A Misstep By the World Health Organization (WHO)
Just what anti-vaccine advocates asked for
When it comes to vaccine advice, we live in a world where every word and every nuance is sure to be made to count. That means that public health agencies have to be especially cautious when they give what might at first glance seem to be common sense, even obvious advice.
When we looked at the website of the World Health Organization (WHO) on July 5, 2021 here is what we read with regard to vaccinating children against COVID-19:
Vaccines are usually tested in adults first, and only later assessed in children when safety has been proven in adults, because children are still developing and growing. COVID-19 has also been a more serious and dangerous disease among older people. Now that the vaccines have been determined to be safe for adults, they are being studied in children.
WHO's Strategic Advisory Group of Experts (SAGE) has concluded that the Pfizer/BionTech vaccine is suitable for use by people aged 12 years and above. Children aged between 12 and 15 who are at higher risk of severe COVID-19 may be offered this vaccine alongside other priority groups for vaccination. Vaccine trials for children are ongoing and WHO will update its recommendations when the evidence or epidemiological situation justifies a change in policy.
While the supply of vaccines is limited, the ongoing priority is to vaccinate those most at risk of serious illness who still have not been vaccinated in many parts of the world: older people, those with chronic health conditions, and health workers.
Most children are at low risk of serious disease and vaccinating them is primarily about reducing transmission, which can also be achieved through public health measures, including: physically distancing from others, cleaning hands frequently, sneezing and coughing into their elbow, wearing a mask if age appropriate and avoiding crowded, poorly ventilated spaces.
The World Health Organization (WHO) guidance on vaccinating children and adolescents against COVID-19 can be easily misinterpreted (source: Shutterstock).
The WHO statement does make clear that the Pfizer/BioNTech mRNA vaccine was tested in children aged 12-15 and found to be both safe and effective. That guidance is much stronger on the website of the U.S. Centers for Disease Control and Prevention (CDC):
CDC recommends everyone 12 years and older should get a COVID-19 vaccination to help protect against COVID-19. Widespread vaccination is a critical tool to help stop the pandemic. People who are fully vaccinated can resume activities that they did prior to the pandemic. Learn more about what you and your child or teen can do when you have been fully vaccinated. Children 12 years and older are able to get the Pfizer-BioNTech COVID-19 Vaccine.
CDC seems to be recommending that all children twelve years old and older get vaccinated, without exception. The CDC website does mention rare cases of myocarditis, an inflammation of the heart muscle, and pericarditis, an inflammation of the membrane around the heart, that have been linked to the mRNA vaccines (Pfizer/BioNTech and Moderna/NIH), in young adults, noting CDC still recommends the vaccine for all people 12 and over. Finding the association between myocarditis/pericarditis and the vaccines in young people shows us that the surveillance system is working for vaccine adverse events, because this is so uncommon it is like finding a needle in a haystack, and yet the rare adverse event was identified and investigated and now physicians know what to look for in a case of a teenager who exhibits any of the signs or symptoms of myocarditis or pericarditis. The great majority of people who get this recover uneventfully without significant amounts of treatment.
We would have expected anti-vaccination advocates to seize upon the myocarditis/pericarditis link and try to make it seem far more common than it is. Hundreds of cases have been reported to the Vaccine Adverse Event Reporting System (VAERS), which only seems like a lot until you consider that millions of doses of vaccine have now been given, making heart inflammation a very rare adverse event that usually resolves without much in the way of medical management. And of course, anti-vaccination advocates did exaggerate the significance of the myocarditis/pericarditis link. But unexpectedly they seized on the WHO guidance to spin a tale that undoubtedly resonated with many parents considering whether to vaccinate their children.
Myocarditis is an inflammation of the heart muscle that has been linked to the mRNA COVID-19 vaccines, especially in young adults. It is, however, rare, and usually resolves without complications (image: Shutterstock)
We know that there have been widespread inequities in vaccine distribution, with people in low-income countries not getting enough vaccine. We also know that children and adolescents, if they do get infected with the virus that causes COVID-19, tend not to get as sick as older adults. With those two facts in mind, we would also be interested in the idea of moving some vaccine to people at higher risk of severe COVID-19 infection in low-income countries with limited supplies of vaccine. The only problem is that to our knowledge no such program of vaccine redistribution has been seriously considered by any high- or moderate-income country or by any vaccine manufacturer. Rich countries have pledged to help out with the Vaccines Global Access (COVAX) initiative, but that is not the same as designating vaccines that would otherwise have gone to children in rich countries to be sent instead to poor countries and given there to elderly people and people with serious pre-existing medical conditions. If the CDC recommendation to vaccinate children 12 and up is not followed, we fear that, especially given the challenges of keeping mRNA vaccines frozen during storage, vaccines would simply be wasted.
So the notion of sending vaccines to more vulnerable individuals in vaccine-deprived countries, however laudable it may sound, was a red herring. No such vaccine redistribution program was ever in the works by WHO or any other international agency.
Good Reasons to Vaccinate Children
The reasons why it is essential to vaccinate children and adolescents against COVID-19 even though they are less at risk for serious complications were nicely explained by three physicians in a New York Times op ed piece published July 4, 2021 and titled “Covid is a Greater Risk to Young People Than the Vaccines.” The risk of a hospitalization from COVID-19 infection, they point out, is still higher than from a complication from a COVID-19 vaccine. Also, whereas myocarditis/pericarditis almost always goes away by itself, some children who get COVID-19 infection develop complications like Multisystem Inflammatory Syndrome in Children or long-COVID-19 syndrome. “So far,” the three physician authors also note, “326 Americans age 17 and younger have died of Covid-19.”
There are serious epidemiological reasons for urging parents to get their children vaccinated. COVID-19 shows signs of sticking around. A survey conducted by the journal Nature found that most experts now believe that SARS-CoV-2 (the virus that causes COVID-19) has become an endemic virus, meaning it will persist in the population and continue to infect unvaccinated people. The more unvaccinated people there are, the greater will be the opportunity for the virus to mutate to strains that are resistant to vaccines. If we ever want to bring the pandemic under control, we cannot have a large population of people—in this case many children and adolescents—unvaccinated and serving as a pool of potentially infected hosts. A small number of those children will get very sick and some will even die from COVID-19. Beyond that, the virus will have an opportunity to battle the immune system and learn how to evade it.
It is easy to see how the WHO guidance misleads people into thinking vaccinating children is unimportant. Epidemiologists, infectious disease experts, and immunologists all want to see everyone vaccinated as soon as possible including children; the WHO is giving advice that seems to undercut that wisdom. We doubt, of course, that experts at the WHO meant their guidance to be misinterpreted this way. Our complaint is that by now public health agencies at local, national, and international levels ought to understand that we are fighting an infodemic in which bad actors will pounce upon any piece of ambiguous advice or guidance they can find to craft misinformation. It is absolutely incumbent upon WHO and all of these agencies to think carefully about how their statements will be interpreted.