This study shows a 60% acceptance rate for HPV vaccines in Ontario which is administered in school during grade 7 typically. The study period includes the shift from vaccinating just girls to girls and boys and the % shift was under 1% indicating parents are vaccinating both genders at about the same rate.
My younger daughter would have received hers this year, but these have been deferred this year. For my older daughter we received a consent form where we indicated if we wanted to have it administered at school, we would have their GP vaccinate her, or we were declining to vaccinate.
And that isn’t just the kids. This is having an outsized impact on women as well. Single mothers in particular, but in the majority of two parent families, mothers are taking on supervising the majority of schooling. Plus women are the majority of teachers - and the majority of health care professionals - both hit hard by Covid. Its impacted women’s employment, their economic security and their mental health. If vaccinating children with the same confidence in safety that we are vaccinating the adult children can reduce the effect this is having on women, that’s something as well.
We allow parents to circumcise infant boys, obviously without their consent. Even advocates of that procedure admit that it’s not medically necessary. It is a much more painful and invasive procedure than receiving a vaccine, and leaves a permanent scar on the genitals. If that’s allowed, why not a Covid-19 vaccine?
We allow parents to circumcise infant boys, obviously without their consent. Even advocates of that procedure admit that it’s not medically necessary. It is a much more painful and invasive procedure than receiving a vaccine, and leaves a permanent scar on the genitals. If that’s allowed, why not a Covid-19 vaccine?
I’m not getting into a circumcision debate. I’ll just say that parents making that decision for their child is not without controversy. Certainly some people think it is unethical.
That said, I don’t think anyone is saying vaccination shouldn’t be allowed. Just that a risk/benefit analysis specific to the age group should be undertaken.
Personally, I think all of the benefits mentioned in this thread can be taken into account.
Interestingly, I had a conversation with my son this morning about this subject. I knew my kids (both 8) had said they wanted the vaccine when it became available. I also explained about the vaccine trial for kids going on now, and he quickly said, no, he wouldn’t want to do that. Primarily because he might have to get more shots. (Like if he got the placebo.) I was a bit surprised, because he’s pretty brave usually, but not always very altruistic – yet.
Everything I’ve read about these vaccines indicate the risk is very small. Something on the order of 1 in 1,000,000 or less. If the risk of death by Covid is greater than that, let’s say 1 in 500,000 for the sake of argument, then the benefits outweigh the risks. Even from the perspective of the individual.
See post 33. The overall excess rate of venous thromboembolism with the AZ vaccine was 25 per million but that’s the overall figure for all demographic groups combined. Women are at higher risk than men and, at least for female subjects, the younger you are the greater the risk. So for young women the rate is significantly higher than the overall figure. The study in question had a lower age cut-off of 18, so we don’t know if this trend continues for ages less than 18.
Anaphylaxis after the mRNA vaccines – perhaps the most dangerous risk for those vaccines – happens at a rate of 2.5 to 11 per million doses. Around 70% of those have occurred within 15 minutes of the shot, and most in people with a history of severe allergies, so there’s a good way to mitigate the risk.
Just as a for instance, though, Covid has been associated with a very serious – sometimes deadly – immune system overreaction in children. What if the vaccine provoked the same reaction at a greater rate than Covid does? Otherwise, it worked just like it does in adults. Don’t we need to know more about the other risks, including from Covid, and need to quantify the risks, to sort out what’s the right call?
Re the HPV vaccine, since the introduction of the vaccine in 2008, the UK has experienced an 88% reduction in pre-cancer cervical cancer rates. That is bloody brilliant.
I’ve also been wondering about the ethics of giving the covid vaccine to young kids. Not because I’m worried about their ability to consent – we routinely allow patents to consent on behalf of their children – but because we need a high degree of confidence that the risk of the vaccine is very low for young kids, given the lower risk of the disease to them.
But that’s why no one even studied it in kids until we had a lot of field evidence from vaccinating adults. And I’m pretty sure J&J and AZ won’t be conducting studies in small children. Because the field evidence from adults suggests those vaccines might be risky for the young. Whereas the data on the RNA vaccines is looking excellent. And we’ll be amassing data on people 12-20 even as the trials for younger kids are underway. I’m very hopeful that the high efficacy and low risks of those vaccines extend to the young, and that clinical trials will show they are acceptable for kids.
It seems like you’re sometimes conflating the ethics around enrolling children in trials with the ethics of parents consenting on the child’s behalf in some hypothetical future where the vaccine is either approved or authorized. For the latter, I can say with certainty that my son is at an age where he will decline, usually accompanied by a fit, any shot of any type for any purpose. But if the side effects are similar as for an adult, I’ll happily consent on his behalf, and help hold him down if necessary. If the risks are significantly different, I’d have to know what they are to reevaluate.
For trials, that’s tougher. I don’t feel like I’m well-enough educated on the procedures and current rules around medical trials on children to really opine here. But I’m not sure we need any new ethics there: it’s absolutely plausible that a COVID-19 vaccine will benefit the children in a way to outweigh the personal risks to them.
