A new analysis of the risks and benefits of offering two doses of COVID-19 vaccination to all 12-17 year olds in England shows that the benefits clearly outweigh the risks, given the current high case rates. In the UK currently a single dose of vaccine is recommended for all 12-17 year olds.
The research, which is in press with the Journal of the Royal Society of Medicine, estimates hospital and ICU admissions, deaths and cases of long COVID averted over a 16-week period by vaccinating all 12-17 year olds in England. The analysis includes high and low case rate scenarios.
The current case rate among adolescents is high (as at 15 September 2021 680/100,000 population/week in 10-19 year olds in England). Government advisers have warned that significant increases in infections in children are likely following the return to school.
The analysis shows that at a higher future case incidence of 1,000/100,000 population/week, vaccination could avert 4,430 hospital admissions and 36 deaths over a 16-week period. At the low incidence of 50/100,000 population/week, vaccination could avert 70 hospital admissions and 2 deaths over a 16-week period.
For long COVID, vaccination would avert 56,000, 16,000, or 8,000 cases in 12-17 year olds, assuming the proportion of teenagers with COVID-19 going on to develop long COVID are 14%, 4%, and 2% respectively.
The benefit of vaccination in terms of hospitalisations in adolescents outweighs risks unless case rates are sustainably very low (below 30/100,000 teenagers/week). Case rates in 12-17 year olds have not been as low as 30/100,000 population/week in England during 2021 and rates are likely to be 20 times higher during the current school term in the absence of vaccination.
Lead author, Dr Deepti Gurdasani, of Queen Mary University of London, said: “This analysis shows that, on clinical risks alone, vaccination is warranted for 12-17 year olds in England. While we wait to understand the long-term effects of COVID-19 on children, the precautionary principle advocates for protecting all children from exposure to this virus and vaccination is a crucial part of that protection.”
She added: “While children with pre-existing illnesses may be at greater individual risk, 60% of hospitalisations in under 18s in England have been amongst children who do not have such conditions, suggesting considerable benefits for all children in reducing severe illness through vaccination.”
The researchers highlight the additional protections needed in schools, alongside vaccination. Another member of the research group, Professor Christina Pagel, of University College London, said: “Immunisations take time and even with this protection, outcomes are better when risk of exposure is lower. England has failed to put in place adequately robust preventative measures in schools thus far, and has removed ones that were in place, including no mask mandates, minimal contact tracing within schools and no requirement for under 18s to isolate if a household member tests positive. It is vital that the UK government invests in mitigations for schools, including assessment and provision of adequate supplemental ventilation.”
Professor Martin McKee, of the London School of Hygiene & Tropical Medicine, added: “The approach taken by the JCVI is completely out of line with that of advisors in many other countries so it really should explain why it thinks they are wrong.” The US, Canada, Australia, New Zealand, Israel and much of Europe and Southeast Asia are currently offering two doses of vaccines to all 12-17 year olds. The US has fully vaccinated over 10 million under 18s and France has already full vaccinated more than 52% of its 12-17 year olds.
Vaccinating adolescents against SARS-CoV-2 in England: a risk-benefit analysis by Deepti Gurdasani, Samir Bhatt, Anthony Costello, Spiros Denaxas, Seth Flaxman, Trisha Greenhalgh, Stephen Griffin, Zoë Hyde, Aris Katzourakis, Martin McKee, Susan Michie, Oliver Ratmann, Stephen Reicher, Gabriel Scally, Christopher Tomlinson, Christian Yates, Hisham Ziauddeen, and Christina Pagel has been accepted for publication by the Journal of the Royal Society of Medicine.
The final edited version of the paper is in press with JRSM.
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