Q&A: Should COVID-19 vaccination be mandatory for children?
Recently, the AAP announced that pediatric cases of COVID-19 surpassed 500,000 in the United States.
In a recent viewpoint in JAMA Pediatrics, Douglas J. Opel, MD, MPH, a pediatrician and director of clinical ethics at Seattle Children’s Hospital, and colleagues said children are “an obvious group to target for mandatory vaccination” once a COVID-19 vaccine is available.
We spoke with Opel about the idea of making COVID-19 vaccination mandatory among children in the U.S.
Question: How effective would a COVID-19 vaccine have to be to consider making it mandatory for children? Would it need to be more than 50% effective?
Answer: Most vaccines currently required for school entry are more than 80% effective at preventing disease, with several having more than 90% effectiveness. We argue that a COVID-19 vaccine should have a comparable effectiveness if we intend to make it mandatory for children.
Q: You mention the U.S. approach to the influenza vaccination in the editorial. Should that be the model for COVID-19 vaccination?
A: No. We recommend using nine criteria to evaluate whether a COVID-19 vaccine should be included in mandatory school immunization programs.
Q: What are the nine criteria?
- Experience to date with the vaccine containing this antigen indicates that it is safe and has an acceptable level of adverse effects.
- The antigen is effective as measured by immunogenicity and population-based prevention.
- The vaccine containing this antigen is as cost-effective from a societal perspective as other vaccines used to prevent the diseases.
- The vaccine containing this antigen should bear some relationship to increasing safety in the school environment.
- The vaccine containing this antigen prevents disease(s) with significant morbidity and/or mortality in at least some subset of the population.
- Vaccinating the infant, child or adolescent against this disease reduces the risk of person-to-person transmission.
- The vaccine is acceptable to the medical community and the public.
- The administrative burdens of delivery and tracking of vaccine containing this antigen(s) is reasonable.
- The burden of compliance for the vaccine containing this antigen is reasonable for the parent/caregiver.
Q: What data are needed to “make firm judgements” — as you wrote in the editorial — about whether to make a COVID-19 vaccination mandatory for children?
A: We need safety and immunogenicity data, we need efficacy and effectiveness data, and we need duration of immunity data. We are far from having these data. For instance, no current phase 2 or 3 COVID-19 vaccine trial, to my knowledge, even includes children.