Coronavirus: To vaccinate or not vaccinate children?

HEALTH AFFAIRS: When it comes to COVID-19, parents and physicians have questions

A TEENAGER receives a vaccination against COVID-19 in Tel Aviv, earlier this year. (photo credit: RONEN ZVULUN/REUTERS)
A TEENAGER receives a vaccination against COVID-19 in Tel Aviv, earlier this year.
(photo credit: RONEN ZVULUN/REUTERS)
 Israel is likely to be the first country to grapple with the ethics of whether vaccinating children to achieve herd immunity is worth the risk.
The rapid administration of more than 10 million doses of the Pfizer COVID-19 vaccine has brought down infection and allowed Israel to become one of the first countries in the world to reopen its economy almost in full.
As early as next month, when Pfizer is expected to have emergency use approval from the US Food and Drug Administration for inoculating 12- to 15-year-olds, Israeli parents will face a dilemma about whether they should vaccinate their children. It seems that while Israeli adults may have rushed to get themselves the shot and “back to life” – a phrase coined by the Health Ministry – when it comes to their children they are much more reluctant.
It is unlikely that vaccinating children against coronavirus will be mandated by the government, just as it is not required to vaccinate kids against measles or diphtheria – although the vast majority of Israeli parents do it.
Vaccine mandates exist to protect the children who are being vaccinated and the public. The more people who are inoculated, the more likely a community is to develop herd immunity and stop disease from spreading.
Such mandates exist in America, France, Germany and Australia, for example. But in Israel, according to the head of the Israel Pediatric Association, Prof. Zachi Grossman, Israel has achieved “better results from convincing parents that vaccination is the right and chosen way.”
When it comes to the coronavirus vaccine, studies are starting to show that the situation may look differently.
A SURVEY released to The Jerusalem Post on Tuesday night predicted a relatively broad reluctance by parents to give the vaccine to children, even among parents who have been vaccinated themselves.
“People have chosen to take risks that they are not willing to take on their children,” said Prof. Michal Grinstein-Weiss, director of the Social Policy Institute at Washington University in St. Louis.
She published a first survey on the subject in March as part of a joint effort with the Interdisciplinary Center Herzliya. This newest updated survey – “Israeli Children and COVID-19 Vaccine Uptake: Key Considerations and Findings” – is meant to come out sometime this month.
The survey found that less than half (41%) of the adults who got vaccinated said they will vaccinate their children.
Moreover, the gaps between adult- versus child-vaccination rates were significant in certain groups. For example, while secular Jews exhibit the highest rate of vaccination among adults, their intention to vaccinate their children is lower than that of religious or haredi Jews.
Specifically, 90% of secular people got the jab, but only 40% said they would vaccinate their kids. Among religious Jews, 84% were inoculated and 52% said they would vaccinate their children. With haredim, 75% were vaccinated and 54% said they would also vaccinate their children.
The greatest vaccine hesitancy remains within the Arab sector, where at the time of the survey only around 77% of adults had gotten the shot. The survey showed that a strikingly low 27% of Arab parents answered that they would vaccinate their children.
There were some surprises from the survey, Grinstein-Weiss told the Post. For example, while in general “we observe a relatively obvious association between educational attainment and vaccination action among adults,” the association on children’s vaccination intention is much weaker.
“The association is not statistically significant,” she said. “That is, even parents who are more educated would not necessarily get their children vaccinated.”
Some 38% of parents without a bachelor’s degree said they would inoculate their children versus 42% of those who have this degree.
Why are parents hesitant? According to the report, they are worried that the vaccine has not been studied for long enough.
Some 79% (a 6% increase from Grinstein-Weiss’s March survey) said fear of long-term effects is their No. 1 reason for not getting their children vaccinated. Some 42% said they do not want to put chemicals in their children’s bodies.
Grossman said that there will likely not be any long-term effects from administering the vaccine.
“With vaccines, we generally know that what we don’t see in the first four to six weeks, we don’t see even if we wait five years,” he said.
But Grinstein-Weiss said that whether there will or will not be long-term effects could currently be of no consequence when it comes to encouraging parents. After all, if it is necessary to provide much more data on the long-term effects of the vaccines, “unfortunately we will not have it in our hands in the near future.” She said if this is what is stopping parents, then “there won’t be anything that could change their minds.”
Other reasons for vaccine hesitancy, the survey found: lack of trust in pharmaceutical companies (34%) and lack of trust in government (29%).
Finally, the survey showed that the younger the kids, the more worried the parents are about inoculation. Only 36% of parents said they would consider vaccinating their children under the age of 11, but some 60% said they would consider vaccinating those 12-16.
“It is clear to all of us that the country and its stakeholders are striving for a state of vaccination as much as possible from the population and the focus right now is on our children,” one parent posted this week on social media. “Scientific: there is no justification for this. Mentally and socially? Certainly not.
“The damages outweigh the benefits, if any,” the poster continued. “Dear parents: Exercise discretion. Pass this on to people who are willing to listen and hear!”
Parent and activist Ilana Rachel Daniel of Jerusalem told the Post that she and many of her colleagues and friends feel like the woman who wrote this Facebook post.
“It is a no-brainer,” she said. “Children run no statistical risk of harm from the coronavirus. We are talking about an experimental technology, and there is no logical reason for parents to sign their children up to be study participants.”
She said that “a moral society does not experiment on healthy children,” and that all data point to the fact that most children experience mild if not asymptomatic cases of the virus, if contracted. “You don’t give medication to someone it is not indicated for.”
Daniel added that many try to turn the conversation around vaccinating youth against COVID-19 into a battle between the pro- and anti-vaccination camps. But she said she believes this is “dumbing it down.”
