Thursday, March 17, 2022

Should I Vaccinate My Child Against Covid?

Yesterday, Florida followed Norway by not recommending the Covid vaccine for children. The CDC recommends them.

What does the data say? As public health scientists, we must be honest both with what we know and what we do not know.

The emergency use authorization for the Pfizer-BioNTech mRNA vaccine for children was based on two randomized clinical trials for ages 5-11 and 12-15, respectively, with a total of 4,528 subjects. In both trials, there was a reduction in mild Covid infections during the two months following the second dose, with the vaccine efficacy in the 68% and 98% range for the younger children and somewhere between 75% and 100% for the 12-15-year-olds (95% confidence intervals).

What these numbers mean is that if the true value is, e.g., 90%, and if 100 children would have been infected without vaccination, then 90 of them will avoid the infection if vaccinated, while 10 children will still get infected despite being vaccinated.

A vaccine that only prevents mild disease is of little use, so what about serious disease, hospitalizations and deaths? There were zero such events among those who received the vaccine. There were also zero such events among those who received a placebo.

Hence, from the randomized trials we do not know if the Covid vaccines prevent hospitalizations and death among children. Neither do they tell us whether the protection against mild infection lasts longer than two months, or whether the vaccine reduces transmission.

With limited information from the randomized trials, we must turn to observational studies and we now have one. In New York State, 23% of children ages 5-11 and 62% of children ages 12-17 had been fully vaccinated by the end of January 2022.

These 1.2 million vaccinated children were studied from November 29 to January 30, comparing them to the unvaccinated children in the State. Here is what we learned from that study, with all risk estimates based on 95% confidence intervals.

The New York study confirms the results from the randomized trials. The vaccine reduces short-term infection risk. During the first two weeks after the second dose vaccine efficacy against infection is in the 62%-68% range for 5–11-year-olds and in the 71%-81% range for 12–17-year-old children.

The protection against infection wanes rapidly. In the fifth week after vaccination, the vaccine efficacy against infection is in the 8%-16% range for 5-11-year-old children and in the 48%-63% range for the older ones. In the seventh week after vaccination, vaccine efficacy dropped further, to the 18%-65% range for the 12-17-year-olds.

This is consistent with the rapid waning in protection that we have seen among adults, although the decline seems more rapid for children.

For the 5-11-year-olds, vaccine efficacy is negative during the seventh week after the second dose, with the unvaccinated having a lower risk of infection in the 29% -56% range. How can this be? A likely explanation is that the unvaccinated children got infected earlier than the vaccinated ones, and once the protection has worn off, the vaccinated children are at higher risk than the unvaccinated ones who have now acquired natural immunity.

That is, the vaccine simply postponed infections by a few weeks or months.

How about deaths from Covid? That is what really matters.

Unfortunately, the New York study does not present mortality data. Why? Over the two years of the pandemic, the survival rate for New Yorkers ages 0-19 is 99.999%. Despite over 3 million children, there may not have been enough Covid deaths during the two-month study period to determine vaccine efficacy against mortality. It would still have been useful to tally the numbers, but the study authors did not do so.

For hospitalization, the study reports that vaccine efficacy is higher than for infection, and while that protection also wanes over time, the decline is slower than for infections. The numbers reported mean that by vaccinating 365,502 children ages 5-11, an estimated 90 hospitalizations were prevented. This would mean that in order to prevent one hospitalization, one must vaccinate 4,047 children. The corresponding number is 1,235 for children ages 12-17.

These numbers are difficult to properly interpret for four reasons. (i) They are based on a two-month period, and the vaccines have additional benefits outside that time window. (ii) They compare vaccinated children with unvaccinated children with or without natural immunity from prior Covid infection. This will underestimate the vaccine benefits for children without a prior infection while overestimating the benefits for those with natural immunity. (iii) They include both hospitalizations that are due to Covid and hospitalizations for other causes with a concurrent unrelated mild Covid infection.

Even if the vaccine had zero efficacy at preventing hospitalization due to Covid, the efficacy against mild Covid infection would ensure that the study reported good efficacy against hospitalization. That the reported vaccine efficacy is higher for hospitalization than for infections indicates that there is at least some efficacy for the former, but it is impossible to properly estimate the level of efficacy without data that distinguishes hospitalizations due to and with Covid. (iv) The study was conducted during a large wave of infections, which has since declined. The benefits are less during the lower transmission period that we have now entered.

