href="https://www.cbc.ca/news/canada/saskatchewan/covid-19-saskatchewan-october-9-1.6206509">in children</a> <a href="https://www.thestar.com/politics/provincial/2021/09/28/ontarios-new-covid-19-cases-could-drop-to-200-a-day-or-rise-to-5000-latest-modelling-projects.html">across</a> <a href="https://www.cbc.ca/news/canada/new-brunswick/new-brunswick-school-covid-19-1.6202893">Canada</a>.</p>
<figure class="align-right ">
<img alt="" src="https://images.theconversation.com/files/410911/original/file-20210712-19-geybnm.png?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/410911/original/file-20210712-19-geybnm.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=600&fit=crop&dpr=1 600w, https://images.theconversation.com/files/410911/original/file-20210712-19-geybnm.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=600&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/410911/original/file-20210712-19-geybnm.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=600&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/410911/original/file-20210712-19-geybnm.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=754&fit=crop&dpr=1 754w, https://images.theconversation.com/files/410911/original/file-20210712-19-geybnm.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=754&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/410911/original/file-20210712-19-geybnm.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=754&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="attribution"><a class="source" href="https://theconversation.com/ca/topics/vaccine-confidence-in-canada-107061">Click here for more articles in our series about vaccine confidence.</a></span>
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</figure>
<p>It is now up to <a href="https://www.cbc.ca/news/health/pfizer-seeks-kids-covid-vaccine-approval-health-canada-1.6215547">Health Canada</a> to consider the data and to decide whether to authorize this COVID-19 vaccine for children. Once it is authorized in Canada, the <a href="https://www.canada.ca/en/public-health/services/immunization/national-advisory-committee-on-immunization-naci.html">National Advisory Committee on Immunization</a> (NACI) will have to decide whether to recommend vaccination for all children in this age group. </p>
<p>This raises the question of how this decision ought to be made.</p>
<h2>Making an ethical decision</h2>
<p>As a moral philosopher who has <a href="http://blog.practicalethics.ox.ac.uk/2021/08/we-should-vaccinate-children-in-high-income-countries-against-covid-19-too/">collaboratively researched</a> <a href="https://doi.org/10.1136/bmj.n1687">ethical issues relating to the vaccination of children</a>, I believe it is important to answer this question, for two reasons. </p>
<p>First, whatever the decision, the principles on which it is based — and should be based — must be clear and transparent. </p>
<p>Second, surprisingly little attention has been paid to this issue in Canada, despite the decision to vaccinate children being a matter <a href="https://www.politico.eu/article/coronavirus-vaccine-children-ethics-science/">of science and ethics</a>. Science can clarify some of the costs and benefits of vaccination, but it cannot tell us which costs and benefits matter and when a cost-benefit ratio is favourable.</p>
<p>Fortunately, there is no need to generate a decision-making procedure from scratch. The procedure used by the <a href="https://www.gov.uk/government/groups/joint-committee-on-vaccination-and-immunisation">United Kingdom’s Joint Committee on Vaccination and Immunisation</a> (JCVI) in deciding whether to vaccinate healthy children aged 12-15 in the U.K. can provide important lessons about what not to do.</p>
<h2>Risks and benefits</h2>
<p>The most important factor is whether the benefits of vaccination outweigh its risks, and the degree to which the benefits outweigh the risks. In weighing these, the JCVI relied on what it called the “health perspective.” </p>
<p>Reasoning from this perspective, the JCVI held (in a <a href="https://www.gov.uk/government/publications/covid-19-vaccination-of-children-and-young-people-aged-12-to-17-years-jcvi-statement/jvci-statement-on-covid-19-vaccination-of-children-and-young-people-aged-12-to-17-years-15-july-2021">series</a> of <a href="https://www.gov.uk/government/publications/jcvi-statement-august-2021-covid-19-vaccination-of-children-and-young-people-aged-12-to-17-years/jcvi-statement-on-covid-19-vaccination-of-children-and-young-people-aged-12-to-17-years-4-august-2021">public</a> <a href="https://www.gov.uk/government/publications/jcvi-statement-september-2021-covid-19-vaccination-of-children-aged-12-to-15-years/jcvi-statement-on-covid-19-vaccination-of-children-aged-12-to-15-years-3-september-2021">statements</a>) that the chief benefits of vaccination against COVID-19 were the prevention of death, hospitalization, intensive care unit (ICU) admissions and pediatric inflammatory multisystem syndrome (PIMS) or multisystem inflammatory syndrome (MIS-C). </p>
