Why the rush to vaccinate children?

How has the UK’s Covid vaccination rollout come to this? We started the year with a jabs programme that was the envy of much of the world. We successfully fought off a wave of infections with a rapid, careful and systematic rollout to those most vulnerable to the virus. But the ongoing row over whether to vaccinate healthy teenagers has led to another tetchy stand-off between politicians and scientists, parents and schools. And to what end?

The UK’s Joint Committee on Vaccination and Immunisation (JCVI) has issued its latest advice on the question of jabs for children. It says that ‘the health benefits from vaccination are marginally greater than the potential known harms’, but ‘the margin of benefit is considered too small to support universal vaccination of healthy 12- to 15-year-olds at this time’.

This is sensible and balanced advice. The committee maintains that ‘the main focus should be the benefits to children themselves, balanced against any potential harms to them from vaccination’. This is an important ethical consideration, which guards against using children as mere means to the end of infection control. Given the minimal risk Covid poses to healthy children, any danger posed by the vaccine must be even smaller. And any social benefit of vaccinating the young needs to be extremely compelling. Considering that the vaccines do not seem to confer lifelong immunity nor prevent transmission of the virus to others, it’s hard to see how vaccinating healthy kids will help much to protect the vulnerable from Covid.

The JCVI’s recommendation is not the last word on the matter, however. Its advice is that the accumulation of ‘longer-term data on potential adverse reactions’ may ‘allow for a reconsideration of the benefits and harms’. It could well be that the risk posed to children by the Covid jab turns out to be much smaller than is currently thought. But it could also turn out that jabbing children provides them with more limited protection than natural infection does. In that scenario, the case for vaccinating kids collapses, both in relation to their own health and to the pursuit of wider population immunity. Our understanding of the vaccines and of Covid itself is still evolving, and in that context the ‘precautionary approach’ recommended by the JCVI is wise.

The trouble is that the JCVI refused to give the advice that the political establishment wanted. It had widely been anticipated that the committee would rubber-stamp the vaccination of teenagers. An extension to the existing vaccine rollout was already being planned accordingly. The JCVI had been under considerable pressure to give the ‘right’ answer, not least from education secretary Gavin Williamson. Last week, he claimed that both the health service and schools would be ready to deliver a programme of jabs for under-16s ‘at pace’. He said that he ‘very much hoped’ the JCVI would make its decision ‘very, very soon’.

Before the pandemic, we might have noted the irony of a government ordering independent health experts to make the decision it wants. Now we are more surprised when an expert committee sticks to its guns and throws the ball back into the government’s court. The JCVI stated that it was not within its remit to ‘consider the wider societal impacts of vaccination, including educational benefits’. It has suggested that the government ‘may wish to seek further views’ from the chief medical officers of England, Scotland, Wales and Northern Ireland. So it’s over to Chris Whitty and the gang to make the final call. Whitehall insiders are apparently ‘confident’ that the CMOs will ‘give a green light’ for health secretary Sajid Javid to roll out vaccines through schools.

Vaccines minister Nadhim Zahawi has assured parents that they will be asked to give consent before their children are jabbed. But he has also suggested that if parents refuse their consent, then children will be able to overrule their parents, under the precedent known as Gillick competence. This has caused outcry among some parents, who have vowed to keep their children off school for the duration of any vaccination programme because they are concerned that their kids will be pressured into having the jab. Teaching unions, meanwhile, have issued dire warnings about the ‘educational disruption’ that will result if kids aren’t vaccinated.

What a mess. Again, we have to ask: to what end? If jabbing kids won’t stop them getting Covid or passing it on, how will it minimise educational disruption? The only reason children have been denied education during the pandemic is that the government and schools have refused to provide it. All they need to do is keep schools open. Children can come in if they are well and stay at home if they are ill, as was the norm prior to 2020.

If the government decides that the JCVI’s advice should be sidelined because it is politically inconvenient, this will further dent public confidence in public health. People will wonder to what extent policy decisions about Covid are really being guided by scientific evidence and clinical judgement. It may well be that many children want to have the Covid jab and that their parents want them to have it too. In that respect, it is not sinister or dangerous to offer it to them. But there is a troubling approach to medical intervention at work here. The government wants to create a demand for something that is unnecessary by framing education as a privilege that is contingent on vaccination.

The question of parental consent could cause the most long-term damage. Undermining the rights of parents could rupture an already uneasy relationship between parents, schools and the state. All of them disagree about who is best placed to make decisions about children’s health and wellbeing. Yes, there are some parents whose opposition to the Covid jab derives from an irrational ‘anti-vax’ perspective. But there are many others who feel that the JCVI’s advice speaks to a rational set of concerns about the relative risks and benefits to their children. These parents rightly think that they should shoulder the responsibility for deciding whether their children are vaccinated.

It is not surprising that some parents feel uneasy about the breezy way that Gillick competence has been invoked in relation to the vaccine rollout. The precedent arises from the judgement given in the 1985 case Gillick v West Norfolk and Wisbech Area Health Authority, which laid out criteria for establishing whether a child has the capacity to provide consent to treatment. As the Care Quality Commission (CQC) explains, the judgement ‘determined that children under 16 can consent if they… fully understand what is involved in a proposed treatment, including its purpose, nature, likely effects and risks, chances of success and the availability of other options’. The ‘Gillick test’ therefore requires a detailed discussion between clinician and child, and comes with some important caveats:

‘If a child passes the Gillick test, he or she is considered “Gillick competent” to consent to that medical treatment or intervention. However, as with adults, this consent is only valid if given voluntarily and not under undue influence or pressure by anyone else. Additionally, a child may have the capacity to consent to some treatments but not others. The understanding required for different interventions will vary, and capacity can also fluctuate such as in certain mental-health conditions. Therefore each individual decision requires assessment of Gillick competence.’

A proper assessment of Gillick competence means much more than simply waiving parental consent when it is inconvenient. Lucinda Ferguson, associate professor of family law at Oxford University, has said that clinicians ‘may well be reluctant’ to accept Zahawi’s claim that parental consent to the Covid jab could be overruled by the children themselves. Ferguson added that clinicians, ‘at least at this early stage, would be reluctant to accept that consent [from a child] is good enough’ because ‘if you treat a child without informed consent… it’s technically battery’.

You can see why parents are worried, too. The fear that their children could be coerced into asking for the jab is hardly unreasonable, given the level of pressure that has already been heaped on young people to do whatever the health authorities tell them. Those breaking the rules have already been accused of ‘killing granny’. No doubt any concerns children raise about getting vaccinated will be painted as selfish and anti-social, too.

When ministers talk excitedly about their rapid Covid immunisation programme for schools, they are clearly not planning for doctors to sit patiently with individual children, to address their concerns and to assess their level of understanding. This is not a recipe for informed consent.

The government’s enthusiasm for vaccinating children is an example of an affliction that we usually associate with teenagers. It is doing something impulsive and for an immediate reward, without considering the longer-term consequences. If ministers rush this rollout through, they could end up doing more harm than good.

Jennie Bristow is senior lecturer in sociology at Canterbury Christ Church University and is on the editorial board of Collateral Global.