COVID vaccinations for young children - a major ethical issue

The Quarantine Zone
1

Continuing the discussion from Coronavirus COVID-19 (2019-nCoV) Thread - 2021 Breaking News:

Quoting from @eschrodinger’s post in that thread*:

Huge vaccine news. Pfizer has applied to the FDA for authorization for its vaccine to be given to 12 to 15 year olds – it was already authorized for 16 and up. That is expected to be approved next week.

Now they will be requesting to make it available for 2 to 11 year olds in September.

My bold.

I split this topic off because it is significant in its own right. I’m going to base this OP around my local rules simply because that’s what I’m familiar with - please feel free to add in your own local rules and your interpretation of their implications.

I read @eschrodinger’s post a couple of days ago and thought, Yeah, that makes sense, that addresses the issue of unvaccinated children forming an ongoing reservoir of infection that can breed new variants which could spill back into the wider population.

It took a couple of days of percolation to realize that this is only one part of the argument.

If I get vaccinated, this is partly for my own good - I could die from COVID or be severely harmed by it. And partly I’m doing it for the greater good - we inch towards herd immunity and control of the disease. For these reasons I accept the risks and consent to vaccination.

A child may not be able to give consent. And in the case of a child, the personal benefits of vaccination may be relatively small - compared, say, to the greater good that we seek to achieve.

From the UK NHS website:

Children under the age of 16 can consent to their own treatment if they’re believed to have enough intelligence, competence and understanding to fully appreciate what’s involved in their treatment. This is known as being Gillick competent.

Otherwise, someone with parental responsibility can consent for them.

(My bold. “Parental responsibility” may mean parent, guardian or Court of Protection)

My reading of this is that, in the case of consent to COVID vaccination, a child would have to be able to understand that whilst the risks associated with COVID might, for them, be relatively slight, there is a greater good to be sought; and that accepting the risks of vaccination (however small they may be) would be a significantly altruistic act, largely to benefit others.

Wow. Well, I think I’m supposed to express an opinion here, in order to start things off. My opinion is this: we really, really need some ethical guidelines on this fast. I don’t know how old a child would have to be in order to understand enough to give consent; but below that age I assume that proof of a positive personal risk-benefit in that age group has to be obtained before vaccination (on the say-so of someone with parental responsibility) can be considered ethical.

Thoughts?

j

* - there seems to be some issue with embedded items in split-off topic, so I quoted from @eschrodinger’s post as I couldn’t embed it.

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I was under the impression that parents can decide what is done with their children, but the kids might be able to insist on whatever they wanted being done if they seemed old enough to understand the issues. But I could be wrong.

Frankly, the pandemic would probably stop quite quickly if children were vaccinated. Schools and kindergartens are superspreaders. I’ve seen that in Europe in at least two countries: the figures shot up after the schools were reopened.

3

Most immunizations happen before a child is able to give meaningful consent. How is the Covid jab any different to the MMR, polio or Hep vaccines?

4

I presume the argument is that there is a positive risk-benefit for the child. See my last para in the OP.

j

5

Exactly this.

Vaccinating children is not a major ethical issue. If people in general weren’t so absolutely crazy about the incredibly minor risks of vaccinations, no one would give it a second thought.

Driving my kid to the doctor’s office where he’s going to get the vaccination is a bigger risk than what’s in the needle.

6

I’d chime in on the side of disagreeing with this. Parents are perfectly capable of making a decision like this. “The vaccine is good for my kid, good for the rest of society, and does carry a slight risk, seems like something I can get behind.”

7

COVID killed probably somewhere around 300-400 children under 18 in the past year in the US. (CDC has 282 as of 5/6, but that is known to be incomplete as their statistics lag behind; the American Academy of Pediatrics has 303 as of 4/29, but that doesn’t include all states, and some states use different age breakdowns). Thousands more were hospitalized, and we don’t yet know what the long-term effects might be for them.

Even at that level, COVID will likely rank among the top 10 causes of death in children/adolescents. (For 2016, fire or burns with 340 deaths was #9 on the list, e.g.)

There’s also the issue that kids are harmed by pandemics even if they don’t get the disease itself. For example, when schools are closed, or closed to in-person instruction, because of COVID cases among the teachers and staff, the kids suffer too (disrupted education, etc.), so it is in the child’s interest to have things return to normal as quickly as possible.

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The received wisdom is that COVID is generally (yeah, I know) a trivial disease in children.

Previously unseen rare but serious adverse events (thus far with AZ and maybe J&J) have been seen in younger persons. We don’t know if there is an adult lower age limit for this effect; and we don’t know if it’s just this (or these 2) vaccines.

I’m all for vaccination, but I’d be uncomfortable (at best) if we were vaccinating children who could not consent, primarily for the benefit of others.

j

9

I understand the OP.

This stuff is hard, primarily because it’s incredibly difficult to put anything approaching solid numbers to it, particularly on an individual level.

So how much personal benefit is my (hypothetical) 9 year-old getting from the COVID vaccine, and how much ‘altruism’ is involved in him/her taking the risk, however small or large it is in aggregate, and/but – impossible to know – however small/large it is in my child’s specific case.