<p>The chief harms of vaccination were myocarditis, or inflammation of the heart, and pericarditis, inflammation of the thin sack surrounding the heart, though it said these were rare and “typically self-limiting and resolved within a short time.”</p>
<p>The JCVI argued that the benefits of vaccination in this age group are only “marginally greater” than the harms and that therefore vaccination would not be offered to all members of this group.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/429412/original/file-20211029-25-1xe05b5.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="A boy wearing a face mask getting an injection" src="https://images.theconversation.com/files/429412/original/file-20211029-25-1xe05b5.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/429412/original/file-20211029-25-1xe05b5.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/429412/original/file-20211029-25-1xe05b5.JPG?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/429412/original/file-20211029-25-1xe05b5.JPG?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/429412/original/file-20211029-25-1xe05b5.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/429412/original/file-20211029-25-1xe05b5.JPG?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/429412/original/file-20211029-25-1xe05b5.JPG?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Twelve-year-old Sam Hallett got his shot at the Aboriginal Health and Wellness Centre in Winnipeg shortly after Health Canada approved COVID-19 vaccination in his age group in May.</span>
<span class="attribution"><span class="source">THE CANADIAN PRESS/Winnipeg Free Press-Mike Deal</span></span>
</figcaption>
</figure>
<p><a href="https://www.canada.ca/en/public-health/services/immunization/national-advisory-committee-on-immunization-naci/recommendations-use-covid-19-vaccines/mrna-adolescents.html">NACI disagreed</a>, but did not outline the ethical principles it relied on in recommending vaccination for children ages 12-17.</p>
<p>JCVI’s decision not to offer all children vaccination against COVID-19 was flawed in numerous respects. (It was later <a href="https://www.gov.uk/government/publications/universal-vaccination-of-children-and-young-people-aged-12-to-15-years-against-covid-19/universal-vaccination-of-children-and-young-people-aged-12-to-15-years-against-covid-19">overruled by the chief medical officers of the U.K.’s four nations</a>.) NACI will do well to avoid these mistakes in making its decision about vaccinating children ages five to 11.</p>
<p>The Independent Scientific Advisory Group for Emergencies (Independent SAGE, a group of British scientists offering independent scientific advice on the prevention of COVID-19) <a href="https://www.independentsage.org/wp-content/uploads/2021/10/Independent-SAGE-JCVI-statement_transparency_final.pdf">has raised a number of concerns about the JCVI’s decision-making process</a>. </p>
<p>One concern is the way in which the JCVI calculated the benefits of vaccination, basing these calculations on risk to the population of all children of death, hospitalization, ICU admission and so on from COVID-19 infection, rather than the risks of these to children with a confirmed infection of COVID-19.</p>
<p>Another concern Independent SAGE raised was that the JCVI did not state which vaccine it considered when it examined the risks, a relevant concern <a href="https://www.reuters.com/business/healthcare-pharmaceuticals/heart-inflammation-rates-higher-after-moderna-covid-19-shot-than-pfizer-vaccine-2021-10-01/">since heart inflammation rates appear to be higher after the Moderna vaccine than after the Pfizer</a> vaccine.</p>
<h2>Direct and indirect benefits</h2>
<p>Some of JVCI’s other mistakes related to value judgments, relying on the health perspective to make its decision. However, the JCVI was not consistent on what this included. </p>
<p>As noted, the JCVI mentioned the prevention of death, hospitalization, ICU admission and PIMS or MIS-C. These are not the only health benefits of vaccination against COVID-19. Some direct and indirect health benefits of vaccination were not clearly included.</p>
