1 00:00:00,060 --> 00:00:06,610 So I think there is a serious case to be had for vaccine mandates for preventing. 2 00:00:06,610 --> 00:00:10,990 Pertussis, measles, meningococcal seen in children, 3 00:00:10,990 --> 00:00:19,270 it's not clear that that really transposes to thinking about COVID in children and both 4 00:00:19,270 --> 00:00:26,980 because the illness is so much milder and because our experience with the vaccine is so much less. 5 00:00:26,980 --> 00:00:31,630 So some countries offer COVID vaccines to young children from the age of five, 6 00:00:31,630 --> 00:00:35,920 and many parents who had no doubts whatsoever to get a vaccine for themselves 7 00:00:35,920 --> 00:00:40,390 are actually quite hesitant when it comes to getting their children vaccinated. 8 00:00:40,390 --> 00:00:46,240 Are they good reasons to be so hesitant? In this interview, I talked to Dominic Wilkinson, who is a consultant, 9 00:00:46,240 --> 00:00:55,210 neonatal specialist at Oxford's John Radcliffe Hospital and the professor of medical ethics at the University of Oxford. 10 00:00:55,210 --> 00:00:59,320 Hello I'm Katrien Devolder, from the Oxford Uehiro Centre for Practical Ethics. 11 00:00:59,320 --> 00:01:04,720 This is thinking out loud conversations with leading philosophers from around the world on topics that concern as well. 12 00:01:04,720 --> 00:01:09,880 If you'd like to see more of my interviews, don't forget to subscribe to the practical ethics channel on YouTube, 13 00:01:09,880 --> 00:01:17,010 and you can also just listen to the interviews on Apple Podcasts. 14 00:01:17,010 --> 00:01:23,090 And so in general, we, of course, have prudential and moral reasons to get vaccinated. 15 00:01:23,090 --> 00:01:28,790 We do it to protect ourselves and to protect others by reducing the risk of transmission. 16 00:01:28,790 --> 00:01:36,110 But how do these reasons play out in the case of vaccinating young children? 17 00:01:36,110 --> 00:01:39,020 So you're right that there are two separate reasons for having any vaccine. 18 00:01:39,020 --> 00:01:42,230 One is for your own health, the other is for the sake of other people's health. 19 00:01:42,230 --> 00:01:49,430 And I think there are some interesting differences when we think about children firstly in terms of the children themselves. 20 00:01:49,430 --> 00:01:54,110 And the question is, do the benefits outweigh the risks? 21 00:01:54,110 --> 00:02:02,270 The reason that this question of balance is different for children is primarily because this is a a very much milder illness in children. 22 00:02:02,270 --> 00:02:10,940 So children are not particularly those who don't have underlying health conditions are very rarely hospitalised, very rarely seen, 23 00:02:10,940 --> 00:02:19,010 seriously ill and thankfully very rarely die as a consequence of COVID, though, all of those things can happen balanced against that. 24 00:02:19,010 --> 00:02:21,830 What we know of that there are complications and risks. 25 00:02:21,830 --> 00:02:26,900 We've got reasonable evidence that the vaccine side effects are very rare and those that do occur like, 26 00:02:26,900 --> 00:02:30,950 for example, heart inflammation in some teenagers are usually pretty mild. 27 00:02:30,950 --> 00:02:33,710 Some people on the face of that say, Look, you've just got to give the vaccine. 28 00:02:33,710 --> 00:02:40,400 We're giving it to everybody else that we should give it to children to others, take a much more cautious approach. 29 00:02:40,400 --> 00:02:48,110 And one of the reasons for being cautious in particular in relation to children is because. 30 00:02:48,110 --> 00:02:53,660 Vaccines are really important for children. We give vaccines many more vaccines to children than we do to adults. 31 00:02:53,660 --> 00:02:57,690 There are many illnesses that we can prevent serious illnesses in children. 32 00:02:57,690 --> 00:03:04,940 But we found, as with MMR, that that community trust in vaccines is quite fragile. 33 00:03:04,940 --> 00:03:12,620 And if they feel that vaccines are being given that are not safe, the whole vaccine programme might be threatened. 