Drs. Stanley Plotkin and Ofer Levy, in a recently released Pediatrics Perspectives, argue for the eventual mandatory vaccination of children against COVID-19 (10.1542/peds.2021-050531). They argue that this virus will persist because vaccines may not prevent replication in the nasopharynx and insufficient numbers of adults may be vaccinated. They anticipate sporadic cases and occasional outbreaks. They hope that vaccines will prove capable of preventing or diminishing excretion of the virus and be deemed safe and effective for use in children. If this is the case, they argue that vaccination of children should be required to both protect children and adults.
Plotkin and Ofer’s argument appears to be contingent on several additional empirical claims. It is contingent on the vaccination producing a long duration of immunity and the virus not frequently developing variants against which existing vaccines are ineffective. While the authors draw an analogy to the rubella vaccine, other potential analogies might include the pertussis and influenza vaccines. If immunity is long lasting, it may be ethically preferable to think about immunizing individuals as children in order to protect them later in life rather than to frame the issue as immunizing children in order to protect adults. COVID-19 may also produce novel nongovernmental mandates or incentives for adult vaccination such as employer mandates.
The COVID-19 pandemic has resulted in massive social disruptions and it is important to begin thinking about mechanisms of long-term control. Plotkin and Ofer identify several characteristics of the vaccine which will be important factors. See what you think about their argument that COVID-19 immunization should eventually be required for children.