For the first few months of this year, the UK led most other nations in vaccinating as many people against covid-19 as quickly as possible. But the country has been one of the slowest to vaccinate teenagers. News of the omicron variant of the coronavirus prompted the UK to recommend that 12 to 15-year-olds can now have a second vaccine dose three months after their first, but 5 to 11-year-olds remain completely unvaccinated. What is behind the UK’s apparent reticence around vaccinating children?
While the UK was a pioneer when it came to vaccinating older adults – it was the first high-income country to approve any covid-19 vaccine – when it comes to children, it is being much slower. The country’s Medicines and Healthcare products Regulatory Agency (MHRA) extended legal approval for use of the Pfizer/BioNTech jab to children aged 12 and over in June, in line with many other countries. Places such as the US and Israel started vaccinating this age group in May and June, respectively.
However, the UK body that decides on vaccine deployment, the Joint Committee on Vaccination and Immunisation (JCVI), to conclude that the benefits of the jab for healthy 12 to 15-year-olds “are marginally greater than the potential known harms… [but] the margin of benefit… [is] too small to support advice on a universal programme of vaccination”.
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Myocarditis and long covid
The JCVI said the benefits of vaccination are smaller for children because they are less likely to get seriously ill from covid-19 and the jab carries the risk of the rare side effect of myocarditis, or heart inflammation. Regarding long covid, something that worries many parents, the committee said in August that estimates of symptoms lasting more than eight weeks in children ranged from less than 1 per cent to 10 per cent – with more rigorous studies “”.
There has certainly been a wide range of estimates for the prevalence of long covid, partly because there is no widely agreed definition: while the core symptoms include problems such as fatigue and headaches, one study linked the condition with . “The problem is long covid has not been defined in children,” says at King’s College London.
Initial research also tended to overstate the condition’s prevalence by failing to use a comparator group of children who had never caught covid-19, as it is common for teenagers to report symptoms such as fatigue, for instance. But in August, a that did use a non-infected comparison group found that 30 per cent of 11 to 17-year-olds who had covid-19 reported three or more symptoms three months later, compared with 16 per cent of those who hadn’t been infected. This translates to about 14 per cent of people in the age group experiencing persistent covid-19 symptoms, higher than the JCVI’s estimate range.
The figure could have been inflated by the fact that only 13 per cent of families who were contacted took part in the study, with those whose children were ill being more likely to do so. One large ongoing survey by the UK Office for National Statistics (ONS) puts the prevalence of persistent symptoms among 12 to 16-year-olds much lower, at , compared with 1.3 per cent in an uninfected control group. “Even if it’s at the lower end of the estimates, with the number of infections we’re seeing, that’s still thousands of kids a week,” says at the University of Leeds, UK. “That’s really worrying for me.”
Slow roll-out
It is hard to evaluate the JCVI’s decision-making, however, as the committee hasn’t yet published a detailed breakdown of its analysis – just some that do not mention long covid. “It’s very difficult to understand how they reached their conclusions,” says Griffin.
In September, the JCVI handed over the decision on vaccinating children to the chief medical officers (CMOs) of the UK nations, as they could weigh up other issues not in the committee’s remit, such as the benefits of teenage vaccination in reducing transmission to adults, and in the children themselves missing less school. Only in mid-September, after the school year had begun, did the CMOs give the go-ahead for 12 to 15-year-olds to have a first vaccine dose.
Countries such as Spain, France and Denmark had already given most teenagers their first jab by this point. “A lot of countries have stormed ahead with vaccinating children,” says at Swansea University, UK. “It’s unsurprising the public are puzzled [in the UK].”
A slow roll-out coupled with many schools dropping mitigation measures like mask wearing led to a surge of infections in UK schools, which spread to other age groups. At the peak in mid-October,  and hospital admissions among 5 to 14-year-olds in England were nearly double the rate during the UK’s second wave in January, at about . The coronavirus was involved in 12 deaths of under-15s in England over September and October, according to .
Uncertain winter
, a former president of the UK’s Royal College of Paediatrics and Child Health, says that while he agrees with the JCVI’s caution, the delivery of vaccines to teens should have happened faster. “Once the decision was made, we didn’t cover ourselves with glory,” he says.
Daily covid-19 infections in the UK have been rising again since early November, and it is unclear what will happen to infection rates this winter, especially if the omicron variant starts circulating widely.
The next tussle is likely to be over the low-dose Pfizer/BioNTech vaccine for 5 to 11-year-olds, which was first offered to children in the US and Israel last month. A trial published in November shows that it .
This vaccine is under review by the UK’s MHRA. But if it gets approved, the initial signs are that, as with teenagers, the UK will be in no rush to use it. A spokesperson for the JCVI didn’t respond to żěè¶ĚĘÓƵ’s questions in detail, but did say the committee “has consistently maintained that the main focus should be the benefits to children themselves, balanced against any potential harms to them from vaccination. It is not within the JCVI’s remit to consider the wider societal impacts of vaccination.”
“I think there’s going to be a bit of a delayed process in the UK this time round too,” says Williams of the low-dose vaccine. “There are signs that history may repeat itself.”
“It’s not an easy call,” says Absoud. “I don’t envy anyone making decisions in a pandemic.”