34 00:03:12,620 --> 00:03:16,220 And indeed, we've seen some of that in this pandemic. 35 00:03:16,220 --> 00:03:17,390 General vaccines. 36 00:03:17,390 --> 00:03:25,910 Vaccine sceptics have been reinforced and that actually some of the regular vaccines have not ended up being given as much as they should. 37 00:03:25,910 --> 00:03:32,270 Much more important, in fact, probably for children to get their regular vaccines than it is to have a COVID vaccine. 38 00:03:32,270 --> 00:03:36,110 Now that's all really in relation to children's health. 39 00:03:36,110 --> 00:03:41,380 There is another factor, again, just focussing on children themselves, which is children's education. 40 00:03:41,380 --> 00:03:46,760 So one of the arguments that has been given for giving vaccines children is that 41 00:03:46,760 --> 00:03:51,740 that would stop them being sick and then off school missing out on school. 42 00:03:51,740 --> 00:03:59,570 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. 43 00:03:59,570 --> 00:04:09,480 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. 44 00:04:09,480 --> 00:04:14,900 But it does seem relevant in the context of a pandemic when children's education has been seriously interrupted and 45 00:04:14,900 --> 00:04:23,150 when in fact the biggest impact direct impact on children has been through that the disruptions to their life. 46 00:04:23,150 --> 00:04:29,630 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. 47 00:04:29,630 --> 00:04:33,470 So that does seem relevant, but it is also contextual. 48 00:04:33,470 --> 00:04:43,820 It depends partly on how we respond to the virus if we respond to virus in schools by excluding children who are, 49 00:04:43,820 --> 00:04:48,870 for example, asymptomatic but have got a positive lateral flow test then. 50 00:04:48,870 --> 00:04:54,750 Yes, they'll end up missing 10 days of school if they get positive. 51 00:04:54,750 --> 00:05:04,620 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, 52 00:05:04,620 --> 00:05:10,800 then again, there's a much higher probability of educational disruption. 53 00:05:10,800 --> 00:05:15,900 If we took a different approach and said we're not going to go looking for the virus in children's nose, 54 00:05:15,900 --> 00:05:20,100 if they're symptomatic, they should stay home just like with every other virus. 55 00:05:20,100 --> 00:05:24,510 But if they're well, they could go to school just like with every other virus. 56 00:05:24,510 --> 00:05:30,150 Then that factor might be a smaller one in terms of the vaccine. 57 00:05:30,150 --> 00:05:37,830 And this is all about children themselves. There's a separate reason to give a vaccine, which is to predict other people. 58 00:05:37,830 --> 00:05:42,360 And of course, when we think about why we should have the vaccine as adults, 59 00:05:42,360 --> 00:05:48,870 partly for our own health needs to protect other people, to stop us from passing the virus on to people who might be vulnerable. 60 00:05:48,870 --> 00:05:56,360 It's a reason why even those people who think that they're healthy and not a very great risk for the virus. 61 00:05:56,360 --> 00:05:59,030 Ethically ought to morally ought to have the vaccine, 62 00:05:59,030 --> 00:06:06,680 but it's a different sort of consideration when it comes to children because particularly for the younger children, 63 00:06:06,680 --> 00:06:11,570 they don't get to make that decision or make that ethical evaluation about. 64 00:06:11,570 --> 00:06:20,690 Taking one for for the country, taking one, having a shot to protect other people, to protect grandma, to protect the the the teacher. 65 00:06:20,690 --> 00:06:24,620 Because if we're vaccinating children to protect other people, some people might say, 66 00:06:24,620 --> 00:06:29,150 Well, look, you're using children as a means that might be justified. 67 00:06:29,150 --> 00:06:35,600 But it is a it is in some senses, a more difficult ethical terrain. 68 00:06:35,600 --> 00:06:44,540 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, 69 00:06:44,540 --> 00:06:49,770 I mean, shouldn't we take many other indirect benefits into account? 