Risks and benefits of vaccinating children against COVID

Alexandra Lützenkirchen, a pediatrician based in the city of Leverkusen in western Germany, will find out on Thursday whether she has good news for her patients. That’s when she’ll know whether the vaccine doses that she has ordered are going to arrive.

“We received 24 doses this week for a practice of two,” she said. “Four vials of the eagerly awaited BioNTech-Pfizer vaccine — but we had ordered 24. Right now, we’re spending a lot of time postponing appointments.”

So far, she and her colleague have vaccinated 100 people, mainly people with Down syndrome who are older than 16 and other young people with conditions that make them more vulnerable to COVID-19, as well as parents of children at high risk of developing serious symptoms.

Lützenkirchen said they had not been not overwhelmed by demand. “We are actively contacting patients over 16 and offering them the vaccine,” she said. “That’s working well, but I am surprised how few healthy young people have inquired about the prospects of getting vaccinated. It’s currently mainly parents who want to get an appointment because they’re very low down on the waiting list at their own doctor’s practice.”

EMA decision expected

Since Canada and the US authorized use of the BioNTech-Pfizer vaccine for 12-to-15-year-olds, there has been much debate about whether it makes sense to do the same in the EU, too. The European Medicines Agency (EMA) is expected to announce its decision very soon. “We are trying to see whether we can accelerate this to the end of May,” Emer Cooke, the head of the EMA, recently told the press.

US leaders have expressed optimism that the approval could give a boost to the nationwide inoculation campaign, which has started to flag. EU politicians say authorization for teens aged 12 to 15 could help bring progress toward herd immunity. Studies conducted by BioNTech have shown that the vaccine has maximum efficacy and limited side effects for this age group.

German Health Minister Jens Spahn said a serial inoculation campaign in schools could make it possible to offer the vaccine to all 12-to-18-year-olds by the end of summer vacation. He said the condition would be that all parents should be vaccinated, too.

‘Hurdles are high’

Jörg Dötsch, the head of the German Society of Pediatrics and Adolescent Medicine (DGKJ), told the public broadcaster Deutschlandfunk that he is not in favor of emergency approval for kids. “It is always very important that a child is vaccinated or given medication only when there is a direct benefit to the child or adolescent,” Dötsch said. “The hurdles are high,” he added, “because this is a vulnerable group that cannot always speak or decide for itself.”

So far, children’s wards in Germany have been protected from the worst effects of the pandemic. According to the German Society for Pediatric Infectious Diseases (DGPI) and the German Society of Hospital Hygiene (DGKH), about 1,200 of the 14 million children in Germany had been admitted to hospitals with COVID-19 through mid-April, with 5% landing in intensive care.

The Robert Koch Institute has recorded about a dozen deaths in children younger than 9 and seven in youths aged 10-19.

Lützenkirchen said she had registered several cases of COVID-19 in children, but “luckily” no serious cases.

“Among the youths, we did have some patients who didn’t feel fit for a few months, but I have not been able to confirm any case of long COVID on the basis of heart and lung tests,” Lützenkirchen said.

She said parents were not only worried about the possible long-term effects of COVID-19 but also about pediatric inflammatory multisystem syndrome (PIMS): a rare condition that can develop several weeks after a child has had COVID-19 and causes inflammation throughout the body.

Though it is mainly the risks of long COVID and PIMS that have been used to justify the vaccination of children and adolescents on medical grounds, there are other arguments. Some experts have expressed doubt that it will be possible to really get to grips with the pandemic if under-16s are not vaccinated. Many epidemiologists say that if children are not vaccinated then more adults will have to be vaccinated.

Debate in Israel

Israel is one of the countries that rapidly vaccinated a large proportion of the population, but this number has stagnated at about 60% for the past two months. Some had argued that children should also be vaccinated. However, a survey conducted in February found that only 41% of parents were certain that they would let children aged 6-1 be vaccinated; 29% said they would not.

Though the Israeli Pediatric Association considers the vaccine safe and effective, about 100 doctors signed an open letter calling on the government to wait until more was known about the impact of inoculation. Since there is currently a very low incidence rate in Israel, the question of vaccinating children has now taken a backseat. 

In Europe, too, there is a possibility that there will be a resumption of certain activities once over 60% of the population has been vaccinated. Beate Kampmann from the London School of Hygiene and Tropical Medicine argued that there was thus a good case for putting the vaccine to use elsewhere. “If the virus no longer spreads in one society and vulnerable groups are vaccinated, more suffering can be avoided by passing on the vaccine to COVID-19 hotspots such as India than by vaccinating teenagers here.”

In Leverkusen, Lützenkirchen is waiting for the EMA’s decision and that of Germany’s Standing Committee on Vaccination (STIKO). Thomas Mertens, who heads the body, recently expressed doubt that it would issue a recommendation that all healthy adolescents be vaccinated. He said that the committee would have to assess whether the benefits of the vaccination actually outweighed the risks to individuals.

If the green light is given, Lützenkirchen has one request: “No more prioritization, please! I would like to use the summer holidays to vaccinate those who are interested by the beginning of the new school year. They should just be able to come.”