Which … depending on where you put the pin on that first ‘individual vs. collective’ benefit continuum … could give rise to ethical questions.

That may be somewhat particular, or more particular, to COVID than to any, many, or most of the other vaccines currently recommended for children. The pin on the same continuum may be in a very different place for other vaccines and the diseases they seek to protect us against.

10

This is a good argument - thanks for posting. Also I had not seen the stats you quoted - valuable info. Of course, the risks of vaccination are yet to be properly addressed in that age group.

j

11

Yes - this is very much my position. Normally we vaccinate children to protect them. With COVID, do we risk vaccinating children to protect others? What’s the ethical basis when it comes to consent for this?

I think we have to be very aware of what we are doing here.

j

12

We already to this when we vaccinate against German Measles. It’s not at all dangerous, but if a pregnant woman gets it at the wrong point in gestation, it causes horrible birth defects (blind and deaf babies). So girls are vaccinated to prevent their potential children from it: boys, just to promote herd immunity.

We give boys the HPV vaccine, as well. HPV can cause throat cancer in some boys, but it’s very very rare. It’s much more about protecting future sex partners.

13

What about the ethics of chicken pox parties?

There is a benefit to the child to either get the disease or the vaccine as a child. Covid, like some other diseases, can be much milder in children and much more severe as adults, so having them enter adulthood with some form of immunity seems like the morally responsible thing to do.

Additionally fighting the disease to help eliminate it via herd immunity is also a benefit of the child and they world they will inherit.

So I’m hard pressed to see anything moral about letting a child go unvaccinated. They are hurting themselves, their future and their world by not getting vaccinated.

The morality issue that the OP expresses seems to be more of consent, but it is immoral to accept consent from one that is deemed unable to do so, and children thus lack that ability (in regards to this subject). Thus the child’s consent is not relevant, and the parent/guardian must make that for the child. That is the moral thing to do.

14

I’m a parent and I make choices for my kids all the time primarily for the benefit of others. I tell them they need to use their inside voices when we’re eating at a restaurant (well, I did back when that was a thing) because other people want to have conversations too. I don’t let them pick the flowers in parks because other people want to look at them. I sometimes pick the movie we’re going to watch because I don’t want to watch Blues Clues for the eleventh time in a row.

That’s a slightly snarky answer, but basically: we (children included) live in a society, and just as we have a duty to not monopolize or destroy public spaces and resources, we have a duty to try not to spread deadly diseases to others, even if those diseases aren’t likely to be deadly to us personally.

Also: spending time with living grandparents is beneficial to children. Being able to have sleepovers at each others houses without masks is beneficial to children. The risks of vaccination are extremely small. Far smaller than risks that we take everyday in life and don’t think twice about. This is all a tempest in a teacup.

15

Another thing I just thought of: even though kids are very unlikely to die from Covid, it still sucks to get sick. If I could vaccinate my kid against the common cold I’d do that too!

16

By definition, with rare and explicitly spelled out exceptions, children can not give consent (at least AFAIK in America).

What’s the difference between a legal guardian giving consent for a minor to getting a Tetanus shot, something I think we’d all agree is uncontroversial, and getting the Covid vaccine?

17

When my kids were minors I made choices for them all the time, some of the meant risk. I had both my kids learn to downhill ski - it isn’t a sport that you do without risk. There was swimming and canoes at my parents, which was on a lake. I even sometimes fed them things that weren’t good for them…I let them eat crappy candy and develop a taste for squishy white bread. They learned to ride bikes, and eventually they learned to drive cars. My son spent hours on a skateboard.

That isn’t even for the benefit of others. Its just how I chose to raise my kids.

You don’t raise them without risk. And you should raise them to do things that benefit others.

18

If you feel that parents who are given authority to make decisions on behalf of a child should not have the freedom to make unselfish community-based decisions on behalf of the child, doesn’t this cause a problem with most vaccinations? So long as overall vaccination rates remain high, a parent could decline vaccination for their child while maintaining protection from the disease through the herd immunity granted by most other children being vaccinated.

Having said that - I think most of us certainly would not be comfortable with a parent making an altruistic decision on behalf of their child to the level of (say) donating a kidney. So clearly it’s not a black and white issue.

19

No. Not only no, but Hell NO!

Many vaccinations start before the child is able to talk, let alone consent:

The parents give consent not the child.

The idea that that young child needs to give consent is weird, where did you get that from?

There are many benefits for the child including not dying.

Yes, the highest death rate is among seniors, but that does not mean kids are immune. They are not.

Nor are they immune for infecting their grandparents, and if little Bobby found out HE, personally, killed Grandma he would be devastated.

20

I agree with this. But I’m struggling to figure out where and exactly why I would draw the line. Clearly it’s not black and white. This, for example, would be far over the line: suppose an adult sincerely holds extremely altruistic ethical views, and would be willing to donate their rare tissue type to save the life of a stranger, even if that involved the certainty of some degree of permanent long term physical disability for themselves. I think everyone would agree that they should not be allowed to make this level of self-sacrificing decision on behalf of their child.