<p>The direct benefits include the prevention of <a href="https://www.who.int/publications/i/item/WHO-2019-nCoV-Post_COVID-19_condition-Clinical_case_definition-2021.1">long COVID</a> — a condition affecting anywhere <a href="https://www.thelancet.com/journals/lanchi/article/PIIS2352-4642(21)00198-X/fulltext">from two</a> <a href="https://www.reuters.com/business/healthcare-pharmaceuticals/english-study-finds-long-covid-affects-up-1-7-children-months-after-infection-2021-09-01/">to 14</a> per cent of children infected with COVID-19 — and potential neurological and cognitive deficits caused by COVID-19 infection. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/429418/original/file-20211029-21-1rwklhi.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="A group of adolescents near a schoolyard play structure" src="https://images.theconversation.com/files/429418/original/file-20211029-21-1rwklhi.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/429418/original/file-20211029-21-1rwklhi.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=422&fit=crop&dpr=1 600w, https://images.theconversation.com/files/429418/original/file-20211029-21-1rwklhi.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=422&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/429418/original/file-20211029-21-1rwklhi.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=422&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/429418/original/file-20211029-21-1rwklhi.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=530&fit=crop&dpr=1 754w, https://images.theconversation.com/files/429418/original/file-20211029-21-1rwklhi.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=530&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/429418/original/file-20211029-21-1rwklhi.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=530&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Families and youth aged 12 and older line up for a COVID-19 vaccine at a Toronto school in May.</span>
<span class="attribution"><span class="source">THE CANADIAN PRESS/Nathan Denette</span></span>
</figcaption>
</figure>
<p>Preventing the <a href="https://doi.org/10.1136/bmj.n2052">negative mental and physical health effects</a> associated with school closures, limits on sporting and other such activities and physical distancing requirements are among the indirect benefits (though these were rightly noted by NACI in its recommendation to vaccinate adolescents). These health effects are important when deciding whether to vaccinate.</p>
<p>These are the known risks and benefits. However, the JCVI’s refusal to recommend vaccination to all children aged 12-15 was due to the uncertainties “regarding the magnitude of the potential harms” of vaccination, including myocarditis. </p>
<p>Although it gave considerable weight to unknown harms or uncertainties of vaccination, the JVCI did not consider potential unknown benefits of vaccination, or uncertainties about benefits. There was no reason to rule these out. Uncertainties about benefits seem to be of as much importance in thinking about the risk benefit profile of COVID-19 vaccination as uncertainties about risks. These, again, matter greatly to this decision.</p>
<p>The JCVI made another ethical error when it said the harms of vaccination should be given greater weight (relatively speaking) than the benefits. </p>
<p>There is no good reason to place a higher relative value on harms compared to benefits. Harms caused by vaccines are not worse than harms caused by COVID-19. It does not appear to be true that the rare and typically mild pericarditis or the myocarditis caused by vaccination is any worse than the pericarditis or the myocarditis caused (at <a href="https://www.newscientist.com/article/mg25133462-800-myocarditis-is-more-common-after-covid-19-infection-than-vaccination/">greater</a> <a href="https://www.nytimes.com/2021/10/06/health/covid-vaccine-children-dose.html?smid=tw-share">frequency</a>) by COVID-19 infection. This is not in line with other treatments considered for children, for which harms are not typically weighed more heavily than benefits.</p>
<h2>The well-being perspective</h2>
<p>It was a mistake for JCVI to make the decision about vaccination against COVID-19 in children purely on the basis of the health perspective. Health is important. But it is not the only value in the lives of children. Health is a priority because without it many other important benefits — enjoying friends, connecting with relatives, absorbing oneself in homework or music lessons — become much more difficult, if not impossible.</p>