70 00:06:49,770 --> 00:06:58,520 So I'm thinking of, yeah, maybe the risk of children infecting their grandparents or, for example, just, you know, 71 00:06:58,520 --> 00:07:03,050 parents that parents who can keep working because they don't have to look after sick 72 00:07:03,050 --> 00:07:08,120 children as good for the economy and surely that will be good for the children. 73 00:07:08,120 --> 00:07:14,930 So where do we draw the line in determining what kinds of indirect benefits we can take into consideration? 74 00:07:14,930 --> 00:07:22,730 Because if we take many into consideration, then of course, the case for vaccinating children becomes very strong, very quickly. 75 00:07:22,730 --> 00:07:28,040 Yeah, I mean, it's going to depend partly on how great these benefits are. 76 00:07:28,040 --> 00:07:32,480 One of the challenges with some of these indirect benefits is that they're much harder to measure. 77 00:07:32,480 --> 00:07:39,050 They're hard to quantify. And that's one reason why I think traditionally. 78 00:07:39,050 --> 00:07:45,000 Panels of scientists and doctors and experts have focussed on the medical. 79 00:07:45,000 --> 00:07:54,540 Considerations, those are much easier to quantify in and model in terms of the data about a particular intervention, 80 00:07:54,540 --> 00:08:00,210 particular vaccine in this case for these direct benefits. There are standard ways of measuring those. 81 00:08:00,210 --> 00:08:07,980 Quantifying those and then calculating is the benefit big enough relative to the cost, indirect benefits become more tricky. 82 00:08:07,980 --> 00:08:12,780 They become more tricky to know how to end up, how to how to model how to measure. 83 00:08:12,780 --> 00:08:19,770 And that's one of the reasons why groups like Joe CVI have traditionally tended to avoid them. 84 00:08:19,770 --> 00:08:27,840 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. 85 00:08:27,840 --> 00:08:34,470 The vaccine expert group in the UK only thinks about medical benefits, medical harms, food. 86 00:08:34,470 --> 00:08:37,410 The child doesn't think about other people. 87 00:08:37,410 --> 00:08:46,590 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. 88 00:08:46,590 --> 00:08:52,620 Conscious of spread of the virus in the community. Thinking about also about children's education. 89 00:08:52,620 --> 00:08:59,220 There's a different, even broader perspective which we might take and which I think is highly relevant to children's vaccines, 90 00:08:59,220 --> 00:09:02,700 which is about how do we do most good overall. 91 00:09:02,700 --> 00:09:10,650 We talked about this really difficult balance for children direct indirect benefits versus on the certain harms. 92 00:09:10,650 --> 00:09:11,460 It's difficult. 93 00:09:11,460 --> 00:09:22,220 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. 94 00:09:22,220 --> 00:09:29,210 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 95 00:09:29,210 --> 00:09:35,240 first dose of a vaccine and who are much higher risk of serious illness from from COVID. 96 00:09:35,240 --> 00:09:40,190 It seems like what you're implying is that we should instead of giving vaccines to children, 97 00:09:40,190 --> 00:09:46,820 we should probably give them to people, adults and in low income countries and so on. 98 00:09:46,820 --> 00:09:55,220 But isn't the problem more that the government sort of supports the pharmaceutical industry who puts, 99 00:09:55,220 --> 00:09:58,430 of course, profits before saving human lives and so on? 100 00:09:58,430 --> 00:10:05,810 So the problem is something much bigger, and the the government could probably solve the problem by focussing on on like, 101 00:10:05,810 --> 00:10:12,440 you know, changing the way patterns work instead of making sure that vaccines could be produced globally. 102 00:10:12,440 --> 00:10:19,010 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. 103 00:10:19,010 --> 00:10:22,770 I mean, there are all sorts of situations where. 104 00:10:22,770 --> 00:10:30,600 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. 