Vaccinating children against Covid: the elusive goal of herd immunity

Among the many twists and turns of the Covid pandemic has been the confused attitude towards vaccinating children and adolescents. This has been especially the case in the United Kingdom during the summer months, with a growing clamour from politicians and many parents to vaccinate those aged 12 years and above, following the example set by other European countries, as well as Israel and the USA. In some countries, even younger children are set to follow.

The reluctance to implement an effective programme for these younger groups has been puzzling given the approval for some Covid vaccines, particularly the Pfizer and Moderna brands, by international medicines regulators including the British MRHA for use with these groups. In the case of the United Kingdom, the main stumbling block was the resistance of Joint Committee on Vaccination and Immunisation, citing the claimed lack of significant cost benefit of such an intervention.

In taking this stance, the Joint Committee on Vaccination and Immunisation was demonstrating a repeat of the narrow frame of reference that initially led to its refusing the extension of Human Papilloma Virus vaccination in the nation's teenage males whilst offering it to teenage girls. The exclusive focus on Human Papilloma Virus as a cause of cervical carcinoma was in the face of increasing rates of oropharyngeal and anal carcinoma associated with changing cultural attitudes and practices and was in contrast to the universal programmes being pursued in North America and Australia. ¹ Perhaps the Joint Committee on Vaccination and Immunisation took the view that British males would neither indulge in a broader range of sexual activities than the traditional heterosexual missionary position and certainly not have sex with other males or foreign women who may not have been vaccinated.

If these considerations underline the importance of advisory bodies being drawn from wider than the quantitative bio-medical sciences, to embrace the social sciences and the anthropology of everyday life, they also remind us that whoever frames the question determines the range of solutions. ²

In the case of the Covid pandemic, the framing of the statistics has regularly led to inadequate interventions, whether through the omission of care home deaths from the tally in the early months, or the later incompleteness of the data set by restricting the mortality count to those dying within 28 days of a positive test for Covid and the exclusion of those dying outside of hospital without a confirmatory test. ³

Since the advent of the vaccination programme, the headline figures in the media have focussed on the seemingly impressive totals of around 90% of the priority vulnerable groups having received at least their first Covid jab. However, on close examination, it transpires that once those who have only received one vaccination are included together with the so-far unvaccinated under 16 cohort, at around 20% of the population, some 40% of the total population have not had the benefit of both vaccines. The desired goal of herd immunity from full vaccination remains some distance away, whilst the virus circulates among so many susceptible human beings.

Meanwhile, the popular press, encouraged by the business community, talks up the ‘end of the pandemic’, and the Corona virus continues its deadly travels, not just at home but also around the world. This continued circulation as control measures are relaxed brings with it the prospect of new, more deadly variants, even than the current troubling delta form. As young people face a third year of disrupted education, together with the prospect of Long Covid blighting their futures, we might well question the fitness for purpose of current advisory committee terms of reference and membership.

Having missed the opportunity of beginning to vaccinate the nation's teenagers before the end of the schools' Summer term and again before the Autumn return, the Chief Medical Officer finally succumbed to political pressure to broaden the basis for the risk assessment of teenage vaccination and gave the go ahead as schools resumed in September.