Vaccines for children should be encouraged – not mandated

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When – as seems likely early in the new year – Australia approves COVID-19 vaccines for children as young as five years old, we will face the question: should they be made mandatory?

The ‘yes’ case is compelling, particularly because widespread vaccination would vastly reduce the prospect of further school closures due to COVID outbreaks.

COVID vaccines are expected to be available to younger children next year. Credit:iStock

It would also minimise the spread of COVID-19 from children into the adult population, where a significant cohort, particularly older people with comorbidities, remain vulnerable even when fully vaccinated.

It almost goes without saying that while children generally experience mild symptoms, vaccinations would guard against the rarer more serious cases.

And, more broadly, if we want to reduce living with COVID-19 to background noise – like cold or flu – it makes sense that we vaccinate as many people as possible against it.

The ‘no’ case is more nuanced.

While we have, as a community, generally accepted that the risks of COVID-19 in adults vastly outweigh the risks of rare side effects from the vaccines, it is a different equation for children.

Studies from Israel and the United States have linked both the Pfizer and Moderna vaccines to the rare heart conditions of myocarditis and pericarditis, which could possibly affect some children even if the risk seems negligible. Overseas trials and the rollout in the US over the past month have been reassuring, but it is early days.

Some also wonder if it could be immoral to use up precious doses on our low-risk children when millions of high-risk adults are going without overseas. The World Health Organisation certainly made that case in a recent update “as a matter of global equity, as long as many parts of the world are facing extreme vaccine shortages”. It was joined by that medical journal of record, The Lancet, whose editorial board argued for “serious ethical and practical debate” on the matter.

Then there’s the issue of consent: it’s one thing for an adult to make an informed decision on their own behalf, to weigh up the pros and cons; quite another to do it on behalf of a child who cannot give informed consent. Does it seem fair to coerce adults into forcing the COVID vaccination on their children? Former deputy chief medical officer Nick Coatsworth is one who believes it is not, recently telling he believed mandatory vaccination for children would amount to government over-reach.

It’s likely making jabs mandatory for all children would be politically unpopular, with polling by a Resolve Political Monitor survey for this masthead indicating that only 69 per cent of all Australians believe all children should be vaccinated against COVID-19, falling to 57 per cent of parents of 5 to 11-year-olds.

That the vast majority – 83 per cent – of those parents say they are likely to get their own kids jabbed suggests there will be strong voluntary uptake, but resistance to making others do the same.

It is vital – when the Pfizer and Moderna jabs get regulatory approval – that the rollout proceeds with caution. We cannot afford a replay of the AstraZeneca debacle from earlier this year, when backflips in health advice confused millions and set the vaccine rollout back months.

Eventually, as with compulsory vaccinations for pre-schoolers in some parts of Australia, it may be unremarkable to require school-aged children to have the COVID vaccine. They might even be mandatory for school attendance, if we as a society accept, as we have with some other childhood vaccines, that the common good outweighs the (apparently) negligible risk to individual children.

Until that time, though, the decision whether to vaccinate children 12 and under should rest squarely with their parents.

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