COVID-19 Resource Center
COVID-19 Resource Center
Source/Disclosures
Disclosures: Opel reports receiving grants from the Eunice Kennedy Shriver National Institute of Child Health and Human Development and the Agency for Healthcare Research and Quality.
September 16, 2020
2 min read
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Q&A: Should COVID-19 vaccination be mandatory for children?

Source/Disclosures
Disclosures: Opel reports receiving grants from the Eunice Kennedy Shriver National Institute of Child Health and Human Development and the Agency for Healthcare Research and Quality.
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Recently, the AAP announced that pediatric cases of COVID-19 surpassed 500,000 in the United States.

Cases of the disease have steadily increased among children, and researchers have speculated that kids may be driving the SARS-CoV-2 infection rate.

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?

Douglas J. Opel

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?

A:

  1. Experience to date with the vaccine containing this antigen indicates that it is safe and has an acceptable level of adverse effects.
  2. The antigen is effective as measured by immunogenicity and population-based prevention.
  3. The vaccine containing this antigen is as cost-effective from a societal perspective as other vaccines used to prevent the diseases.
  4. The vaccine containing this antigen should bear some relationship to increasing safety in the school environment.
  5. The vaccine containing this antigen prevents disease(s) with significant morbidity and/or mortality in at least some subset of the population.
  6. Vaccinating the infant, child or adolescent against this disease reduces the risk of person-to-person transmission.
  7. The vaccine is acceptable to the medical community and the public.
  8. The administrative burdens of delivery and tracking of vaccine containing this antigen(s) is reasonable.
  9. 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.