The Covid-19 vaccine can be given to children first to protect the elderly

The World Health Organization is discussing the best way to allocate and prioritize when the Covid-19 vaccine arrives.

It focuses on the imminent crisis. To quickly reduce mortality when the dose of vaccine available is very limited, it is best to vaccinate older and vulnerable people, even if the vaccine protection is relatively inadequate. Expected to be an option. That’s because older people are very likely to die of the disease.

But as we produce more vaccines, the goal is to return to a normal state where they can mix freely without increasing risk. If the vaccine is not very effective for the elderly, more people, including children, need to be vaccinated. One possible strategy is to prioritize your child.

Why are children first?

The risks and benefits of a particular Covid-19 vaccination strategy depend on information we do not yet have. For example, it is not yet known whether the vaccine is effective or safe for certain populations such as young people and the elderly.

However, it is worth thinking in advance about the ethics of various strategies. In a pandemic, time can save lives.

The Covid-19 vaccine may be less effective in the elderly because the immune system naturally declines with age and is unable to provoke an efficient and defensive immune response after vaccination.

This is seen with the flu vaccine. Influenza-like illness is reduced by about one-third and deaths are reduced by about half after age 65.

If similar results are obtained with the Covid-19 vaccine, it may be necessary to vaccinate young people, who generally have a strong immune response, to prevent transmission to the community in order to return to normal. .. This protects older and vulnerable people by reducing the chances of the virus reaching it.

Yes, this is controversial. Children cannot autonomously agree to be vaccinated. Adults who make these decisions on their behalf are also likely to benefit from a reduced risk of getting the virus in their homes, making the decisions a potential conflict of interest.

When is this okay?

We sometimes make altruistic decisions on behalf of our children. For example, a child can be a bone marrow donor who saves his brother’s life, despite the risks.

You can also apply the idea that you can limit your freedom if you risk harming others. For example, if a child is infected with Covid-19, it should be quarantined and quarantined like an adult.

However, vaccination differs from both cases in one important way. With vaccination, it is unlikely that there will be a specific person that the child will help or that they will help on their own. Instead, the potential benefits are collective for more people.

Vaccination may be an easier option if the child lives with a sibling who is in an underlying condition that makes him particularly vulnerable to Covid-19, or if he lives with his grandparents.

Three factors can help us make a decision

When considering whether a child should be vaccinated before an adult, we can ask:

1. How serious is the threat to public health?

To date, more than one million people have died in Covid-19. It also in terms of overwhelming health care risk and the risk of excessive non-Covid-19 deaths economically, socially, educationally and as a result (eg, due to suicide or delayed access to health care). There is also additional collateral damage. Covid-19 affects everyone in society, including children.

2. Is there an alternative?

If vaccinations work well for vulnerable people, or if there are other strategies to achieve the same effect, such as general adult vaccinations, then they should be used instead.

3. Is the response proportional to the threat?

Vaccination of the vulnerable and the general adult reduces the severity of the crisis, even if it is not effective enough. At that stage, it is necessary to assess whether the remaining issues require the child to be vaccinated.

Assuming we meet these conditions, we argue that prioritizing vaccination of children is the right strategy, at least voluntarily.

How about compulsory vaccination?

Compulsory vaccination may be justified if voluntary strategies do not achieve herd immunity, or if it is not achieved fast enough to protect vulnerable people.

It may be necessary to consider how deadly and infectious the virus is in order to determine if compulsory vaccination is worth it.

For example, smallpox mortality was up to 30% (although transmission requires fairly long contact). It was eradicated by 1979 by vaccinations required in many countries. In Covid-19, 0.1-0.35 percent of infections are fatal.

By definition, compulsory vaccination involves some form of coercion. This includes withholding financial benefits and access to early childhood education (in Australia, no jabs, no wages, no jabs, no play). Fines (Italy) to prevent children from enrolling in school (specific rules vary by US and state). France even has legal provisions for imprisonment for parents who refuse certain vaccines.

For groups at high personal risk with Covid-19, such as health care workers, the elderly, men, and other people in good health, forced immunization (of some sort) with incentives such as increased freedom. May be justified. Even the payment is not enough. For these groups, vaccines are beneficial to both sides. It protects both others and those who have been vaccinated.

And mandatory vaccination for children?

The situation is more tricky for children. Unless there is an underlying health condition, or a rare but severe inflammatory condition after infection, children are less likely to become infected with severe Covid-19 or die from it.

Therefore, the risk of the vaccine itself (still unknown) is greater.

Children, on the other hand, benefit from relationships with grandparents and other freedoms provided by a pandemic-free society.

Mandatory vaccination may be justified for a child if the following criteria are met:

• Vaccines are very safe for children (still unknown in the long run) and have proven to be safer than the effects of the disease

• Children are a major spreader of the infection (at least not for Covid-19 in their teens)

• There are other non-Covid benefits for children, such as a return to normal social and educational life (school) and access to normal medical services not otherwise available.

• Measures are rational and proportional, for example, by limiting childcare benefits (rather than sending parents to jail, for example).

In particular, we do not yet meet these criteria for forced immunization of children against Covid-19 because we do not know how effective and safe vaccine candidates are in different populations.

Julian Savlesk He is a visiting professor of biomedical ethics at the Murdoch Children’s Research Institute, a prominent visiting professor at the University of Melbourne, and chair of Kamihiro’s Practical Ethics. Oxford University.. Margie Danchin Associate Professor at the University of Melbourne Murdoch Children’s Laboratory..

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