The UK government is currently deciding whether to extend its vaccination programme to children aged 12 and older, after the Medicines and Healthcare Products Regulatory Agency approved the Pfizer-BioNTech vaccine for this age group.

The topic has sparked debate among experts, with many public health figures questioning whether now is the right time considering many of the world's low-income and middle-income countries (LMICs) are reporting vaccine shortages.

Vulnerable people should be prioritised 

In an article published by the BMJ, Dominic Wilkinson, Ilora Finlay, and Andrew J Pollard say that the net benefit of vaccinating children is unclear, and vulnerable people worldwide should be prioritised instead. 

They say that in order for a for a health system to offer any vaccine to a child, two key ethical questions must be asked. First, do the benefits outweigh the risks? Second, if the vaccine is in short supply, does someone else need it more?

“Careful attention to both questions suggests that we should not yet roll out Covid-19 vaccination to otherwise healthy children," they write.

They acknowledge that for both older adults and children with certain chronic or acute serious illnesses, the benefits of Covid vaccination are likely to outweigh the rare side effects. However, they state that in otherwise health children, "no one can currently be sure." 

One thing we can be sure of, they say, is that in the UK, some people are currently at much higher risk from Covid-19 than healthy children. Furthermore, most lower income countries have fully vaccinated less than 5% of their community.

Considering that there are a limited number of vaccine doses, they conclude that the vaccine has to be prioritised for people at the highest risk of dying and children must wait their turn; and their turn will come, but not yet. 

Vaccinating children against Covid-19 protects them (and others) from the risk of harm and death

Lisa Forsberg and Anthony Skelton argue the contrary, stating that vaccinating children against Covid-19 protects them (and others) from the risk of harm and death from infection. They say this is the best way to promote children’s wellbeing as it would minimise the need for restrictions or disruptions to their lives resulting from failure to properly manage infection spread. 

The pair say that the argument that children are less likely to be severely harmed by Covid-19 infection, and they therefore benefit less from a vaccination protecting them from it, is mistaken.

“It exposes children to unknown risks of severe disease and of long-term health complications. Moreover, we now know that exposing children to those risks disproportionately harms already disadvantaged children," they write.

Furthermore, they argue that the current global vaccine supply shortages result from policy choices and we should "exert whatever pressure we can to minimise vaccine hoarding and distribute vaccines to developing countries, while releasing patents and allowing the manufacture and supply of vaccines at a larger scale, to enable vaccination of adults and children everywhere."

They believe that accepting the “austerity” narrative that children must wait until the most vulnerable people in other countries can be vaccinated diverts focus from the real problem: that profits are valued over lives.

"We should be calling for change, not accepting manufactured scarcity as inevitable," they conclude.