Thread by @jeffgilchrist

COVID-19: UK decision not to universally vaccinate children 12-15

The UK's Joint Committee on Vaccination Immunisation (JCVI) recently announced they did not support universal vaccination of 12-15 year olds at this time ( gov.uk/government/new… ). 🧵1/

How did they come to a different conclusion than all the other countries who are already offering vaccines to those 12+ despite actually admitting that the benefits from the vaccine for 12-15 are "marginally greater than the potential known harms"? 2/

As usual, you need to look at the fine print and context they were using. First, they seemed to be using ICU treatment as their baseline and noted that only 2 healthy children per million need ICU care which was too small of a benefit ( washingtontimes.com/news/2021/sep/… ). 3/

The rate of ICU admission among children with underlying health conditions was much higher at 100 per million. 4/

For some reason they did not consider hospitalization serious enough to take into account risks which occur at a rate of 0.7% ( 7000 per million) children in the UK and 1% (10,000 per million) in the USA who get infected. 5/

That is not even taking into account Long COVID which occurs to 1 in 7 (142,857 per million) infected children. JCVI's assessment of risk is very flawed and if you underestimate the risk to children of severe disease as they have done, you underestimate the benefits. 6/

Analysis that used the appropriate denominators (assessing risk based on exposure rather than population) also clearly shows that benefits of vaccines are much greater than the risk ( osf.io/grzma/ ). 7/

JCVI's estimates of mortality and hospitalization appear based on the whole population under 18 as a denominator (12M children) instead of the # of reported COVID-19 cases or an estimate of overall infections which substantially underestimate the risks of outcomes in children. 8/

COVID-19 outcomes depend on risks of exposure, rather than total population size. Exposure to infection varies considerably over time and depends on context such as protective public health measures in place. 9/

The higher the exposure is expected to be, the greater the benefit of vaccinations (since it averts more cases for the same number of people vaccinated). 10/

Any risk-benefit analysis must consider potential benefits of vaccination at different levels of exposure to infection, as done by the CDC. 11/

With England starting school again without any protective measures in place and no universal vaccination program, exposure risk will be very high for students at schools. 12/

Some research previously predicted that without any mitigation in place (no masks, no distancing, etc...) that 80-90% of all students would be infected by the end of the first term from the Delta variant (covsim.hosted-wordpress.oit.ncsu.edu/school-level-m… ). 13/

The CDC in the USA is currently showing the hospitalization rate for unvaccinated teens is 10 times higher than vaccinated teens ( cdc.gov/mmwr/volumes/7… ). 14/

JCVI also stated they were not taking into account any community or societal benefits in their analysis which might lead to a stronger recommendation for a universal vaccination program (e.g. reducing transmission in the community, infecting older people, etc...) 15/

In the UK they have had more than 2,300 children hospitalized since July 1st, with some developing chronic disabilities (

https://twitter.com/dgurdasani1/status/1434175299630030849

). There are more than 11,000 children in the UK who have had COVID-19 symptoms for more than a year now. 16/

While the JCVI is arguing that most hospitalizations are in those with pre-existing conditions, the fact is that completely "healthy" kids are often impacted as well. 17/

It seems one of the main points from the JCVI is the risk of myocarditis from the vaccine. What is interesting is that despite the risk of myocarditis being much higher from the vaccine in 16 year olds than 12 year olds; JCVI did actually recommend vaccines for those 16-17. 18/

Experts who have specifically looked at vaccine induced myocarditis found the vaccine induced versions were almost all mild and patients recovered with or without treatment ( ahajournals.org/doi/10.1161/CI… ). 19/

Despite the very rare cases of vaccine induced myocarditis, they found that the vaccine shows a favourable balance for all age and sex groups so supported vaccination being recommended for everyone 12+. 20/

These same experts are trying to get the message across that COVID related risks are much worse than vaccine induced myocarditis. 21/

You can see numerous world-leading experts on vaccines and children talking about the benefit vs risk of vaccines in adolescents here:

22/

The risk-benefit analysis from the US and CDC clearly shows the benefits greatly outweigh the risks from the vaccine, even without taking into account reducing educational disruption of children or long COVID (

https://twitter.com/dgurdasani1/status/1434175290444599299

). 23/

They found the following predicted cases prevented vs myocarditis cases for every 1 million second dose vaccinations over 120 days (see image). 24/

Another myth is that scientists have advised against vaccination of 12-15 year olds when in fact most scientists strongly support vaccination of this age group (

https://twitter.com/dgurdasani1/status/1434175306177433601

). 25/

There are some outliers like JCVI and parts of the UK pediatric community that don't but this view is in no way the consensus. The global scientific consensus currently in the world is to vaccinate adolescents. 26/

It is not even just a consensus view, but also very well evidenced in the literature and in real-world evidence. JCVI keeps claiming that COVID-19 is not very severe in children. 27/

While it may be less severe than in adults, it does have a significant impact as seen from hospitalizations and Long COVID above. Children are currently vaccinated routinely for other viruses with far less benefit. 28/

Weighing unknown long-term effects, you need to look at the relative probability and weigh risks from COVID-19 infection and risks from the vaccine. 29/

For the vaccine you have 8-10 per million myocarditis cases for females 12-17 and 56-59 per million for males 12-17 which are typically mild with good recovery and no deaths. 30/

There are unknown long-term impacts from vaccines for the more than 14 million adolescents vaccinated across the world. For myocarditis, 95% of cases are largely mild and seen within 1 week. 31/

Of all the other vaccines to date, almost no vaccines have been shown to have long term effects after 4 months and no non-live virus vaccine has shown new side effects after 5 months, so this is very unlikely. 32/

The unknown long term impacts from COVID-19 infection known outcomes are very worrying and not considered by JCVI's risk analysis including the 1 in 7 children who have symptoms lasting 3-4 months and the 11,000 children in the UK for more than a year. 33/

Neurocognitive symptoms are common, and brain changes in metabolism have been seen at 5-6 months. 34/