Archiving notice

Since their introduction in early 2020, COVID-19 vaccines have saved at least 1.4 million lives in Europe alone. Worldwide, more than 12 billion doses of the vaccines have been administered as of March 2024, and between 14 and 20 million lives have been saved. In light of this success and the generally high vaccination uptake in most countries around the world, we have decided to discontinue updating of this wiki. The existing material may be of interest for archival reasons and will remain accessible, but not further updates will be undertaken. If you have any questions about the wiki or the Handbook, please contact the authors.

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_{Note: text in green identifies latest update. (See last updated time stamp at top of page.)}

COVID-19 Vaccines and Children

• COVID-19 Vaccines and Children
  • Impact of COVID-19 on children
  • Are the COVID-19 vaccines safe for children?
  • Informing parents and children about COVID-19 vaccines
  • Attitudes towards vaccinating children

Impact of COVID-19 on children

Children can and do become infected with COVID-19. In the US in October 2021, up to 25% of weekly reported cases were among children. A study looking at transmission rates in primary school children in Belgium found that children tested positive for COVID-19 at similar rates to adults (Meuris et al., 2021).

However, for most children and young people COVID-19 is usually a milder illness that rarely leads to complications–-children also tend to be symptomatic for shorter period of time than adults (Meuris et al., 2021). For a very few the symptoms may last for longer than the usual 2 to 3 weeks (see our section below on long-term consequences of COVID-19) (Bhopal & Absoud, 2021).

Monitoring case rates among children is nonetheless important. While the percentage of children who suffer severe or long-term outcomes from COVID is small, if case rates are high, this still translates into large numbers of children being affected.

For example, in England, case rates for children rose in September 2021 following the opening of schools. The age group that comprised likely parents of schoolchildren also saw an uptick in case rates at the same time. This matched a trend observed in Scotland slightly earlier (corresponding with earlier school start times in that country).

_{Source: Prof Christina Pagel & UK Independent SAGE–-read her full explanatory thread on Twitter!}

Using numbers from the figure above, if almost 158,000 children test positive during the September 2021 school term and 2% of these go on to develop long COVID, about 3,000 children will be suffering from long COVID (see section below on long-term consequences of COVID-19).

Vaccination could have a protective effect on children’s case rates–-the same patterns above were not seen in the back-to-school period for countries where children were vaccinated prior to returning to school.

_{Source: Prof Christina Pagel & UK Independent SAGE}

High COVID-19 incidence rates provide a compelling reason for children to be vaccination: a recent (November 2021) risk-benefit analysis in England found that vaccinating all 12-17 year olds could avert 4,430 hospitalisations and 36 deaths in a 16-week period if case rates stand at 1% of children each week; only if case rates are very low (below 0.03% of children each week) do benefits stop exceeding risks–-although the researchers noted that vaccination benefits for children in terms of preventing death and/or long COVID always exceed the risks (Gurdasani et al., 2021).

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Are the COVID-19 vaccines safe for children?

Before a vaccine is considered safe for children it must go through rigorous testing in clinical trials. Positive test results then lead to authorization of a vaccine by regulatory authorities like the Food and Drug Administration (FDA), the Medicines and Healthcare products Regulatory Agency (MHRA), or the European Medicines Agency (EMA).

• The Pfizer-BioNTech COVID-19 vaccine is authorized by the Food and Drug Administration (FDA) in the US for children 12 years and older and was also recommended for everyone 12 years and older by the Advisory Committee on Immunization Practices (CDC’s ACIP). The CDC updated its clinical guidance to allow COVID-19 vaccines to be administered at the same time as other routine vaccines.
• The European Medicines Agency (EMA) authorized the Pfizer-BioNTech and the Moderna COVID-19 vaccine for children 12 years and older. As a result, these vaccines are also recommended by several national technical advisory groups in Europe (for example: STIKO Germany). In fact, COVID-19 vaccines are now available for children 12 years and oldern in the US, in Europe (e.g., Denmark, Germany, Switzerland), in the Middle East (e.g., Israel), in Asia-Pacific (e.g. Indonesia, New Zealand) and Africa (e.g., South Africa). An overview is provided by Reuters.
• However, the technical advisory group in the UK, the Joint Committee on Vaccination and Immunisation (JCVI), does not recommend COVID-19 vaccines for all children below the age of 16 because "the margin of benefit was considered too small". The UK is still planning to roll out COVID-19 vaccines for 12 year olds based on recommendations from the UK’s chief medical officers.

It is important to note that the absence of a recommendation by JCVI is not based on general safety concerns. In fact, the Medicines and Healthcare products Regulatory Agency (MHRA) in the UK approved the use of Pfizer/BioNTech COVID-19 vaccine in 12- to 15-year-olds based on the quality, effectiveness and safety data of the vaccine in this age group on 4th June 2021. Over 2,000 children aged 12-15 years were studied as part of the randomised, placebo-controlled clinical trials. There were no cases of COVID-19 from 7 days after the second dose in the vaccinated group, compared with 16 cases in the placebo group. In addition, data on neutralising antibodies showed the vaccine working at the same level as seen in adults aged 16-25 years. These are extremely positive results.

Latest update: Since October 2021, the US Food and Drug Administration advisers recommend authorizing shots for children aged 5 to 11. That recommendation is a first step for authorizing COVID-19 vaccines for younger children in the US. Likewise, the European Medicines Agency (EMA) also starts evaluating use of COVID-19 vaccine in children aged 5 to 11.

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Informing parents and children about COVID-19 vaccines

It is one thing to know whether a vaccine is recommended and safe for children. But it is also important to communicate with children about vaccination. There are specific tips in the COVID-19 handbook on how to communicate about vaccination in general. The following video by UNICEF provides insights on how we need to change our way of communication for different audiences – from children to experts.

Attitudes towards vaccinating children

A survey by the UK Office for National Statistics prior to the vaccine roll-out for children aged 12-15 found that 86% of parents would likely accept a COVID-19 vaccine for their children.

However, a small minority are still against vaccinating their children. In some of these cases, parents and children may hold opposing views regarding whether the child should be vaccinated. As with any other medical treatment, if a child under 16 disagrees with their parent about getting a vaccine, the authorities need to decide whether the child is competent to make the decision for themselves. This is known as "Gillick competence": assessing whether a child is capable of understanding the benefits and risks of treatment and explain their views on it (Majeed et al., 2021).

This is why it is important for parents, teachers, and healthcare professionals working with children to be able to communicate about vaccines in child-friendly terms. Leaflets about vaccination are currently addressed to parents, but we need to talk about the risks and benefits of vaccination to support parents and children in making an informed decision.

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_{Page contributors: Philipp Schmid, Dawn Holford}

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_{Note: text in green identifies latest update. (See last updated time stamp at top of page.)}

_{This project has received funding from the European Union’s Horizon 2020 research and innovation programme under grant agreement No 964728 (JITSUVAX).}

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