The world got lucky: The toll of COVID-19 on young people and children has been much lower than it has been for adults. But in part because of that lower toll, some parents are on the fence about getting their school-age children and teens vaccinated. As reports of side effects from vaccination emerge, the risks from vaccines can seem greater than those posed by the coronavirus. However, it still makes sense — indeed, it is crucial — to vaccinate young people against COVID-19. This remains true even when we consider the worst possible outcomes from vaccination.
For example, an advisory committee for the Centers for Disease Control and Prevention met on June 23 to review data showing a likely association between a rare condition called myocarditis, or inflammation of the heart muscle, and COVID-19 vaccination with mRNA vaccines among teenagers and young adults in the US. They found that more than 1,200 cases have been reported, and that they are mostly mild. The C.D.C. continues to recommend all people age 12 and older get vaccinated. (Children younger than 12 may be able to get vaccinated as early as this fall.)
That’s the right call. To understand why, it’s important to realise the choice is not “vaccinate or do nothing.” It’s “vaccinate or eventually contract the coronavirus,” and the risks that come with it. Most experts now believe that the virus is destined to be endemic, meaning it will circulate among humans indefinitely.
The best analysis comes by way of a simple thought experiment: What would happen if every child were eventually naturally infected with the coronavirus compared with what would happen if every child were to be vaccinated instead? By gaming out those two scenarios we can help parents and young people make the right choice. The correct lens to encapsulate these risks, we believe, is hospitalisations. In the demographic with the highest rates of vaccine-associated myocarditis, boys ages 12 to 17, the rate of myocarditis in the week following vaccination appears to be 14 to 155 times the background rate of their unvaccinated peers. The obvious question might seem to be, what are the outcomes of that? But the better question is, what are the outcomes for all adverse reactions in young people from vaccines combined?
So far, among the 6.14 million Americans 17 and under who have been fully vaccinated, there have been 653 possibly related hospitalisations lasting a day or longer, which could include myocarditis and other conditions, lasting one day or more. If that rate holds, it means that if all 73 million Americans ages 17 and under are eventually vaccinated, there will be around 7,700 hospitalisations.
Most of these hospitalisations would be like the ones seen so far: brief and uneventful. Over 74 percent of vaccine-associated hospitalisations among this age group that we have data for lasted three days or less. Just 3.5 percent lasted longer than a week.
According to the American Academy of Paediatrics, 0.1 percent to 1.9 percent of all coronavirus infections in young people require hospitalisation. To be fair to those who believe, as early data has suggested, that around 45 percent of those hospitalisations were actually unlikely to be caused by COVID-19, and to account for the large number of undocumented infections that have already occurred, we could imagine the real hospitalization rate could be even lower, say as low as 0.02 percent, or one in 5,000 paediatric coronavirus infections.
That means that if the coronavirus were eventually to infect all 73 million children in the United States, we would conservatively expect COVID-19 to be responsible for around 14,600 hospitalisations. Unlike the vaccine-related hospitalisations, adolescent hospitalisations for COVID-19 can be punishing, with a quarter lasting six days or more. A recent C.D.C. study found that COVID-related hospitalisations in adolescents can be long and complicated, with nearly one-third requiring patients to enter the intensive care unit. So far, 326 Americans age 17 and younger have died of COVID-19.
The longer-term impact of COVID-19 on young people is unknown. But some children with COVID-19 develop a complication known as Multi-system Inflammatory Syndrome in Children. Based on available prevalence data, eventually letting 73 million people age 17 and younger acquire the coronavirus could lead to over 27,000 additional hospitalisations from the syndrome. Notably, heart complications of the syndrome are both more common overall and far more long-lasting than what’s seen with vaccine-related myocarditis among teenagers.
Some doctors and parents may wonder, why not let teenage boys, who seem to be at the higher risk for myocarditis, wait a few years to be vaccinated, especially in areas with low case counts? Or why not vaccinate them with one dose?
That argument assumes that young people won’t get infected in the near term. With more variants emerging, that’s not certain. Data also shows that both doses are needed for the most protection and to help prevent spread. Another reason not to wait is that the older a person is, the higher his risk is for severe disease when he does ultimately contract COVID-19.
Getting young people, including children, vaccinated is also critical to reaching high levels of COVID protection in the United States, and it will help prevent the spread of the coronavirus among other vulnerable adults and the emergence of more variants. Rather than play roulette with variants over the next several years, we can safely end this crisis by accepting an increased yet still exceedingly small risk of side effects that have not been seen to cause medium-term problems, let alone long-term ones.
Bad things inevitably happen to a small number of people after any vaccination, a few caused by the vaccines, but most not. The risk of vaccination must be compared against the risk of the disease that a vaccine prevents, not against zero risk. The choice is between getting vaccinated against COVID-19 and eventually getting it. Given the current data, the conclusion is clear: The virus is more dangerous.
Faust and May are physicians and Gounder is an epidemiologist
The New York Times