The US and Canada now allow the BioNTech-Pfizer vaccine to be administered to teenagers. Germany could follow suit this summer. But how sensible are the coronavirus vaccines for those under 18?
According to the US health protection agency (CDC), some 600,000 individuals between the ages of 12 and 15 were given the BioNTech-Pfizer vaccine after the US Food and Drug Administration (FDA) approved its use for children and teens.
Canada was the first country to approve vaccine for children aged 12 and above on May 5, and plans to give all children and teenagers at least one dose before schools reopen in autumn.
The European Medicines Agency (EMA) is expected to approve the use of the vaccine for younger people in late May, according to EMA director Emer Cooke.
Medical experts and parents, meanwhile, have been debating whether or not it is sensible to vaccinate children and teens against COVID-19. Several German doctors have issued a paper in which they draw attention to key aspects that ought to be considered before determining whether children and teenagers should get inoculated.
DW takes a look at what role children and teenagers between the ages of 12 and 15 play in contracting and spreading the coronavirus, how likely they are to develop COVID-19, and how safe the BioNTech-Pfizer vaccine is for that age group.
Please note: DW has concentrated on examining the facts, leaving aside ethical questions regarding the cost and benefit of vaccinations, and the basic rights of children and teens.
The assumption that vaccinating adults against COVID-19 will also protect children is false. Statistically speaking, children and teenagers make up such a large proportion of the global population that they need to be included in efforts to build herd immunity.
One year ago, the WHO said vaccinating 60% to 70% of the global population would suffice to reach this target. Now, however, many public health experts — including US immunologist Anthony Fauci — say we should be aiming for a 85% vaccination rate. Many have also expressed doubts this target can be reached, given the spread of new coronavirus mutants.
The head of Germany's Robert Koch Institute (RKI), Lothar Wieler, expects that we will only contain the pandemic when "significantly more than 80%" of the population have reached immunity either through a previous infection or from receiving a jab.
The UN Department of Economic and Social Affairs (DESA) estimates that children and teenagers up until the age of 17 comprise 30.2% of the world's population — the equivalent of 2.35 billion people.
In mid-May, less than 10% of the global population had received at least one vaccine dose.
Professor Karina Top, who studies vaccines and epidemiology at Canada's Dalhousie University, says reaching herd immunity will depend "on getting enough adults vaccinated, and I know there's concern in many countries that many adults are not willing to get vaccinated."
"We're seeing a slowdown in vaccinations in the US, for example, as all the people that are very eager and keen to get vaccinated have been vaccinated," Top added. "And now they're moving through that group that may be a bit harder to convince, so I think that is going to be important." That is why, in her opinion, vaccinating children and teens is now important.
Saying that children and teenagers are less likely to develop serious cases of COIVD-19 is misleading. Nevertheless, the RKI says that the majority of infected children either have no or only mild symptoms.
An Italian study from 2020 found that teenagers under the age of 18 have a lower risk of developing a serious case of COVID-19. It found that of 3,836 infected children and teenagers, only 4.3% fell seriously ill, with four dying. Cardiologists across the world say that between 0.6% to 2% of children with COVID-19 require treatment in intensive care units. In very rare instances, children and teenagers suffered heart failure.
The American Academy of Pedriatics reports that since the coronavirus outbreak began, 3.85 million US children tested positive for COVID-19. Of these, 0.1% to 1.9% were hospitalized. In total, about 0.3% of children died in connection with the virus (though only two-thirds of US states have provided data).
Germany's Federal Ministry of Education and Research (BMBF) agrees, saying that children are just as likely to contract the coronavirus as adults, but are less likely to fall ill. The BMBF website states that "this age-dependent difference has been observed with regard to other infectious diseases and is linked to children's and teenagers' immune systems reacting differently to those of adults." Immune systems become less effective as individuals age. Whether this applies to coronavirus infections as well has not yet been scientifically established.
Germany's Association of Physicians in Child and Adolescent Medicine (BVKJ), however, has drawn attention to a study by the RKI which found that 11% of girls and 16% of boys under the age of 17 suffer from chronic illnesses. "Just think about the children with serious heart conditions or Down syndrome, who despite their young age are at risk of developing severe [COVID-19] infections," says Axel Gerschlauer of the BVKJ. "These children urgently need an opportunity to get vaccinated, this is about protecting individuals, rather than building herd immunity."
Very little research has been done on the effects of COVID-19 vaccines on children and teenagers. Vaccines are usually first tested only on adults.
Canada and the US approved the BioNTech-Pfizer vaccine for children between 12 and 15 only after a study on 2,260 individuals from this age bracket was completed. 1,131 study participants were given the vaccine. BioNTech-Pfizer says the vaccine proved 100% effective in this age group, making it more effective than in any other group.
Canadian vaccine researcher Karina Top says the relatively small number of study participants is appropriate. "I think that is appropriate because we have so much more data and experiences in people 16 and over who were in the larger studies," she said. "There have been well over 100 million doses of the Pfizer vaccine given around the world ... and we have data coming out around the effectiveness and the safety of that vaccine in those people." Similar findings for 16- to 25-year-olds, she said, make it reasonable to extend approval for those between 12 to 15 years old.
But caution remains key, she adds: "We always have to continue monitoring safety of vaccines after they are approved for use in the population, because even with 30,000 people in a study, you can't detect very rare adverse events that occur in one in 100,000 or one in a million."
Karina Top and German pediatrician Axel Gerschlauer agree that vaccines developed for adults are not automatically suitable for children. Top says it is not uncommon that the same vaccine type is administered. Sometimes, as in the case of tetanus vaccinations, babies are given a modified vaccine mix that differs from the one administered to children and teenagers. Sometimes, different age groups receive different amounts of doses. Top says "individuals under the age of 14 may receive two HPV vaccine doses, at least in Canada; but those 15 and up need a third dose because their reaction is not as strong."
Children's immune systems react differently to vaccines than those of teenagers and adults, the experts say. Finding the safest and most effective vaccine dose is thus essential. BioNTech-Pfizer is currently conducting studies with children aged six to 11. Moderna, AstraZeneca und Johnson & Johnson are too, but no findings are available yet.
This article has been adapted from German.