Are COVID vaccines for children under 12 in their best interest  or just everyone else's?
This advertisement has not loaded yet, but your article continues below. Children are unlikely to be hospitalized with COVID and deaths are rare, but we may need them to help the rest of us reach herd immunity. Advertisement Story continues below This advertisement has not loaded yet, but your article continues below. Article content COVID vaccines could be cleared for the under 12s  11-year-olds down to six-month-old babies  in late fall, and its already posing a dilemma over whether its right to vaccinate young children not as much for their own good, but for the sake of everyone else. We apologize, but this video has failed to load. tap here to see other videos from our team. Back to video Pfizer-BioNTech plans to ask American regulators to expand emergency authorization of its vaccine to children ages five to 11 as early as September, and younger children soon thereafter, a senior Pfizer executive told a virtual symposium on COVID-19 and kids last week. Pending data demonstrating safety and immunogenicity, meaning the ability of the shots to provoke an immune response in younger children, Pfizer expects to follow similar timelines for a submission to Health Canada, Pfizer Canada spokeswoman Christina Antoniou told the National Post Monday. In May, Canada became the first nation in the world to authorize Pfizers shots for 12- to 15-year-olds. Moderna is also trialling its formula in children under 12. Advertisement Story continues below This advertisement has not loaded yet, but your article continues below. Article content If we werent able to achieve herd immunity  without a mandate for children, its something we should definitely consider Anthony Skelton, Western University Children are much less likely to be hospitalized with COVID and deaths are more rare still. But bad outcomes can happen and COVID in children hasnt been portrayed the way it should be, Dr. Rochelle Walensky, director of the U.S. Centers for Disease Control and Prevention told the symposium. Young, healthy children are not supposed to die and comparing the proportion of deaths in children to adult deaths is absolutely the wrong benchmark, Walensky said. Still, the COVID story in kids is more nuanced. Now, if were contemplating rolling out this vaccine to a population which is, were all grateful to say, less likely to get severe disease themselves, how does that change the messaging, the conversation, pediatrician and author Dr. Perri Klass said in an interview. Advertisement Story continues below This advertisement has not loaded yet, but your article continues below. Article content Philosopher Anthony Skelton believes there are several reasons children should be vaccinated. If the jabs prove safe and effective in younger children, thats a less risky option than leaving them open to an infection, said Skelton, an associate professor of philosophy at Western University. What experts say about vaccine etiquette Researchers are still learning about long COVID in children. Reactions to Pfizers vaccines in older children appear pretty small and manageable, he added. And children are part of the herd. He and others worry Canada wont reach effective herd immunity with just the over 12s alone. As of April, the 0-11 age group accounted for 12.5 per cent of Canadas population (4,783,652 children), according to Statistics Canada. Advertisement Story continues below This advertisement has not loaded yet, but your article continues below. Article content Certainly, I think if it is a very low cost, very safe, very effective way to prevent the spread of COVID-19, then I dont see why we wouldnt vaccinate children purely for that reason, said Skelton, who, together with Dr. Lisa Forsberg of Oxford University, has argued for mandating the vaccination of children against COVID-19. If it came to pass that we werent able to achieve herd immunity without some kind of mandate, and in particular a mandate for children, its something we should definitely consider, Skelton said. Its not forcing people to be vaccinated; its not forcibly injecting them or anything like that, of course. But University of Oxford professor of medical ethics Dominic Wilkinson believes a strong case could be made for holding out on vaccinating younger kids. Even if the vaccine is highly effective in children, it can only eliminate an already tiny risk, Wilkinson and Jonathan Pugh wrote in The Conversation. Advertisement Story continues below This advertisement has not loaded yet, but your article continues below. Article content Photo by Getty Images There are two ethical questions when it comes to vaccination, Wilkinson said in an interview. For children, at this point in time, I think the answer to the first question is uncertain; for younger children its more uncertain, simply as a function of the fact that there has been very little experience in them. About 4,500 children are participating in the Pfizer trials, while Moderna plans to enrol 7,000. In Canada, just over 271,000 COVID infections have been reported in children under 19. Of those, about 1,400 children have been hospitalized and 13 have died, including most recently a girl under 10 from the Winnipeg health region. When COVID does infect children, most have mild or no symptoms. With the exception of a sometimes life-threatening condition known as multisystem inflammatory syndrome, a hyper-immune reaction to having had COVID that can cause coronary aneurysms, children seem to be mostly spared COVIDs worst, though researchers are still struggling to fully explain why. Advertisement Story continues below This advertisement has not loaded yet, but your article continues below. Dominic Wilkinson, Oxford university Pfizer tested a range of doses to find the sweet spot, the minimum dose required to provoke an immune response. Kids do have a stronger immune response, so its super important that we have the right dosing and we figure out the right schedule before we go ahead and do it, said Dr. Fatima Kakkar, an infectious diseases paediatrician at CHU Sainte-Justine hospital in Montreal. Pfizer has settled on a three-microgram dose per shot, for children ages six months to five, and 10-microgram doses for five- to 11-year-olds. Each adult dose has 30 micrograms. If vaccines are recommended for the youngest, the risk-benefit calculus will include whether the shots reduce infections, hospitalizations and deaths in children, versus the risk of potential adverse events. The mRNA vaccines from Pfizer and Moderna now appear to be associated with a rare but higher risk of myocarditis, inflammation of the heart muscle, a risk only detected after