I don’t think I’m conflating them. I think I’m bringing up both circumstances.
And for myself, I agree with what you’ve said here. I don’t think “new” ethics are needed, but the existing ethics need to be applied.
People need to think about it, and not just rush into making decisions with unknown or unweighed risks because they are, in general, pro-vaccination. For the mRNA vaccines, if the risks are like they are for adults, then it’s a pretty easy decision, unless, perhaps, you have a kid who has severe allergies.
And as I said before, I think, I’m not talking about not letting parents consent. I’m talking about making sure that there’s a discussion, consideration of the risk, of the possibility that a fully pro-vaccination parent might need to stop and consider what the best choice is for their kid.
Can you explain how it’s any different for this vaccine than for any other vaccine? Is it just because they are newer?
My son got the HPV vaccine even though it’s really, really unlikely that he personally benefits from it. All of my kids got the chicken pox vaccine even though that disease isn’t that big of a deal for kids. Someone mentioned German measles, which is very mild for kids but terrible for pregnant women. Kids get vaccinated all the time for diseases that are mild for them but can help the community.
Well, not “newness” per se, but yes, it is not yet fully approved, we don’t yet know the side effects for kids, until they are I wider use – whether risks could emerge like the ones seen in the AZ and J&J vaccines in young adults. (As far as I know, AZ had been conducting a trial in children, which was paused and then scrapped when those complications came to light.) Because Covid tends to be relatively mild in kids, a risk like the blood clot issue can change the calculus if it emerges. I think it made sense for to AZ cancel their trials because at least one of the apparently less risky mRNA vaccines (Pfizer) was also testing in kids. So kids would/will probably wind up with a safer alternative.
I think the OP’s question is more along the lines of, what if the AZ vaccine were the only option for kids? (Or what if the available vaccines had similar risks, or the chance of similar risks.) How big of a risk should parents consent to on behalf of their kids, where the main benefit is more indirect or altruistic? How do we weigh up the ethics of that?
Assuming Pfizer and Moderna end up getting approved for kids, the ethics are, you get them vaccinated. I already mentioned other vaccines that don’t really benefit kids directly (especially the HPV one for boys). But, for COVID, kids do end up dying, and also end up with all kinds of other short and long term effect, plus the effect on the kids if their parents or grandparents die from it, or they can’t go to school, etc.
This is a part of what I wanted to explore; the other part does not appear to be (much of?) an issue in the US (to my surprise) - informed consent given by children, and the ability to judge whether they are capable of truly informed consent when/if they are being asked to be vaccinated for primarily altruistic reasons. (See the link re Gillick competence in post 37).
A young person under 16 may have the capacity to consent – or refuse – such treatment, depending on their maturity and ability to understand what is involved. In deciding whether a child has capacity to consent, it must be determined that they can understand the nature, purpose and possible consequences of investigations or treatments proposed, as well as the consequences of not having treatment.
It seems to me that this determination is particularly challenging in the case of a primarily altruistic request (though I accept that good posts have questioned just how altruisic COVID vaccination might be in practice).
There have been some very useful comparisons drawn. HPV vaccination is an excellent example. My slight concern with it is that, in the matter of what we might call health balance sheets, I find it an awful lot easier to be comfortable with asking a young person to be altruistic towards another young person, rather than towards someone who is old or very old. There’s a big difference in QALYs there. Likewise German measles.
I have to say, I fully approve of the use of Gillick competence in the treatment of a child. In a case where vaccination was purely altruistic I would be deeply uncomfortable going against a competent child’s wishes. I accept that in this case vaccination may not be purely altruistic. But I still see a lot of grey area here.
Is there really still an absolute rule in medical practice re the consenting of minors in the US? - that is to say, under age 16 it is entirely the parent’s choice? If so I find that both surprising and regrettable.
I don’t think this follows at all. How can it be ethical to give a child a vaccine they don’t consent to to prevent another child from potentially being born blind and deaf 25 years from now, but not to give them a COVID vaccine that could kill someone? Like, I’m allowed to override their consent if the potential death reaches some threshold of likelihood of occurrence and years lost for others?
I can see an argument of “it’s new, and so may have unknown risks, so parents should err on the side of caution and first do no harm”. But I really can’t see “My child’s right to bodily autonomy overides their obligation to old people, but not young people”.
As for what you quoted, it comes down to pragmatism - count the QALYs. As I said, it’s “in the matter of what we might call health balance sheets” - I’m not adopting an ethical position. Is it easier to ask a child for altruism in order to prevent a full lifetime of disability (the potential consequence of German measles); or to prolong an eighty five year old’s life by a couple of years (COVID)? When it comes to those two questions, I don’t think we’re comparing like with like.
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ETA - I should add, I’m grossly oversimplifying in this example, of course.
I didn’t ask my kids anything when it was time to get their vaccines, not even my son when he got his HPV vaccine. They got what the doctor recommended.
If I had small kids (my youngest is 20) and Pfizer was approved for small kids, they would get vaccinated. They don’t get a vote.