COVID vaccinations for young children - a major ethical issue

The Quarantine Zone
21

I appreciate the questions in the OP. I think it’s important to ask them, even if we wind up right back where things were headed, because it’s important to think things like this through.

I know that, when I first heard about the mRNA vaccines in development, I anticipated that I would want one of the ones using more traditional technology. Once those mRNA vaccines were available, I’d become satisfied enough that I couldn’t wait to get it. I still thought I might hesitate before having my kids get it, with the limited safety data available.

More recently, I’ve looked into whether there were any trials of the vaccine for kids near me. I don’t know if I would have signed them up if there had been. It’s a different calculation for them than it is for me. That said, once the safety data is in, if it’s similar to the adult safety data for Pfizer, I will likely get my kids vaccinated, and I already know they are willing.

Interestingly, and tangentially related to the OP question, when I was looking into the Pfizer trials for kids, there was info there about the fact that, for kids who can’t legally give their own consent, the trial still required the child’s “assent.” It said they would explain at the child’s level the risks and benefits of the trial, and make sure the kid agreed, if the child was capable.

Ultimately, though, once the vaccine is approved, and having the safety data available, I think it will be ethical for parents to choose to vaccinate even over the child’s objection if the child doesn’t yet have the right to refuse, as long as the vaccine doesn’t pose a large risk to kids. Covid will be a top 10 cause of death for kids for 2020. And I think the other benefits already stated are also good points.

Chicken pox kills around 1 in 100,000 young kids. But the risk of death and severe illness rises with age. (More rapidly, I think, than with Covid.) It becomes a severe illness in adults. It makes sense to vaccinate young kids to keep it from circulating as much as possible, even though it doesn’t do young kids much harm. And, young kids will eventually get older and benefit from the practice as well.

22

There’s nothing different about this and any other health decision that parents make for their children that may be more beneficial to them as adults than as children.

There is a lot of talk about how keeping others from getting sick is an altruistic action. And it is—but not entirely. You have to look bigger picture than that. Getting the disease under control means it won’t be still lurking to then get me and mine sick in the future.

We owe it to our kids to try and get this under control (or even stop the virus) now, and doing that means keeping our kids from being able to spread the virus to others. Otherwise we’re choosing for them to have to deal with the COVID-19 when they are adults. And putting the adults who take care and f them at unnecessary risk in the mean time. (Remember, the vaccines only reduce your chance of getting the disease by a factor of 20—they’re 95% effective.)

Not to mention that, the longer the pandemic goes on, the more chances a child has of being infected, and the risk to children is not zero.

This is clearly a case where the parents have not only the right but the responsibility to make this decision for their child.

And, for those for which it is approved, at least, that decision is to vaccinate them against COVID-19.

23

But that’s only half the equation. Yes, there are good reasons to vaccinate. We don’t yet know what the risks are for vaccinating children. Two vaccines have turned out to have much higher risks for a particular demographic group than anticipated based on the trials. If I were a woman under 40, I would care very much which vaccine I was getting. And if those risks turned out to be similar in kids, I would have a dilemma if those were the only vaccines available to my kids.

I’m extremely pro-vaccination, because I understand science and risk, and that the vaccines in use for kids fall quite far on the positive side of balancing the risks.

These are new vaccines, and a new disease. We don’t know yet exactly how the risks will balance out.

24

Did they? Doesn’t the blood clotting thing have an incidence rate lower than any trial would have caught?

That said, this is definitely true, and while there’s no way to know for sure, I’d sign my kids up for a Pfizer trial if given the chance. My best assessment of the information I have is that the vaccine poses a significantly lower risk to them than Covid does.

25

We don’t know that. Children have died. We have no idea what the long term effect for them is. It’s clear, that in adults, there can be severe, debilitating and even lethal long term effects. We simply don’t have the data. If I had a child, I’d get them this vaccination as soon as I could. Just as I would get them all of their recommended vaccinations.

26

@eschrodinger I want to ensure I understand you correctly. Are you less worried about the potential threats the the swift-spreading variants pose to children than the risk that the vaccines, despite the extra precautions in pediatric trials, might harm children after approval?

27

True.

And even if not devastated, she might be mortified if her mild case caused her whole school class to stay home for the next two weeks. I might even like him/her better if he’s the kind of kid who does get mortified over that.

Meaningful consent is a matter of degree. If I spend days reading the medical literature (after having done well in my college statistics class), then, assuming no psychiatric condition impairs judgment, my consent is highly meaningful. If I consent based on verbal statements from my physician, which give percent for different options and outcomes, that might be meaningful if the quality of research is high.

If I haven’t ever read even one well-reviewed non-fiction book on medical research topic, the quality of consent is likely low. But, at least with an adult, there was some level of choice to spend my time reading relevant research, and Statistics for Dummies, or to not. But a child, who never has had a meaningful opportunity to learn statistics, or to read medical history to get an idea how often docs get it right or wrong, cannot give meaningful consent.

The legal concept of meaningful consent is different.

28

I don’t know. The information I’ve seen is that children have quickly become a higher percentage of Covid cases, though that’s partly because of adults becoming vaccinated. It’s not yet clear whether any of the variants pose a greater risk to kids. I’m saying, at this point, it’s a tough decision because the information is so limited on both sides of the equation.

I will almost certainly get my kids vaccinated when it becomes available, unless the Pfizer vaccine turns out to have more risks in kids than it did in adults. I won’t wait to see how it plays out in actual use, but I will have some degree of worry about that. And if the risk profile is very different, then I’d have to understand the risks of the vaccine vs the risks from Covid, vs potentially waiting for a different vaccine, etc.