When deciding whether to vaccinate a child, we must also consider known and potential adverse reactions. From the CDC’s Vaccine Safety Datalink we know that the Pfizer and Moderna vaccines can cause myocarditis among adolescents and young adults. Current risk estimates are in the range of one myocarditis for every 3,000 or 8,000 vaccinated adolescents and young men. Women have lower risk. There may also be additional still unknown adverse reactions.

The Covid vaccine has been widely used for children without solid information about its efficacy on hospitalizations and deaths, and without the ability to conduct a proper benefit-risk evaluation. The recent observational study from New York State adds a few important pieces to the puzzle, but we still do not know whether the benefits outweigh the risks.

For older people who have not yet had Covid it makes sense to get vaccinated. While there may be unknown low-risk adverse reactions, the large reduction in mortality risk far outweighs any such risks. For children, the mortality risk is very small and the known and any still unknown risks from adverse reactions may outweigh the benefits at reducing hospitalizations and death from Covid, which are unfortunately still unknown.


What Covid health orders have done to the social lives of children

I was disturbed by what I saw happen to our children in late 2021 during lockdowns and vaccine mandates. Our kids have acted unselfishly despite being at little risk of Covid, accepting the mantra that they need to be restricted and not become ‘vectors of transmission’ passing this virus on to their elders.

Dr. Aaron Kheriaty, Professor of Psychiatry and Ethics, offers this in response, ‘Any society that uses children to shield adults from harm has entirely lost its moral bearings.’

I offer some observations.

A group of teenagers bounce through the local mall with a mixture of chat and laughter. They go in to browse the local merchandise when one of them stops. Most of the group proudly show a vaccine passport, enter the store, and continue shopping but one teenager notices that one of the other girls doesn’t. She knows the other girl is not vaccinated and decides to stay outside with her friend. She does not make a scene, but patiently waits for their friends to come back. They seem oblivious to what has happened, and why should they notice? They are doing what teenagers have always done. I am, however, uncomfortable at the ease at which children show private health information and cannot understand the justification for the risk of stress and social anxiety to kids in the prime of their life.

Two younger teenagers enter a shop. They are below the age required by Health Orders for mandatory vaccination. They look around and are approached by a shop assistant who demands to see their proof of vaccination. One girl proudly displays her green tick while the other volunteers that she is under the age required and is not vaccinated. That girl is abruptly escorted from the premises as if she was a criminal. Under normal circumstances, this would result in a sternly worded complaint from the parent to the manager or police. It has never been considered reasonable to treat children in such a way. Disturbingly, the shop assistant is complying with the health order. The girl is not allowed in the store unless she is closely accompanied by a vaccinated parent. The parent was just outside looking at a lengthy list of things to do during a busy and stressful day.

Fast forward to March 2022. I walked through our local shopping centre and observed that around 20 per cent of people were wearing masks. Individual choice is paramount and there can be a variety of reasons for this, but a little surprising was that young people comprised the highest number. Why were they masked? The fatality rate for those under 50 is around 0.0035 per cent, below the 0.0044 per cent risk of dying while on the road. Do the same people mitigate risk when driving by wearing helmets and fire suits? Or do they accept that there is risk in everything they do? If it is not for physical safety, then does it provide psychological safety? If so, why are the young fearful?

NSW Health Minister Hazzard recently rejected the Health Department’s demands to bring back mask mandates and other restrictions and deserves credit for demonstrating leadership. Some may be sceptical at this newfound courage, but I would like to propose a test. Now that the fatality rate is in line with that of Influenza why not simply repeal the Public Health Orders? At a stroke of a pen, it was enacted and at the stroke of a pen, it can be repealed, thus showing consistency with Premier Perrottet’s desire for ‘personal responsibility’ and the Prime Minister’s statement that the public have had a ‘gutful of governments telling them what to do’.

The last two years have demonstrated that the longer governments bypass the usual accountability measures the more the tendency will be to coerce and exhibit influence and power over people’s lives.

Paediatric Neurosurgeon turned politician Ben Carson notes, ‘We’ve been conditioned to think that only politicians can solve our problems. But at some point, maybe we will wake up and recognize that it was the politicians who created our problems.’

Clinical Psychologist and Spectator UK contributor Dr. Gary Sidley recently posed the question, ‘Should a civilised democratic society be deliberately inflicting emotional distress on its people?’

The child who asked his mother if he was going to die had just learned he had contracted Covid. He experienced symptoms one would expect from a seasonal flu and was back bouncing off the walls after a day. The induced fear, however, has had a lasting impact. The severity and duration of which we don’t yet know.

Is this what we really want for us and for our children?

We might do well to remember the words of the German theologian Dietrich Bonhoeffer, ‘The ultimate test of a moral society is the kind of world that it leaves to its children.’




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