So I think there is a serious case to be had for vaccine mandates for preventing.
Pertussis, measles, meningococcal seen in children,
it's not clear that that really transposes to thinking about COVID in children and both
because the illness is so much milder and because our experience with the vaccine is so much less.
So some countries offer COVID vaccines to young children from the age of five,
and many parents who had no doubts whatsoever to get a vaccine for themselves
are actually quite hesitant when it comes to getting their children vaccinated.
Are they good reasons to be so hesitant? In this interview, I talked to Dominic Wilkinson, who is a consultant,
neonatal specialist at Oxford's John Radcliffe Hospital and the professor of medical ethics at the University of Oxford.
Hello I'm Katrien Devolder, from the Oxford Uehiro Centre for Practical Ethics.
This is thinking out loud conversations with leading philosophers from around the world on topics that concern as well.
If you'd like to see more of my interviews, don't forget to subscribe to the practical ethics channel on YouTube,
and you can also just listen to the interviews on Apple Podcasts.
And so in general, we, of course, have prudential and moral reasons to get vaccinated.
We do it to protect ourselves and to protect others by reducing the risk of transmission.
But how do these reasons play out in the case of vaccinating young children?
So you're right that there are two separate reasons for having any vaccine.
One is for your own health, the other is for the sake of other people's health.
And I think there are some interesting differences when we think about children firstly in terms of the children themselves.
And the question is, do the benefits outweigh the risks?
The reason that this question of balance is different for children is primarily because this is a a very much milder illness in children.
So children are not particularly those who don't have underlying health conditions are very rarely hospitalised, very rarely seen,
seriously ill and thankfully very rarely die as a consequence of COVID, though, all of those things can happen balanced against that.
What we know of that there are complications and risks.
We've got reasonable evidence that the vaccine side effects are very rare and those that do occur like,
for example, heart inflammation in some teenagers are usually pretty mild.
Some people on the face of that say, Look, you've just got to give the vaccine.
We're giving it to everybody else that we should give it to children to others, take a much more cautious approach.
And one of the reasons for being cautious in particular in relation to children is because.
Vaccines are really important for children. We give vaccines many more vaccines to children than we do to adults.
There are many illnesses that we can prevent serious illnesses in children.
But we found, as with MMR, that that community trust in vaccines is quite fragile.
And if they feel that vaccines are being given that are not safe, the whole vaccine programme might be threatened.
And indeed, we've seen some of that in this pandemic.
General vaccines.
Vaccine sceptics have been reinforced and that actually some of the regular vaccines have not ended up being given as much as they should.
Much more important, in fact, probably for children to get their regular vaccines than it is to have a COVID vaccine.
Now that's all really in relation to children's health.
There is another factor, again, just focussing on children themselves, which is children's education.
So one of the arguments that has been given for giving vaccines children is that
that would stop them being sick and then off school missing out on school.
It would stop disruptions in the classroom where, you know, for example, sending home a whole lot of kids because somebody in the class has got COVID.
Now that educational interruption is not usually a factor that included when we think about the medical risks and benefits of a vaccine for children.
But it does seem relevant in the context of a pandemic when children's education has been seriously interrupted and
when in fact the biggest impact direct impact on children has been through that the disruptions to their life.
It hasn't been because of the virus, it's because it been because of what we've had to do in response to the virus.
So that does seem relevant, but it is also contextual.
It depends partly on how we respond to the virus if we respond to virus in schools by excluding children who are,
for example, asymptomatic but have got a positive lateral flow test then.
Yes, they'll end up missing 10 days of school if they get positive.
And if we have any more active policy of sending home the whole class, if anybody in the class has got the virus as we did at some stages,
then again, there's a much higher probability of educational disruption.
If we took a different approach and said we're not going to go looking for the virus in children's nose,
if they're symptomatic, they should stay home just like with every other virus.
But if they're well, they could go to school just like with every other virus.
Then that factor might be a smaller one in terms of the vaccine.
And this is all about children themselves. There's a separate reason to give a vaccine, which is to predict other people.
And of course, when we think about why we should have the vaccine as adults,
partly for our own health needs to protect other people, to stop us from passing the virus on to people who might be vulnerable.