29

Perhaps I phrased this badly. I meant, it was not anticipated, based on the trials, that anyone would have this risk. Now, it turns out that one demographic group has a much higher risk than others of a serious and potentially fatal side effect.

30

True. But I think the important thing to realize with respect to weighing risks is that a risk that’s too small to show up in the trial is very likely a smaller risk than that of Covid.

Like, the trials had tens of thousands of people in them, and 100 or so of those people died of Covid. The clotting shows up at a rate of about 1 in a million, and about 1 in 10 million died from it.

Obviously, there could be some vaccine side effect that shows up in 1 in 50,000 kids and a trial just barely misses it, and that could be very bad for risk analysis, but most of the risk factors of the vaccine are dwarfed by the risks of Covid.

31

One of the things that’s really salient in these discussions is the perception of control.

We often say that “you’re at greater risk driving to the place where you get your vaccination than you are from the vaccination itself.”

Which may be statistically true, in aggregate, but …

People feel like they have a great deal of control behind the wheel of their automobile – maybe an unrealistic view of how much control they have.

But take a pill, go unconscious for a surgery, get into the body of a plane that seats hundreds of people, or roll up your sleeve for an injection ?

Not much control there.

And for many of us, taking measures to dramatically reduce our individual risk of contracting COVID is much more akin to piloting our automobiles: we feel much more in control, much better able to protect ourselves.

And that’s aside from what I referenced earlier: that averages across large sample sizes don’t tell us all that much about what’s going to happen to us.

My brother spent a few years dealing blackjack at a casino. He could tell you the odds of the next card being, say, a 10. But that was just odds. Wise people didn’t bet the rent money on it.

I have long said that large sample size trials give you odds at best. But just like the deck of cards at the blackjack table, the utility of knowing those odds is really quite minimal.

Which is also where that sense of control really comes into play.

32

An ethical issue for me is that in–person education is superior to on-line, especially for younger children. See Learning loss due to school closures during the COVID-19 pandemicL

Even though U.S. schools are re-opening, kids are often sent home if one child tests positive. By far the most common harm of childhood COVID is reduced learning.

Ideally, teachers would accept that their job, like that of a dentist, entails above average risk of catching an infectious disease. But since lots of them won’t , it is in the interest of the kids that they be immunized as soon as is feasible. Yet another year of learning loss is unacceptable.

P.S. What about the idea that even one life lost, to a childhood vaccine reaction, is unacceptable? I would balance that not just against COVID risk, but also against the higher homicide victimization rate of less educated Americans.

33

These numbers are very far off from the latest known. And it isn’t yet known how much higher the risk is when the demographic group is narrowed to those most at risk.

(See this post: AstraZeneca approval in the US - #393 by eschrodinger)

I’m not getting into that argument directly here though. The point is that it is important to look at the risks on both sides and not just assume that any vaccination is worth any risk.

Covid is also a risk. As I said, it will be a top 10 cause of death for children in 2020. Both risks require information to properly assess. And, again as I said, unless there turns out to be much more risk for kids than for adults, I anticipate getting my kids vaccinated when it becomes available for them.

34

No. That doesn’t work. The teachers are not the only ones at risk. The children can infect other children. Then every adult that those children are in contact with are the ones being put at risk.

It’s the same as before, when we were talking about teachers getting vaccinated, and why that alone was not enough to eliminate the risk at schools. Even if the teachers were 100% immune, all of the safety protocols (including shutdowns) would still need to be put in place to protect the parents and other adults the children may come in contact with.

The point where you might not need to shut down is when all said adults are vaccinated. Though you’d still be worried about the children themselves.

35

We don’t need any fancy new ethics here. Of course we hope that everyone who gets the jab gets some individual protection, but mandatory vaccinations have always had a significant public health component.

As for minors, the ethic is: parents and doctors decide what’s medically necessary for a child, including public health concerns, and administer it with indifference toward the child’s opinion (as it always has been, or should be).

If there’s any new set of ethics that we need, fast, it’s a set of ethics that slaps people in the face and says “like it or not, you’re part of a society, and as such, sometimes you pull up your big-boy pants and do things that aren’t solely for your own benefit, so put on your mask and get your jab, you big selfish baby. And no, you cannot dodge this by hopping onto Google to ‘do your own research’.”

That’s the ethic we need.

36

This, I think, is an excellent example of the sort of ethical question that vaccinating young children against COVID raises. I am not familiar with the program - do you have further information to share? Things like age of vaccination for boys, standard consent procedures, rates of uptake?

j

37

The consent procedure for a child under 16 is described in the OP. Here’s a more detailed article on Gillick competence:

I am absolutely fine with the concept of Gillick competence. But it seems to me to be a difficult concept to apply in practice, if the child is being asked to make a decision which is essentially altruistic.

(I note that many posts have argued that, in a broader view, this isn’t an altruistic decision. Good points all).

j

38

… which sounds very like Gillick competence. Do we know if this is something peculiar to this study? (And maybe therefore is a reflection of the particular ethical issues I have been trying to highlight?) Or is it a more general requirement for clinical studies in children in the US? Or simply expected for the medical treatment of children in the US?

j

39

Midst the existing thread about just dropping links and running away, I’m hesitant, but …

Re: minors, medical procedures or trials, and consent vs. assent:

40

Very germane. From the link:

Assent must be obtained from children unless:

*… Your child might benefit from the treatment or procedure being studied in the trial…

This also addresses the matter of altruism and the consent of children. If they may benefit, then their assent is not an absolute requirement. Conversely, the inference is that they must assent if they do not stand to benefit.

j