The pandemic has thrown up many challenges for everyone. Among them is the medical approval to vaccinate children. AMY BUTLER* seeks answers to questions parents are asking from fellow Gospel, Society and Culture member NALINI PATHER*.
This week marks the next landmark in a long phase of COVID control measures – the roll out of vaccines to children aged between five and eleven. When I became eligible for a vaccine in the middle of 2021, I was confident enough in the science and the ethics of the vaccine to roll up my sleeve. I am committed in principle to the rationale behind the vaccines as a layer of protection for the whole community. But now there are new issues to navigate as I make decision on behalf of my younger children.
For example, over the last two years we’ve heard a lot about risk versus benefit when weighing up the wisdom of undergoing medical interventions. When decided to have my vaccination, the risk was largely to myself. However, as a parent, my natural inclination is to make decisions that mitigate risk to my children. There is some level of risk associated with vaccination, but there is also risk that children can become seriously ill with COVID. What are the principles and evidence which should guide me as I decide if, and when, to book a vaccination for my children?
I posed a number of my questions to medical science, UNSW professor, and fellow GS&C member NALINI PATHER*.
Over the course of the pandemic, we’ve been reassured that the risk of serious disease caused by COVID to children is quite minimal. If this is the case, why is it now a priority to vaccinate children?
It’s important to note first that the Omicron variant is highly transmittable, as can be seen in the significant increase in the number of people testing positive since November 2021. This increase includes children, who in the main have mild symptoms that can be managed at home.
Vaccines continue to be our best strategy to end the pandemic. Adults have taken the vaccines as protection from serious disease and hospitalisation and to prevent spread to those we love. It is for the same reason that we need to protect children. Being vaccinated and boosted is especially important with the rise in cases due to the Omicron variant. Children are a largely unvaccinated population and are more vulnerable than before to infection. More contagious strains like Omicron can spread quickly and infect more children and through them also infect other vulnerable groups such as grandparents and younger children.
We don’t know the risk that the virus poses to children. Our historical experience with viruses provides context that for some children, there is a risk that COVID-19 may lead to serious neurocognitive impairment, visual and hearing impairment, diabetes, or other chronic conditions. It is for this reason that childhood vaccine programs are an important part of public health guidelines in children and largely subscribed to in our population, as shown in the 2017 national survey of Australian parents’ attitudes to vaccination.
At this point in time the Therapeutic Goods Association’s approval for vaccines for five- to 11-year-olds is provisional. What does the word ‘provisional’ imply? Should it be cause for alarm?
The COVID-19 vaccines have provisional approval – this is the same approval process that was followed when the vaccines were recommended for adults and for the 12–16-year age group last year. Provisional approval means the vaccines can be legally administered in Australia because the need for early access outweighs the risks (ATAGI recommendations are here). The relevant authorities will continue to collect data on vaccine safety and efficacy of the vaccine and, if needed, adjust the recommendations and/or guidelines for use. The manufacturers will also apply for full approval for use in this age group as soon as possible.
Health authorities seem eager for as many kids as possible to be vaccinated before the beginning of the school year. Could you explain how increased vaccination rates could correlate to less disruption to our kids’ education?
If schools have a large unvaccinated population, the risk of infection to large groups of people in the school community is high. It is likely in this scenario, as was seen in the UK, that there will be an increase in cases of disease with frequent closure of schools for decontamination and cleaning. This can be disruptive for children and for families. Subsequent transmission in the community is also likely with increased spread in schools. On the other hand, if there is a significant number of people vaccinated, the risk of disease transmission decreases proportionally. The primary reason though for vaccinating this age group of people is to reduce the number of children who get seriously ill or are impacted by long term complications.
Even with vaccinations, it will continue to be important for schools to use a combination of precautions, including regular handwashing and improved air quality and ventilation.
Do you have any pointers on how parents can make sure they are making an informed choice about vaccines for their children? Are there genuine risks associated with the vaccine that we need to take into consideration?
All the factors we considered when deciding on vaccinations for ourselves need to be considered in the decision for our children. This means weighing the risks and benefits of taking the vaccine considering each of our personal context and child’s wellbeing. Some things to consider include existing underlying health concerns, disruption from school attendance and social engagement, and the amount of circulating virus in the local community. As parents, we assess these risks/benefits regularly when making decisions, for example, when we subscribe to childhood vaccination programs for diseases such as measles, chickenpox, and rubella. At present, due to the high number of cases and the amount of virus circulating in the community, the risk of contracting COVID-19 is high, including for children. The risk of exposure to new variants as they emerge, is also high for children.