It's a reason why even those people who think that they're healthy and not a very great risk for the virus.
Ethically ought to morally ought to have the vaccine,
but it's a different sort of consideration when it comes to children because particularly for the younger children,
they don't get to make that decision or make that ethical evaluation about.
Taking one for for the country, taking one, having a shot to protect other people, to protect grandma, to protect the the the teacher.
Because if we're vaccinating children to protect other people, some people might say,
Well, look, you're using children as a means that might be justified.
But it is a it is in some senses, a more difficult ethical terrain.
So I have some questions about the things that you said. So if we take such an indirect benefits into account as a reason for vaccinating children,
I mean, shouldn't we take many other indirect benefits into account?
So I'm thinking of, yeah, maybe the risk of children infecting their grandparents or, for example, just, you know,
parents that parents who can keep working because they don't have to look after sick
children as good for the economy and surely that will be good for the children.
So where do we draw the line in determining what kinds of indirect benefits we can take into consideration?
Because if we take many into consideration, then of course, the case for vaccinating children becomes very strong, very quickly.
Yeah, I mean, it's going to depend partly on how great these benefits are.
One of the challenges with some of these indirect benefits is that they're much harder to measure.
They're hard to quantify. And that's one reason why I think traditionally.
Panels of scientists and doctors and experts have focussed on the medical.
Considerations, those are much easier to quantify in and model in terms of the data about a particular intervention,
particular vaccine in this case for these direct benefits. There are standard ways of measuring those.
Quantifying those and then calculating is the benefit big enough relative to the cost, indirect benefits become more tricky.
They become more tricky to know how to end up, how to how to model how to measure.
And that's one of the reasons why groups like Joe CVI have traditionally tended to avoid them.
I think that there are some interesting questions when it comes to vaccine about who the decision maker is and what they take into account.
The vaccine expert group in the UK only thinks about medical benefits, medical harms, food.
The child doesn't think about other people.
That's one reason why they came up with a different recommendation for teenagers than the health ministers who were thinking about the bigger picture.
Conscious of spread of the virus in the community. Thinking about also about children's education.
There's a different, even broader perspective which we might take and which I think is highly relevant to children's vaccines,
which is about how do we do most good overall.
We talked about this really difficult balance for children direct indirect benefits versus on the certain harms.
It's difficult.
It's probably in favour of giving the vaccine, but there's another group for whom it's very clear the benefits way outweigh the risks and for whom.
Who ought to be a much higher priority, and those are particularly those in the in the developing world who have not yet had their
first dose of a vaccine and who are much higher risk of serious illness from from COVID.
It seems like what you're implying is that we should instead of giving vaccines to children,
we should probably give them to people, adults and in low income countries and so on.
But isn't the problem more that the government sort of supports the pharmaceutical industry who puts,
of course, profits before saving human lives and so on?
So the problem is something much bigger, and the the government could probably solve the problem by focussing on on like,
you know, changing the way patterns work instead of making sure that vaccines could be produced globally.
Instead of saying like, Oh, look, we're not going to vaccinate our own children, we're going to like, give these vaccines to two other people.
I mean, there are all sorts of situations where.
We can imagine that if our society had taken a different path or was structured in a different way, that there would be a better.
Overall distribution of benefits or well-being. The point is, how do we what should we do at this particular point in time?
I mean, we're talking right now, but if we could rewind six months or 12 months, the question is what do you do at that point?
You have a limited supply of vaccines.
You've vaccinated those who are at risk in your own country and you are starting to to go to those who are decreasing risk,
personal risk from the virus. The question is is it right to be giving the vaccine to those in your own country who are very
low risk of serious illness from the virus when there are others elsewhere at very high risk?
You remain a very high risk. You still haven't had access to a first dose.
If people, if these people within our own borders, we would say no, of course,
we wouldn't give it to the children before we would give it to 40 year olds, 50 year olds, those who got underlying illness.
Now we've got to give it to them first. Of course we do. But because they're elsewhere.
We think we can just ignore their needs. Now, of course, it would be better if we could do both.
If we had a different vaccine development supply or if there were some global allocation
scheme that that gave countries a fair share in proportion to need in population,
et cetera, that would be great if there were such a system. We're not going to get to that overnight.