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<a href="https://images.theconversation.com/files/429417/original/file-20211029-27-7g7pj5.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="A 12-year-old girl wearing a face mask with a sticker reading 'I got vaccinated'" src="https://images.theconversation.com/files/429417/original/file-20211029-27-7g7pj5.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/429417/original/file-20211029-27-7g7pj5.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=450&fit=crop&dpr=1 600w, https://images.theconversation.com/files/429417/original/file-20211029-27-7g7pj5.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=450&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/429417/original/file-20211029-27-7g7pj5.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=450&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/429417/original/file-20211029-27-7g7pj5.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=565&fit=crop&dpr=1 754w, https://images.theconversation.com/files/429417/original/file-20211029-27-7g7pj5.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=565&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/429417/original/file-20211029-27-7g7pj5.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=565&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<span class="caption">Sound ethics and sound science show that vaccinating children is, all things considered, beneficial.</span>
<span class="attribution"><span class="source">(AP Photo/Angie Wang)</span></span>
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<p>The JCVI mentioned the beneficial effects of vaccination on education. But it did not factor these benefits into the decision relating to vaccinating children against COVID-19. </p>
<p>Educational and other benefits afforded to children by vaccination matter greatly and must be factored into this decision. Moving beyond the health perspective into the well-being perspective encompasses a larger range of benefits and protections from vaccination, including safe and stable learning environments, time with extended family, sport, music performances and the many other things that make life happy and meaningful for children.</p>
<p>When making the decision whether to vaccinate children aged five to 11 against COVID-19, regulators in Canada must rely on both sound science and sound ethics. They must in particular consider all the health and well-being impacts of vaccination more generally; they must consider the uncertain harms and benefits of vaccination; and they must treat benefits and harms symmetrically.</p>
<p>Doing so will show that vaccinating children is, all things considered, beneficial.</p>
<p><em>Do you have a question about COVID-19 vaccines? Email us at <a href="mailto:ca-vaccination@theconversation.com">ca-vaccination@theconversation.com</a> and vaccine experts will answer questions in upcoming articles.</em></p><img src="https://counter.theconversation.com/content/169820/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Anthony Skelton does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>When making the decision whether to vaccinate children aged five to 11 against COVID-19, regulators in Canada must rely on sound ethics as well as sound science.Anthony Skelton, Associate Professor of Philosophy and Core Member of the Rotman Institute of Philosophy, Western UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1699282021-10-18T19:14:44Z2021-10-18T19:14:44ZCOVID-19 cases rise when schools open – but more so when teachers and students don’t wear masks<figure><img src="https://images.theconversation.com/files/426838/original/file-20211018-17-10q41fx.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/coronavirus-impact-on-education-little-girl-1908799819">Shutterstock</a></span></figcaption></figure><p>As students return to schools in Victoria and New South Wales after months of lockdowns, many people may be worried about the risks to their kids – and transmission overall.</p>
<p>The role that schools play in transmission of the virus that causes COVID-19 has been difficult to work out, but new evidence can finally answer that question. Schools do amplify community transmission, but the good news is that some relatively simple mitigation measures can make schools much safer places.</p>
<p>To successfully navigate the next phase of the pandemic and protect our kids, we need to switch to a so-called “<a href="https://insightplus.mja.com.au/2021/34/vaccination-alone-not-enough-to-control-covid-19/">vaccine-plus</a>” strategy – vaccination together with <a href="https://ozsage.org/media_releases/protecting-children-from-covid-19-and-making-schools-and-childcare-safer/">measures to clean the air</a>.</p>
<h2>What new evidence says about opening schools</h2>
<p>A <a href="https://www.pnas.org/content/118/42/e2103420118">new study</a> conducted in the United States found school reopening in late 2020 was associated with an increase in COVID-19 cases and deaths. </p>
<p>Some of the increase can be attributed to other restrictions being eased at the same time, and to parents having the ability to return to the workplace, where transmission also occurs. </p>
<p>But importantly, cases and deaths increased most in counties where students and teachers did not have to wear masks at school.</p>
