(Photo credit: vacunació professionals commons)

Covid vaccines will be offered to all 12 to 15-year-olds, following a review by the UK Chief Medical Officers (CMOs) of England, Scotland, Wales and Northern Ireland, who unanimously supported giving one dose of the Pfizer vaccine to all children in this age group.

The MHRA, the UK’s medicines regulatory body, had previously confirmed that the Pfizer vaccine is safe and effective for this age group.

However, the Government’s decision to offer the Covid jab comes a week after the JCVI (Joint Committee on Vaccination and Immunisation), decided not to recommend vaccination for all healthy 12 to 15-year-olds, instead, advising vaccines only be offered to children with underlying health conditions. This has naturally led to some confusion about the differing advice and leaves parents with the decision on whether or not to vaccinate their children.

In a statement to Parliament, the then Vaccine Deployment Minister, Nadhim Zahawi, said that the remit of the JCVI was to assess the benefit of Covid vaccinations to children’s health, but did not extend to assessing the wider impact, such as reducing school absences or the mental health benefits of knowing you have some protection from the virus.

The JCVI thus advised that the Government may wish to seek further views, incorporating the potential wider impacts of vaccination from the UK’s Chief Medical Officers.

The CMOs recommended vaccination after taking into consideration the assessment of the JCVI and MHRC, views of other health care professionals including the Royal College of Paediatrics and Child Health and reviewing data from other countries that have vaccinated this age group.
Reviewing all the data, the CMOs recommended vaccination.

The Government has stated that whilst the health benefits of vaccinating this age group are finely balanced, it has accepted the advice of the CMOs that it should offer one dose of the Pfizer vaccine at this point.

The NHS is now preparing to deliver a school-based vaccination programme, supported by GPs and community pharmacies. Invitations to receive the vaccine are expected to begin by the end of September. Parental or guardian consent will be sought by vaccination healthcare staff prior to vaccination, in line with existing school vaccination programmes.

The JCVI is an independent advisory committee that advises the Government on immunisation, vaccine schedules and safety. Their role was to assess whether there was a significant and clear advantage to giving the jab to healthy 12–to-15-year-olds by evaluating the potential risks from side effects of the vaccine versus the effects of covid.

Data and research on the safety profile of the vaccines have been steadily growing as millions of people worldwide have now been vaccinated. The mRNA vaccines produced by Pfizer and Moderna, whilst having a good safety profile, have been identified as carrying a tiny risk of inflammation of the heart (myocarditis).

Whilst this usually clears up in a few days, it has been highlighted as a potential side effect; no drug is ever 100% safe, and all medicines have side effects. Myocarditis was found to be more common after the second dose of the Pfizer vaccine (thus only one dose will be offered at this stage) and more common in boys; for every million Pfizer, second doses given to boys aged 12 to 15 around 60 will develop myocarditis.

The number is lower in girls at 8 in a million. This risk must be weighed up against potential risks from catching Covid.

Covid does not cause serious illness in children, so the JCVI determined there is little benefit in giving healthy 12 to 15-year-olds the jab. The JCVI’s decision seems to be based on a rare side effect from the vaccine versus a low risk from the disease itself.

However, as Covid is a new disease, the long-term effects of Covid in children are still not known and the vaccine’s effect on this is, as yet, also unknown.

In older adults, the risk to benefit ratios is straightforward. Covid in older people is much more likely to result in severe illness, hospitalisation, long-term symptoms and even death, so the benefits of vaccination become clear.

In contrast, with younger teens, Covid rarely causes severe illness or long-term complications; paediatricians say that healthy children with Covid end up in intensive care at a rate of two in one million.

The JCVI, therefore, concluded that as healthy children are at such a low risk from the virus, the vaccine would offer only a marginal benefit and recommended the vaccine be offered to teenagers with underlying health conditions that put them more at risk from Covid.

Following the JCVI’s recommendation, the Government referred the decision to the CMOs. They took a broader approach to the benefits of vaccinating secondary school-aged children, including disruption to education by reducing outbreaks in schools and unanimously backed vaccinating all 12 to 15-year-olds and said they are making this recommendation based on the benefits to children alone and not the benefits to adults or wider society.

In light of the known side effects of myocarditis, the recommendation for this age group is to receive one dose of the vaccine only.

Other countries have already gone ahead with vaccinating this age group. In America, over 10 million 12–15-year-olds have been given the vaccine. Similarly, Ireland, France, Italy, Canada, Qatar and Israel have extended their vaccination programmes to include all teenagers.

In the UK, there are about 3 million children in the 12 to 15 age ranges. Parents and guardians will be asked to give consent for the vaccine, the Vaccine Deployment Minister Nadhim Zahawi said in his statement to Parliament.

‘We must continue to respect individual choice.’ And ‘whatever decision teenagers and parents take, they must be supported and not stigmatised in any way.’Data about the side effects of Covid in teenagers will continue to be monitored, and the JCVI will advise before any decision is made on a second dose.

Rachel Kayani