millions of doses were given. The risk appears higher in teenage boys and young adult males, and usually within days after the second dose. The risk is small  for every one million second doses of vaccine, there have been about 67 cases reported in teenage boys ages 12 to 17 in the U.S.  and most reported cases so far have been mild and treatable. Still, it doesnt fill parents with a lot of joy, said University of Ottawa epidemiologist Raywat Deonandan. Advertisement Story continues below This advertisement has not loaded yet, but your article continues below. Article content Photo by Getty Images Where it becomes more complex is whether the benefit side of the equation in young children includes going back to school, and how do you quantitate that, Dr. David Kessler, chief science advisor of the White House COVID response team said at last weeks symposium hosted by Johns Hopkins University and the University of Washington. Does it include the reduction in transmission from a public health perspective for a country, or countries? Before any decision is taken for the under 12s, were going to have to look carefully at the data, Kessler said, adding that if vaccines are approved for the under 12s this fall, we wont yet have the typical six months of safety data. Adults may have a duty of easy rescue, meaning the ethical duty to do something that comes at little risk or cost to themselves, but offers significant benefits to others, Wilkinson said. Advertisement Story continues below This advertisement has not loaded yet, but your article continues below. Article content If you see someone who is drowning in a pond and you can save him without putting yourself at personal risk, then you have a duty to do so, he said. You might not have a strong ethical duty to put yourself at great risk if its a fast-flowing stream and somebody is being washed away and you jumping in might cause you to die as well. However, the duty of easy rescue argument doesnt yet apply to children, he said, because we just cant be sure yet whether this is a situation where the person is sort of paddling into shallow water, and at no risk, or whether our children would be in deeper water and at more significant risk. The pandemic has also exposed enormous inequalities within and between societies, including access to vaccines, and Wilkinson said surplus shots should be redirected to people in poorer countries at a much higher risk of dying, before rich countries start vaccinating their youngest. Advertisement Story continues below This advertisement has not loaded yet, but your article continues below. Article content If we get sufficient population immunity wrapped around the kids, then we can get away with having not to vaccinate them Raywat Deonandan, University of Ottawa Its unlikely an under-12 vaccine will be available before schools open in Canada in September, which makes control in other age groups and high vaccination rates for all eligible Canadians doubly important, experts said, as well as getting ventilation right in schools, better contact tracing and other measures to keep outbreaks out of classes. I think there will be a lot of uneasiness amongst a lot of parents, so long as their children remain unvaccinated, said Deonandan, the parent of a 14-month-old. Hes not comfortable making the argument that the best reason to vaccine children is for everybody else. However, the epidemiology suggests that, ideally, you get the kids vaccinated. That makes everyones life easier. Advertisement Story continues below This advertisement has not loaded yet, but your article continues below. Article content But you dont really need to if were willing to do the other things. If we get sufficient population immunity wrapped around the kids, then we can get away with having not to vaccinate them, I think. Its hard to say. Hes also worried that the first dose uptake among adults appears to be plateauing at around 70 per cent. Photo by Getty Images Realistically, if we want to reach herd immunity in the short term its likely that were going to have to vaccinate kids, said University of Toronto infectious diseases epidemiologist and modeller Ashleigh Tuite. The Delta variants reproduction number is in the range of six to eight  each infected person goes on to infect six to eight others. Because the vaccines arent perfect at preventing transmission, youre talking about vaccinating all of the eligible population age 12 and older, which we know were not going to hit, Tuite said. Advertisement Story continues below This advertisement has not loaded yet, but your article continues below. Article content Families are already struggling with what to do with unvaccinated children, Kakkar said. Can we socialize with other families? Klass, a professor of paediatrics and journalism at New York University, believes its reasonable to ask children to do something to help us all, including them, get back the world that we want them to live in and grow up in. I think we need to give children credit: They know whats going on. They worry. Theyre anxious. Theyre thinking about what theyre seeing, she said. This is not about Dig a moat around your house, make that safe and stay inside. Weve been through that stage, said Klass, author of A Good Time to Be Born: How Science and Public Health Gave Children a Future. This is about, how can we make our family, our community, our town, our country, our world safe so that it can be the place that we want children to have the chance to grow up in. But we also have to look at it from the child advocacy perspective, said Dr. Ari Bitnun, a physician at SickKids in Toronto. Its not a straightforward question, he said. Its us adults that are largely deciding for them, so we have a responsibility to make the right decision. Its like any intervention for a child.  Share this article in your social network        Advertisement Story continues below This advertisement has not loaded yet, but your article continues below. NP Posted Sign up to receive the daily top stories from the National Post, a division of Postmedia Network Inc. Email Address There was an error, please provide a valid email address. Sign Up By clicking on the sign up button you consent to receive the above newsletter from Postmedia Network Inc. You may unsubscribe any time by clicking on the unsubscribe link at the bottom of our emails. Postmedia Network Inc. | 365 Bloor Street East, Toronto, Ontario, M4W 3L4 | 416-383-2300 Thanks for signing up! A welcome email is on its way. If you don't see it, please check your junk folder. The next issue of NP Posted will soon be in your inbox. We encountered an issue signing you up. 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