We might think about how we could get to that for the next pandemic. The question is what do we do at this point in time?
There was something else that you mentioned that I would like to hear a little bit more, but that I find really interesting.
So of the magnitude of the indirect benefits of vaccinating children like school closures, and this will depend on regulations that are in place.
Like you pointed out, so in some countries, like you said,
children have to remain home when there's just been been a close contacts, they've been in close contact with someone.
Prove it, or there is like one case in the class and in other countries, like in England, classes just remain open.
Even when there are a lot of cases, like in my daughter's class at the moment,
it seems like the reasons for vaccination of children become stronger, the more restrictive the regulations are.
Does that so? So it seems, and that countries have to choose like either you keep your restrictive policies,
but you vaccinate the children so they don't have all these disruptions or you loosen policies.
And then the reason for vaccinating children just becomes much weaker.
Does that sort of right? So I think there is definitely a connexion between restrictiveness the general policies and approach to vaccination.
And one way of identifying that is those countries where they are deliberately attempting to keep the cases very, very low.
There's a real need to get the whole population immunised as quickly as possible because otherwise you're stuck.
And it's one of the reasons why some of the zero COVID countries have found themselves.
In a dilemma they've been able to to in many periods in the pandemic, live normal lives, but then they've been trapped.
They can't get out of the zero COVID situation without having very high immunisation rates until they've got that they can't relax the rules.
So, so the two are tightly connected.
If you have a more lax general policy in terms of allowing virus spread, allowing virus cases, then.
There are two ways in which the case for vaccination might become smaller.
One is because the disruptions to lives are smaller, so these indirect benefits are smaller.
The other is because so many in the community have already had the virus that the
the marginal benefit of vaccination in terms of reducing spread is much smaller.
It's not so clear that you would gain a huge amount for adults, for example, at this point by vaccinating children in the UK.
It just seems highly unlikely when the vast majority of adults have already had boosters in the UK.
Ecuador has introduced a vaccine mandate for all of its citizens from the age of five,
and so the government's justification is that it has a duty to protect the right to health of its citizens.
So apart from reasons that such a policy might increase vaccination hesitancy in general, do you think it's a justified policy?
I think there are definite cases for mandatory vaccination, including in children.
And I think the strongest cases are where we've got vaccines that we've used for a very long time.
And we're very we've got lots of evidence about their safety. And we've also got very serious illnesses that we're trying to prevent.
So I think there is a serious case to be had for vaccine mandates for preventing.
Pertussis, measles, meningococcal seen in children,
it's not clear that that really trains transposes to thinking about COVID in children and both because the illness is so much milder and because our
experience with the vaccine is so much less that there would be a risk in such a policy that we'd end up doing more harm than good to children.
And of course, if we did, then we we'd find find ourselves in real trouble with with vaccine politics and vaccine acceptance.
And so maybe to end say, what do you think is the most important lesson learnt from this pandemic?
Like, what should we do better when preparing for or tackling the next pandemic?
Well, I do think we need to think about the big picture and priority for vaccines.
One of the things about a new pandemic is that it presents a threat to the whole world.
That means that the scale of the problem is enormous. It's global,
and it generates real problems with resource allocation because we can't possibly have enough to treat everybody in the world simultaneously.
So if you didn't develop new treatments or new vaccines, you're going to have to work out, who do you give it to first?
Now, I think our response in this pandemic of allowing rich countries to buy up quickly big stocks,
stockpiles of the vaccine to then get all their citizens vaccinated first and then down the track to say,
Oh yes, well, we might have Bill Russell in a bottom drawer.
Oh, we've got a few doses here.
You can have these and a year, two years down the track, there are still many patients, people in developing countries who haven't.
Got close to a vaccine.
Of course, there are other problems, there are problems with vaccine delivery and supply that contribute to some, but not all of those problems.
That's a serious problem that as a global community,
we haven't found a good solution for and are the the things that we had put in place prior to the pandemic and the COVAX initiative.
Although they did some some positive things really just weren't up to the task of of addressing this problem.
If you liked this video, don't forget to subscribe to the practical ethics channel and the thinking out loud Facebook page.