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<p>We shouldn’t be surprised at this finding, because face masks are one of the most effective ways to prevent the spread of COVID-19. An investigation into school outbreaks, supported by the US Centers for Disease Control (CDC), found that schools without an indoor mask requirement were <a href="https://www.cdc.gov/mmwr/volumes/70/wr/mm7039e1.htm">3.5 times more likely to have an outbreak</a> than schools in which students and staff did have to wear masks.</p>
<p>This is why the CDC <a href="https://www.cdc.gov/coronavirus/2019-ncov/community/schools-childcare/k-12-guidance.html">recommends universal indoor masking</a> by all children aged two and older, as well as teachers and visitors to schools, regardless of whether they’re vaccinated.</p>
<h2>More evidence to support masks in schools</h2>
<p>One of the reasons it has been hard to see transmission in schools is because children generally have mild symptoms. This leads to infections going undetected. But the picture is very different when researchers actively look for cases.</p>
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Read more:
<a href="https://theconversation.com/cant-get-your-kid-to-wear-a-mask-here-are-5-things-you-can-try-166648">Can't get your kid to wear a mask? Here are 5 things you can try</a>
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<p>Researchers in Belgium conducted a <a href="https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2784812">study</a> where primary school children and their teachers were tested once per week for 15 weeks. They found many instances of transmission between children and adults that spread beyond the school to the children’s parents and to the teachers’ partners. Some mitigation measures were in place in the school, but not mask wearing.</p>
<h2>Other measures help too</h2>
<p>Perhaps the most dramatic example of failing to protect schools comes from England. Schools reopened this September without a mask mandate and with very little investment in ventilation. </p>
<p>Within one month, <a href="https://www.ons.gov.uk/peoplepopulationandcommunity/healthandsocialcare/conditionsanddiseases/bulletins/coronaviruscovid19infectionsurveypilot/15october2021">random testing showed</a> that 8% of secondary school children and 3% of pre-primary and primary school children had an active infection.</p>
<p>This occurred despite <a href="https://www.gov.uk/government/news/four-in-five-people-aged-16-and-over-vaccinated-with-both-doses">more than 80%</a> of people aged 16 and older having received two vaccine doses. Accordingly, infections in adults were much lower — around 1% or less in all age groups.</p>
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<p>This clearly shows that high levels of vaccination in adults aren’t sufficient to protect children, because children easily transmit the virus to each other.</p>
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Read more:
<a href="https://theconversation.com/we-may-need-to-vaccinate-children-as-young-as-5-to-reach-herd-immunity-with-delta-our-modelling-shows-164942">We may need to vaccinate children as young as 5 to reach herd immunity with Delta, our modelling shows</a>
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<p>It also shows that infections in children don’t simply reflect overall community transmission. Schools play a key role in amplifying the spread of COVID-19.</p>
<h2>Why we need to protect children</h2>
<p>We need to prevent infections in children for a number of reasons. First, although most children with COVID-19 experience mild illness, a small proportion become <a href="https://theconversation.com/no-we-cant-treat-covid-19-like-the-flu-we-have-to-consider-the-lasting-health-problems-it-causes-164072">unwell enough to need hospitalisation</a>.</p>
<p>This might not sound like a big problem, but we can expect almost all of Australia’s 3.8 million children to eventually get infected if we don’t vaccinate them. A small proportion of this is a big number, and could <a href="https://journals.lww.com/jphmp/fulltext/2020/07000/covid_19_in_children_in_the_united_states_.9.aspx">easily overwhelm children’s hospitals</a>, which is what <a href="https://www.npr.org/sections/coronavirus-live-updates/2021/09/01/1033233408/childrens-hospitals-coronavirus-covid-capacity-federal-help">happened in the US</a>.</p>
<p>Children who get COVID-19 can also be left with persistent symptoms, known as <a href="https://theconversation.com/the-mystery-of-long-covid-up-to-1-in-3-people-who-catch-the-virus-suffer-for-months-heres-what-we-know-so-far-161174">long COVID</a>. It’s not clear exactly how often this occurs, but the condition is common enough that England’s National Health Service has set up <a href="https://www.england.nhs.uk/2021/06/nhs-sets-up-specialist-young-peoples-services-in-100-million-long-covid-care-expansion/">15 long COVID clinics</a> for children. In Israel, long COVID clinics have <a href="https://www.haaretz.com/israel-news/the-new-frontier-israeli-hopsitals-contend-with-long-covid-in-children-1.10280661">long waiting lists</a>.</p>