“When it comes to children, I think people are going to be more cautious and understand that the stakes are higher,” she said.
In contrast, Yael from Tel Mond – who asked that her last name not be used in this article – told the Post that if and when the vaccine becomes available for kids, “I would take my kids to get vaccinated – absolutely.”
Yael is the mother of five children. She said that “I am very ‘pro’ doing your part in society, and I believe that once the vaccines have met accepted safety standards, it is the correct thing to do.”
She accused those who are against vaccination of being “psychologically driven” and said deciding not to vaccinate when doctors say it is OK is not based on science or facts.
“Go talk to your pediatrician,” she advised those who are hesitant. “If your pediatrician tells you that it is safe and appropriate to get your child vaccinated, get your child vaccinated.”
THE SITUATION became even more complicated this week, when in the course of a 72-hour period, two groups of physicians published position papers on the subject in open letters – one group against vaccinating children and the other in favor.
The first letter, which came out Sunday, was signed by 93 doctors in a joint protest against giving coronavirus vaccines to children – at least for now.
“We believe that even a handful of children should not be endangered through mass vaccination against a disease that is not dangerous to them,” the doctors wrote in a letter addressed to the Health Ministry, fellow doctors and the general public. “Furthermore, it cannot be ruled out that the vaccine will have long-term adverse effects that have not yet been discovered, including on growth, the reproductive system or fertility.”
They further said, “Do not rush to vaccinate children as long as the full picture is not clear.... Coronavirus does not endanger children, and the first rule in medicine is ‘first do not harm.’
“The full picture is expected to be obtained in many months, and possibly years,” they continued. “Warnings about severe or even life-threatening side effects are added months and years after drug approval, due to the fact that severe but rare toxins emerge, naturally, only over time.”
Among the physicians who signed the letter were the director of the emergency department at Laniado Medical Center in Netanya and the head of the intensive care unit at Kaplan Medical Center in Rehovot. There were also doctors from Ma’aynei Hayeshua Medical Center in Bnei Brak, among other places, who saw masses of haredi COVID-19 patients during the course of the pandemic.
On Tuesday, another position paper surfaced, this one from the Israel Pediatric Association and the Israeli Society for Pediatric Infectious Diseases, which came out in support of vaccination for children between the ages of 12 and 15.
In their letter, they explained that the Pfizer vaccine has been found to be 100% effective in preventing disease among youth, according to the most recent trial, and that it has an “excellent safety profile both in clinical studies and in large-scale distribution in Israel.”
They acknowledged that some people have argued that children do not need the vaccine, because they are less likely to get seriously sick from it. However, they stressed that pediatric morbidity could result in hospitalization. One out of seven children who were hospitalized with the coronavirus in Israel were in moderate or serious condition, and seven of them died, the paper said.
Furthermore, even those children who experience relatively mild cases of the virus can later develop pediatric inflammatory multisystem syndrome temporally associated with COVID-19 (PIMS-TS), which is similar to Kawasaki disease or toxic shock syndrome. They can also develop long COVID, which is marked by persistent symptoms even after recovery, such as shortness of breath and fatigue.
“These numbers are not describing a healthy situation,” Grossman said. “Children have more mild cases than adults, and we are happy about that. But there is quite a significant level of morbidity among children, and we need to consider this.”
According to research cited by the associations, international studies indicate that one out of every seven or eight children who was diagnosed with COVID-19 suffered from persistent symptoms. In other words, if in Israel some 300,000 children were diagnosed with the virus, more than 40,000 are likely to still be suffering to some degree.
Infection among children also leads to the closure of schools, which, according to the associations, has caused “significant psychological damage to children and adolescents.”
GROSSMAN SAID that looking at the physicians who signed the anti-vaccination letter, they are all people who are against vaccination in general. He said while there have been rumors and false information shared on the Internet about vaccines, most – if not all of them – are scientifically false.
“We are satisfied with the safety [of the Pfizer vaccine] and the level of antibodies,” Grossman told the Post. “When you weigh the risk versus the benefits, we are convinced it is safe.”
Grinstein-Weiss also said that she believes parents should vaccinate their 12- to 15-year-olds.
“These are the children hit most by COVID in terms of missing school,” she said. “We can see they have three times more anxiety now than before the pandemic. They are suffering a lot. To get them back to routine, we need to vaccinate them.”
There are also those who argue that children need to be vaccinated against coronavirus for Israel to achieve what is known as herd immunity, which most medical professionals agree is around 70% to 80% of the population being vaccinated or recovered.
“Right now, we have more than five million vaccinated citizens and around 800,000 recovered out of nine million Israelis,” Grossman said. “And do not forget there are about a million Israelis above the age of 16 who did not go to get vaccinated yet. If you want to reach the six million or seven million number, you need to aim to vaccinate children.”
There are about 800,000 children in Israel between the ages of 12 and 15, he said, and if the country manages to vaccinate even 500,000 of them, “this [would be] a big step forward.”
He added that vaccination also affects the formation of mutations. As long as many people are not vaccinated, there is more likelihood that variants will develop. The opposite is also true. The more people who are vaccinated, the smaller the space in which the mutations can develop.
Grossman said that he believes that if pediatricians and the media do “good work explaining and convincing” despite what surveys show, parents will probably move forward with vaccination.
In September, before Pfizer vaccines landed in Israel and became available to the masses, a survey conducted by Assuta Medical Centers in conjunction with Midgam found that at least 25% of Israelis would be unwilling to get the jab. Today, more than 90% of people over the age of 30 are vaccinated with at least one shot.
As such, when the option of getting their child vaccinated is truly on the table, it is likely that the reluctant attitudes presented by parents right now will become more flexible.•