105 00:10:30,600 --> 00:10:38,430 Overall distribution of benefits or well-being. The point is, how do we what should we do at this particular point in time? 106 00:10:38,430 --> 00:10:47,700 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? 107 00:10:47,700 --> 00:10:51,120 You have a limited supply of vaccines. 108 00:10:51,120 --> 00:11:00,810 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, 109 00:11:00,810 --> 00:11:07,650 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 110 00:11:07,650 --> 00:11:15,380 low risk of serious illness from the virus when there are others elsewhere at very high risk? 111 00:11:15,380 --> 00:11:19,380 You remain a very high risk. You still haven't had access to a first dose. 112 00:11:19,380 --> 00:11:22,800 If people, if these people within our own borders, we would say no, of course, 113 00:11:22,800 --> 00:11:29,010 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. 114 00:11:29,010 --> 00:11:34,970 Now we've got to give it to them first. Of course we do. But because they're elsewhere. 115 00:11:34,970 --> 00:11:40,340 We think we can just ignore their needs. Now, of course, it would be better if we could do both. 116 00:11:40,340 --> 00:11:49,820 If we had a different vaccine development supply or if there were some global allocation 117 00:11:49,820 --> 00:11:58,310 scheme that that gave countries a fair share in proportion to need in population, 118 00:11:58,310 --> 00:12:02,870 et cetera, that would be great if there were such a system. We're not going to get to that overnight. 119 00:12:02,870 --> 00:12:08,690 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? 120 00:12:08,690 --> 00:12:13,880 There was something else that you mentioned that I would like to hear a little bit more, but that I find really interesting. 121 00:12:13,880 --> 00:12:23,720 So of the magnitude of the indirect benefits of vaccinating children like school closures, and this will depend on regulations that are in place. 122 00:12:23,720 --> 00:12:27,530 Like you pointed out, so in some countries, like you said, 123 00:12:27,530 --> 00:12:33,740 children have to remain home when there's just been been a close contacts, they've been in close contact with someone. 124 00:12:33,740 --> 00:12:39,350 Prove it, or there is like one case in the class and in other countries, like in England, classes just remain open. 125 00:12:39,350 --> 00:12:45,170 Even when there are a lot of cases, like in my daughter's class at the moment, 126 00:12:45,170 --> 00:12:56,450 it seems like the reasons for vaccination of children become stronger, the more restrictive the regulations are. 127 00:12:56,450 --> 00:13:03,950 Does that so? So it seems, and that countries have to choose like either you keep your restrictive policies, 128 00:13:03,950 --> 00:13:12,410 but you vaccinate the children so they don't have all these disruptions or you loosen policies. 129 00:13:12,410 --> 00:13:17,000 And then the reason for vaccinating children just becomes much weaker. 130 00:13:17,000 --> 00:13:26,600 Does that sort of right? So I think there is definitely a connexion between restrictiveness the general policies and approach to vaccination. 131 00:13:26,600 --> 00:13:37,040 And one way of identifying that is those countries where they are deliberately attempting to keep the cases very, very low. 132 00:13:37,040 --> 00:13:43,610 There's a real need to get the whole population immunised as quickly as possible because otherwise you're stuck. 133 00:13:43,610 --> 00:13:51,280 And it's one of the reasons why some of the zero COVID countries have found themselves. 134 00:13:51,280 --> 00:14:01,030 In a dilemma they've been able to to in many periods in the pandemic, live normal lives, but then they've been trapped. 135 00:14:01,030 --> 00:14:10,160 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. 136 00:14:10,160 --> 00:14:14,800 So, so the two are tightly connected. 137 00:14:14,800 --> 00:14:26,560 If you have a more lax general policy in terms of allowing virus spread, allowing virus cases, then. 138 00:14:26,560 --> 00:14:30,150 There are two ways in which the case for vaccination might become smaller. 