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Read more:
<a href="https://theconversation.com/no-we-cant-treat-covid-19-like-the-flu-we-have-to-consider-the-lasting-health-problems-it-causes-164072">No, we can’t treat COVID-19 like the flu. We have to consider the lasting health problems it causes</a>
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<p>High levels of transmission in children also leads to educational disruption. Two weeks after the start of the autumn term in England, <a href="https://www.theguardian.com/education/2021/sep/21/more-than-100000-pupils-off-school-in-england-last-week-amid-covid-surge">more than 100,000 children were absent from school</a> due to confirmed or suspected COVID-19.</p>
<p>And <a href="https://theconversation.com/children-may-transmit-coronavirus-at-the-same-rate-as-adults-what-we-now-know-about-schools-and-covid-19-150523">children can easily transmit the coronavirus</a> to other children and to adults. This will lead to parents and others in the wider community getting sick, including some vaccinated people.</p>
<p>Although COVID-19 vaccines are very good at preventing severe disease, they’re not perfect, and <a href="https://www.cdc.gov/mmwr/volumes/70/wr/mm7031e2.htm">breakthrough infections can occur</a>. To keep breakthrough infections to a minimum, we must keep community transmission low. </p>
<h2>Here’s how we can make schools safer</h2>
<p>It’s not difficult to make schools much safer places, but it does require putting more emphasis on cleaning the air rather than cleaning our hands. This is because COVID-19 is caused by an <a href="https://onlinelibrary.wiley.com/doi/10.5694/mja2.51131">airborne virus</a> that can drift through the air like cigarette smoke.</p>
<p>Independent scientific advisory group OzSAGE recently launched <a href="https://ozsage.org/media_releases/protecting-children-from-covid-19-and-making-schools-and-childcare-safer/">comprehensive guidance</a> on how to prevent this type of transmission in schools.</p>
<p>OzSAGE recommends vaccinating children, their parents, and teachers as soon as possible; increasing ventilation and using <a href="https://www.cdc.gov/mmwr/volumes/70/wr/mm7027e1.htm">HEPA air filters</a> to clean indoor air; and ensuring masks are worn by all staff and children who can safely wear them.</p>
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Read more:
<a href="https://theconversation.com/from-vaccination-to-ventilation-5-ways-to-keep-kids-safe-from-covid-when-schools-reopen-166734">From vaccination to ventilation: 5 ways to keep kids safe from COVID when schools reopen</a>
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<p>These measures will likely have benefits beyond the pandemic. Stuffy air in classrooms isn’t good for learning, and <a href="https://www.wired.com/story/school-classroom-ventilation-fresh-air-fix/">academic outcomes have been shown to improve</a> with ventilation.</p>
<p>Cleaning the air is an investment for our children’s future.</p><img src="https://counter.theconversation.com/content/169928/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Dr Zoë Hyde is a member of the OzSAGE independent scientific advisory group.</span></em></p>A new study in the United States found school reopening in late 2020 was associated with an increase in COVID-19 cases and deaths. But this was mostly the case where masks weren’t required.Zoë Hyde, Epidemiologist, The University of Western AustraliaLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1649422021-08-05T02:58:23Z2021-08-05T02:58:23ZWe may need to vaccinate children as young as 5 to reach herd immunity with Delta, our modelling shows<figure><img src="https://images.theconversation.com/files/414473/original/file-20210804-12-feze9m.jpg?ixlib=rb-1.1.0&rect=0%2C1%2C1000%2C664&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/group-elementary-pupils-classroom-138148427">from www.shutterstock.com</a></span></figcaption></figure><p>Recently released <a href="https://www.doherty.edu.au/news-events/news/doherty-institute-modelling-report-for-national-cabinet">modelling</a> from the Doherty Institute, which the federal government used to back its roadmap out of the pandemic, misses one critical point — the importance of vaccinating children.</p>
<p>The Doherty modelling instead focuses on vaccinating 70-80% of the adult population as thresholds for easing various restrictions, such as lockdowns. It says vaccinating younger adults, in particular, is important to reach these thresholds.</p>
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<p>However, <a href="https://www.medrxiv.org/content/10.1101/2021.07.16.21260642v1">our modelling</a> shows vaccinating children is vital if we are to reach herd immunity, which would allow us to ease restrictions and safely open up. </p>
