As more and more adults receive the highly anticipated COVID-19 vaccine, we are all aware that those younger than 16 years of age are not yet eligible for the vaccine.
There is much discussion about how and when to initiate vaccine trials in children. On the one hand, children are at lower risk for severe disease (with the notable exception of Multisystem Inflammatory Syndrome in Children, or MIS-C), and school and child care attendance is not associated with superspread.
On the other hand, pandemic control may not be entirely possible unless and until children are vaccinated as well. Schools and child care centers may not fully be able to re-open, and this has enormous implications for children’s emotional, social, and educational growth, as well as for parental employment opportunities and mental health. Further, there is growing evidence that virtual schooling may be widening the educational gap, with those children who do not have the advantage of ready access to internet, computers, and appropriate home supervision falling further and further behind their peers.
There are other ethical issues regarding timing of testing the vaccine in children. Too soon, and it may put children at high risk for adverse events. Too late, and children may be denied some of the positive effects of the vaccine.
Recently, in Pediatrics (10.1542/peds.2020-040717), we published a Special Article written by a group of bioethicists, led by Dr. Kevin Mintz at the National Institutes of Health, which discusses the issues surrounding COVID-19 vaccine trials in minors. It is important for all of us to be aware of these issues, and to read their thoughtful proposal for how and when to begin testing the COVID-19 vaccine in children.