Why UK has been less keen than US to give Covid jab to children
The UK and US may have many things in common, but when it comes to vaccinating children against Covid, the approach has been markedly different.
In May, the US Food and Drug Administration’s emergency use authorisation of the Pfizer/BioNTech jab was expanded from people aged 16 and older to those aged 12 to 15, with two doses recommended for all those eligible.
In late October, the FDA went further, extending it to five- to 11-yearolds – although with lower doses than older age groups. Since then some experts, including the American Academy of Pediatrics, have pushed strongly for even younger children to be vaccinated.
However, the UK has shown significantly less speed in expanding its Covid vaccination programmes to children despite a successful rollout among adults, with almost 70% of the population having had two jabs.
The Medicines and Healthcare products Regulatory Agency (MHRA) approved the Pfizer/BioNTech vaccine in June for children aged 12-15 and the Moderna jab for 12- to 17-year-olds in August. However, a first dose was only made available to 12- to 15-yearolds from 13 September. The decision was finally made by the UK’s four chief medical officers after the Joint Committee on Vaccination and Immunisation (JCVI) advised that while the health gains from vaccinating this group were greater than the risks, “the margin of benefit is considered too small” to support it on health grounds alone.
The Guardian understands the JCVI is already discussing whether the vaccination programme should be expanded to children as young as five.
Meanwhile leaked reports suggest the NHS is already preparing to roll out the jab to this age group in the spring.
However, the MHRA has yet to announce whether, like the FDA and European Medicines Agency, it will approve the use of Covid jabs for younger children.
Covid infection levels have remained high for months in the UK, with
school-age children among the most affected. The daily case numbers are expected to hit new records as a result of the Omicron variant, which has been found to dodge – at least to some degree – the immune responses provided by vaccination or natural infection.
In the US, many experts believe the case for vaccination of children is clear cut.
“The Delta wave in the summer convinced everybody that Covid-19 can cause a lot of devastating illness in kids and adolescents,” said Dr Peter Hotez, co-director of Texas children’s hospital Center for Vaccine Development.
Hotez, who is also dean of National School of Tropical Medicine at Baylor College of Medicine, said the UK’s decision was perhaps based on “local data” that differed from the US experience.
Other US experts advocate vaccines for young children as a tool to prevent this age group from becoming a reservoir of disease, which could pass Covid-19 to high risk groups such as grandparents.
However, the JCVI has cited concerns over a very rare side-effect linked to Covid jabs among young people, myocarditis, including the potential long-term effects of the condition. Among other issues, the JCVI has also been concerned about the impact of rolling out Covid jabs to older children could have on the delivery of other school immunisation programmes.
With children far less likely than adults to become seriously ill with Covid, there was an ethical concern over the appropriateness of vaccinating children to protect others. This was particularly acute given the uncertainty about the impact the vaccination of 12to 15-year-olds would have on transmission in the face of the Delta variant.
One expert, who is no longer part of the JCVI, suggested it could be better for children to gain protection from natural infection rather than taking a possible risk with a vaccine.
Some scientists described the reluctance of the JCVI to approve jabs for older children “completely shocking”, with further concerns raised after it emerged its decision was taken despite modelling that suggested a rollout would reduce infections, hospitalisations and some deaths in this age group.
However, Russell Viner, professor of adolescent health at University College London Institute of Child Health, and a participant in the Scientific Advisory Group for Emergencies during the pandemic, suggested there were a number of reasons why the UK and US have taken different approach, including cultural differences in medicine.
“US physicians are generally much more pro-interventionist. In the UK there is a stronger recognition of the potential for harm,” he said.
Viner also noted the US has been hard hit by Covid in terms of children. “Their health system does not protect the vulnerable and deprived as ours does,” he said.
Although the UK had not handled the pandemic as well as some other countries with regard to adults, Viner added, “we have done very well in terms of children and serious Covid disease”.
One source with knowledge of JCVI matters said a key difference between the UK and the US was that in the latter, parents may have to pay for expensive care for their child if they fell ill. The US has also had lower uptake of jabs among adults, which could be driving the push to vaccinate children to try stem the pandemic, the source added.
But the question remains whether the UK and the US will eventually end up at the same destination, and to what degree Omicron has changed the equation.