<p>This would mean potentially vaccinating children as young as 5 years old. </p>
<p>However, we are still waiting to see if this is safe and effective, with trials under way in the United States. So we need a plan that assumes we may never achieve herd immunity.</p>
<p>Here’s what our modelling shows and how it differs from the modelling used to advise the federal government.</p>
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Read more:
<a href="https://theconversation.com/we-need-to-start-vaccinating-people-in-their-20s-and-30s-according-to-the-doherty-modelling-an-epidemiologist-explains-why-165540">We need to start vaccinating people in their 20s and 30s, according to the Doherty modelling. An epidemiologist explains why</a>
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<h2>Here’s what we did</h2>
<p><a href="https://www.medrxiv.org/content/10.1101/2021.07.16.21260642v1">Our modelling</a>, which we’ve uploaded as a pre-print and has yet to be peer-reviewed, considers different vaccine strategies for Australia to achieve herd immunity. That’s when we can expect no sustained transmission of the virus in the community.</p>
<p>We take into account the Delta variant, which is twice as infectious as the original Wuhan strain of the virus, and has a reproduction number estimated between <a href="https://fm.cnbc.com/applications/cnbc.com/resources/editorialfiles/2021/07/30/CDC_slides.pdf">5 and 10</a>. In other words, this is when one person infected with Delta is estimated to infect 5-10 others.</p>
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Read more:
<a href="https://theconversation.com/scientific-modelling-is-steering-our-response-to-coronavirus-but-what-is-scientific-modelling-135938">Scientific modelling is steering our response to coronavirus. But what is scientific modelling?</a>
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<p>We also consider different contact patterns across various age groups. This is because some age groups are more mobile and have many contacts. If infected, these people are more likely to infect many others, particularly of similar age, which can lead to reservoirs of transmission. </p>
<p>We combine this information with possible vaccine effects. These include the possibility of having the vaccine then becoming infected, having symptoms, and if infected, how serious the illness is and how infectious people are. </p>
<p>This allows us to model what’s likely, given we’re focused on the Delta variant for now, and allows us to assess the impact of strategies across different age groups, types of vaccines and percentage vaccinated.</p>
<p><a href="https://covid-19-aithm.shinyapps.io/vaccine_coverage_analysis/">Our interactive tool</a> also allows rapid response to changing information, such as new variants, or new evidence about vaccine impact.</p>
<h2>Delta is more infectious</h2>
<p>The Wuhan strain had a <a href="https://ourworldindata.org/explorers/coronavirus-data-explorer?zoomToSelection=true&time=2020-03-01..latest&pickerSort=asc&pickerMetric=location&Metric=Reproduction+rate&Interval=7-day+rolling+average&Relative+to+Population=true&Align+outbreaks=false&country=USA%7EGBR%7ECAN%7EDEU%7EITA%7EIND">basic reproduction number of 2.5</a>. This means, at the start of the pandemic, one person infected with it was expected to infect 2.5 others.</p>
<p>If the Delta variant is twice as infectious, this means its basic reproduction number may be over 5 (at the lower range of international estimates). So this changes the number (and type) of people we need to vaccinate to reach herd immunity considerably.</p>
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<p>The simplest form of the herd immunity equation would suggest we needed to fully immunise 60% of the population to achieve herd immunity for the Wuhan strain but as much as 80% for the Delta variant.</p>
<p>If we take into account how different age groups mingle or are in contact with others, the situation is worse. </p>
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Read more:
<a href="https://theconversation.com/is-it-more-infectious-is-it-spreading-in-schools-this-is-what-we-know-about-the-delta-variant-and-kids-163724">Is it more infectious? Is it spreading in schools? This is what we know about the Delta variant and kids</a>
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<p>For the Wuhan strain, children were not as infectious or susceptible to infection and we predict that if we vaccinate 65% of the adults, transmission would not continue among children.</p>
<p>However, with the Delta variant, we predict children will continue to infect other children, even when most adults are vaccinated.</p>