While it seems like we are breaking new ground in Australia with COVID vaccines being available to children this week, it is important to note that these vaccines have been administered to many children in the 5-11 age group in other countries. For example, in the USA, 4.8 million children in this age group have had one jab and 1.4 million have had the second jab. In comparison, there are only 2.3 million children in the 5-11-year age group in Australia. From the clinical trials on children, short-term side effects are present for some children, more so after the second dose of the vaccine. The data also suggests that the 5–11-year-olds had short-term side effects less often than older adolescents and adults. The most common side effects are pain at the injection site, headaches, tiredness, and fever. Side effects In the Australian 12–16-year group who have been vaccinated, resolved within 2-3 days.
I believe the vaccines are relatively safe but in a sinful, fallen world, there is always risk and there will be some people who will be affected negatively by the vaccine. Since the development of the first vaccines in 1796, our knowledge and use of vaccines has grown extensively. The COVID-19 vaccines have been administered in large numbers across the world and appear to be relatively low risk. At present, 59.3% of the world’s population has received at least one dose of a COVID vaccine This equates to 9.46 billion doses. A rare side effect seen especially among males aged 16-24 is myocarditis and pericarditis; this is an inflammation of the heart muscle and heart ‘sac’, respectively.
If my children are not double vaxxed before school starts, should I keep them home?
This is a good and a very relevant question because of the delays in vaccination appointments at the start of the rollout to this age group. Again, decisions regarding these matters depend on your family’s context, your child’s health and wellbeing and your assessment of benefit versus risk to harm. One study found that a single dose of the COVID vaccine reduced the risk of developing multi-organ inflammation in teenagers by 91%.
With the current rate of transmission and number of cases in NSW, it seems unlikely that closing schools will reduce transmission. This seems to be supported further by the continued access to sporting events and other social gatherings in NSW. There are good reasons to not delay the start of the school year including concerns about social development and mental health, as well as the increased obesity witnessed during previous lockdown periods. For some, there is an increased risk of abuse.
We know from the Australian COVID-19 Children’s Surveillance Report published on 4 January 2022 that children are not the main source of the current high transmission of the Omicron variant. The main source up to the end of 2021 was the 20-29 age group. While it is too early for Australian data, a US study suggests that the Omicron variant does not present with serious illness in most children in the 5-11 year group compared to the Delta variant. What this means is that while many more children will get infected with the Omicron virus, fewer will be admitted to hospital with serious illness. Both the number infected and admitted to hospital will also decrease with higher rates of vaccination in this age group. The data for children under 5s, however, is unclear. Some places are reporting higher incidence of more serious illness in the 1–4-year-old group.
As noted above, once children go back to school, it will still be important to implement covid-safe measures such as staying at home when ill and improving air quality.
As a Christian, a medical educator and a parent, please share your wisdom about how our faith can inform the decisions we make about vaccines?
I am not sure that I have more wisdom to share about decisions regarding vaccinations beyond the extensive coverage published on the Covid-designated pages of the Gospel, Society and Culture’s website (direct link here). Vaccination is a very personal decision and each of us should consider our own context while respecting the decisions others make. Romans 14: 3-4 reminds us that: “The one who eats everything must not treat with contempt the one who does not, and the one who does not eat everything must not judge the one who does, for God has accepted them. Who are you to judge someone else’s servant? To their own master, servants stand or fall. And they will stand, for the Lord is able to make them stand.’”
I can offer the three reminders below:
- Vaccination is a way of loving each other. While we don’t know a lot about the long-term impact of the virus, and the long-term risk/benefit of the vaccine, we do know thus far that vaccination prevents the spread of the disease, decreases the risk of new variants and decreases the severity of the disease if contracted.
- Living with COVID-19 means learning constantly and living with a degree of discomfort. As new information becomes known, we need to evaluate this information and change our opinions and decisions accordingly. Authorities will make decisions with which we don’t always agree. We can be thankful for the comfort of living in a country that has good health care with excellent medical professionals.
- God is sovereign in all things. Isaiah 45.18 says: But Israel is saved by the Lord with everlasting salvation; you shall not be put to shame or confounded to all eternity or thus says the Lord, who created the heavens (he is God!), who formed the earth and made it (he established it; he did not create it empty, he formed it to be inhabited!): “I am the Lord, and there is no other…”
*NALINI PATHER, is a senior academic in medical sciences at the University of NSW. She holds a doctoral degree in cell biology and additional postgraduate qualifications in clinical anatomy, and university learning and teaching. Nalini serves on the Gospel, Society and Culture committee. She is married to Glen and they serve in ministry at Rose Bay Presbyterian Church.
*AMY BUTLER lives in rural NSW. She home schools her children and has written about her experience on this website. Other blogs include people’s need for a ‘soul vaccination’. Amy is a member of the Gospel, Culture and Society committee of the Presbyterian Church in NSW.