139 00:14:30,150 --> 00:14:36,030 One is because the disruptions to lives are smaller, so these indirect benefits are smaller. 140 00:14:36,030 --> 00:14:41,390 The other is because so many in the community have already had the virus that the 141 00:14:41,390 --> 00:14:46,740 the marginal benefit of vaccination in terms of reducing spread is much smaller. 142 00:14:46,740 --> 00:14:55,530 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. 143 00:14:55,530 --> 00:15:03,630 It just seems highly unlikely when the vast majority of adults have already had boosters in the UK. 144 00:15:03,630 --> 00:15:11,190 Ecuador has introduced a vaccine mandate for all of its citizens from the age of five, 145 00:15:11,190 --> 00:15:19,200 and so the government's justification is that it has a duty to protect the right to health of its citizens. 146 00:15:19,200 --> 00:15:31,890 So apart from reasons that such a policy might increase vaccination hesitancy in general, do you think it's a justified policy? 147 00:15:31,890 --> 00:15:39,000 I think there are definite cases for mandatory vaccination, including in children. 148 00:15:39,000 --> 00:15:45,690 And I think the strongest cases are where we've got vaccines that we've used for a very long time. 149 00:15:45,690 --> 00:15:53,370 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. 150 00:15:53,370 --> 00:15:59,970 So I think there is a serious case to be had for vaccine mandates for preventing. 151 00:15:59,970 --> 00:16:04,350 Pertussis, measles, meningococcal seen in children, 152 00:16:04,350 --> 00:16:15,990 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 153 00:16:15,990 --> 00:16:24,330 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. 154 00:16:24,330 --> 00:16:33,270 And of course, if we did, then we we'd find find ourselves in real trouble with with vaccine politics and vaccine acceptance. 155 00:16:33,270 --> 00:16:39,360 And so maybe to end say, what do you think is the most important lesson learnt from this pandemic? 156 00:16:39,360 --> 00:16:45,450 Like, what should we do better when preparing for or tackling the next pandemic? 157 00:16:45,450 --> 00:16:51,480 Well, I do think we need to think about the big picture and priority for vaccines. 158 00:16:51,480 --> 00:16:58,710 One of the things about a new pandemic is that it presents a threat to the whole world. 159 00:16:58,710 --> 00:17:03,660 That means that the scale of the problem is enormous. It's global, 160 00:17:03,660 --> 00:17:12,240 and it generates real problems with resource allocation because we can't possibly have enough to treat everybody in the world simultaneously. 161 00:17:12,240 --> 00:17:19,380 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? 162 00:17:19,380 --> 00:17:27,780 Now, I think our response in this pandemic of allowing rich countries to buy up quickly big stocks, 163 00:17:27,780 --> 00:17:36,090 stockpiles of the vaccine to then get all their citizens vaccinated first and then down the track to say, 164 00:17:36,090 --> 00:17:40,650 Oh yes, well, we might have Bill Russell in a bottom drawer. 165 00:17:40,650 --> 00:17:41,790 Oh, we've got a few doses here. 166 00:17:41,790 --> 00:17:50,640 You can have these and a year, two years down the track, there are still many patients, people in developing countries who haven't. 167 00:17:50,640 --> 00:17:52,050 Got close to a vaccine. 168 00:17:52,050 --> 00:17:59,550 Of course, there are other problems, there are problems with vaccine delivery and supply that contribute to some, but not all of those problems. 169 00:17:59,550 --> 00:18:02,850 That's a serious problem that as a global community, 170 00:18:02,850 --> 00:18:12,930 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. 171 00:18:12,930 --> 00:18:24,270 Although they did some some positive things really just weren't up to the task of of addressing this problem. 172 00:18:24,270 --> 00:18:41,328 If you liked this video, don't forget to subscribe to the practical ethics channel and the thinking out loud Facebook page.