<p>We also know both the AstraZeneca and Pfizer vaccines are <a href="https://www.nejm.org/doi/full/10.1056/NEJMoa2108891">less able to protect</a> against the Delta variant, with a reduced efficacy after one dose and slightly reduced efficacy after two doses.</p>
<p>All this makes achieving herd immunity a great challenge. </p>
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Read more:
<a href="https://theconversation.com/when-will-we-reach-herd-immunity-here-are-3-reasons-thats-a-hard-question-to-answer-164560">When will we reach herd immunity? Here are 3 reasons that's a hard question to answer</a>
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<p>We estimate if the reproduction number is 5, then vaccinating 85% of the population, including children down to age 5, will be necessary to achieve herd immunity. </p>
<p>If the reproduction number is as low as 3, then vaccinating children will not be necessary to achieve herd immunity and we will only need to vaccinate 60% of the population.</p>
<p>The Doherty modelling uses an effective reproduction number of 3.6. This explains why its modelling does not see vaccinating children as critical to reaching herd immunity. This is the major difference between our model and theirs.</p>
<h2>What happens next?</h2>
<p>Of course, new variants may arise pushing Delta aside, and the world post-COVID is unpredictable. </p>
<p>The lesson from Delta is if we don’t vaccinate children, we may need to continue some form of public health action to prevent large-scale circulation of the virus. </p>
<p>This would not require stringent lockdown, but may require ongoing mask use and physical distancing, including in children. The alternative is to reduce the focus on case numbers, expect transmission and focus on protecting the most vulnerable.</p>
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Read more:
<a href="https://theconversation.com/should-we-vaccinate-children-against-covid-19-we-asked-5-experts-165316">Should we vaccinate children against COVID-19? We asked 5 experts</a>
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<h2>Do we need to reach herd immunity?</h2>
<p>Herd immunity is not the only possible target. Even if we don’t reach full herd immunity, we may achieve “herd protection”. This provides some reduced risk to people who can’t or won’t be vaccinated, and it will make outbreaks smaller and easier to control.</p>
<p>And without full herd immunity, individuals still benefit from vaccination as they are dramatically less likely to die from COVID.</p>
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Read more:
<a href="https://theconversation.com/how-well-do-covid-vaccines-work-in-the-real-world-162926">How well do COVID vaccines work in the real world?</a>
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<h2>Do we need to change our vaccination strategy?</h2>
<p>We predict Australia’s strategy of vaccinating the elderly and vulnerable first is the best strategy for reducing deaths under most circumstances, particularly when there is insufficient vaccine available. </p>
<p>But once the most vulnerable groups have been covered, we should turn our attention to the highest transmitters to achieve herd protection. In Australia, this group is the late teens and young adults. </p>
<p>Whether we next focus on vaccinating children is controversial and many people have voiced their concerns about going down this path. This is because COVID is generally a very mild illness for most children — although <a href="https://www.thelancet.com/journals/lanchi/article/PIIS2352-4642(21)00124-3/fulltext">long COVID</a> and <a href="https://jamanetwork.com/journals/jama/article-abstract/2777026">life-threatening complications</a> can arise.</p>
<p>So we need to balance the risks with benefits. But included in the benefits should be the potential benefit of herd protection and the freedoms that may bring.</p>
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Read more:
<a href="https://theconversation.com/national-cabinets-plan-out-of-covid-aims-too-low-on-vaccinations-and-leaves-crucial-questions-unanswered-165447">National Cabinet's plan out of COVID aims too low on vaccinations and leaves crucial questions unanswered</a>
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<img src="https://counter.theconversation.com/content/164942/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Emma McBryde receives funding from NHMRC. She is affiliated with the Australian Tuberculosis Forum and the Austrasian Society of Infectious Diseases. </span></em></p>But herd immunity is not our only option. If we don’t vaccinate children, we may have to settle for lesser protection of the population.Emma McBryde, Professor of Infectious Disease and Epidemiology, James Cook UniversityLicensed as Creative Commons – attribution, no derivatives.