Thread by @SGriffin_Lab

So, a LOT of arguments currently around #Covid in kids, both long and short versions, and kids vax. @LongCovidKids is something I feel strongly about, as is kids vax.
I have been criticised by some...who say criticism of policy isn't acceptable 🤦‍♂️...well, tough.

Feels to me that

some of the arguments have become so polarised that the rabbit holes that follow are inescapable, for both "sides". We need to focus on the bigger picture, which, in my opinion, paints this whole situation around COVID in kids as totally absurd, especially compared to other 🦠s.

So, some observations and thoughts on things in no particular order. No jokes, no gifs, no, you can find your own data sources...

1. Has there EVER been another kids vax policy/rollout that was a) offered, then withdrawn, b) endorsed as "non-urgent", optional, etc c) had SUCH a

poor uptake as a result?
2. Has there ever been a vaccine where an arbitrary timestamp has been implemented that means anyone born after 2017 will now need to wait until they are 50 to get one, despite ongoing pandemic circulation? HT @chrischirp

https://twitter.com/chrischirp/status/1658164598367739918?s=20

3. Incorporating point 2 into a policy that, ironically, is based upon the likely continued presence of said pathogen...
4. How can those with knowledge advocate the folly of such an immunologically flawed and outright dangerous idea of the COVID equivalent of chicken pox parties

using childhood infection to (supposedly) "top up" adult immunity. Notably, zoster can be very nasty in kids and adults, there are v good vaccines, and where they have been rolled out we see a curious absence of a mass shingles/pox wave in adults...weirdly enough.
5. 1-4 seem to

underpin a recent, yet backwards looking idea that infection-induced, or "natural" immunity is best, based upon the ensuing response to the disease in question...this way well be the case in some instances, but it ignores the inherent risks of getting to this point. Similarly, b4

the value of puss from the hands of milkmaids was recognised, "variolation" (skin, rather than respiratory exposure to smallpox puss) induced fantastic immune responses...assuming you survived. One can only imagine where we'd be now had this continued...
6. There's a study that

illustrates this well, and which, ironically, is often used to "prove" that "natural" infection beats that of vax...

nejm.org/doi/full/10.10…

So, sure enough, the infection induced immunity does appear to last longer (just), and a bit better by other measures...BUT...
First, we know in adults that 3 jabs are the minimum for effective responses...this study counts kids aged 5-11 ever having had just 1 OR 2, all one grp.

...there were ~190k infected kids (no vaccines), ~270k vaccinated.

For the vax group, there were 15 hospitalisations, no deaths.
For the infection only, there were 309 HOSPITALISATIONS AND SEVEN DEATHS!!!💔
The authors conclude that kids require boosters, whether vaxd/ infected.

7. Vax immunity IS "natural," at least in the sense that it elicits responses vs. the same targets as infection. Of course, there's a narrower repertoire as there's only spike, but the flip side of this is that SARS2 can suppress innate immunity, alter adaptive responses, and

there's the issue of imprinting. Also, kids sometimes don't seroconvert - this is also seen 4 flu.
8. Nevertheless, protection vs severe disease in vax group remains VERY high, with vastly lower risk.
9. I often hear that the vax doesn't prevent transmission, in fact this is

cited by some as a reason to not vaccinate kids... the implication being we would ONLY do this to protect others, not the kids themselves 🙄. Well, for a start, we know there IS an effect upon transmission (ie, preventing infections, reducing onward spread), but it's partial and

short-lived vs omicron subvariants...no medicine is perfect.
10. In this regard, yes, there are always rare adverse effects from vaccines, and if you give >13bn doses you're going to see a sizeable number, sadly. Also, as per AZ, some are so rare that they only manifest in phase

4, as the incidence is so low you need this many doses to distinguish it from baseline...
This in no way detracts from the suffering of individuals, many of whom aren't getting the right support faced with these issues. BUT, it does NOT mean that the frankly poisonous 💩 about

every sudden death being due to vax is true. The benefits of vax are clear, COVID is devastating, but remember this is a population scale argument, there will always be exceptions, but we need understanding and support, not misinformation from disgraced medics, MPs and YouTubers.

11. Yes, the UK is now in a position where many people have either had a vaccine or have been infected. This means that the risk/benefit calculation of continuing vaccines has changed...BUT, whilst risk may have reduced on one side of this equation, it's also increased in other

respects. Most importantly, long COVID and other SARS2 sequelae need to be factored into these decisions, not just acute admissions, deaths, etc as in days gone by. We also need to "save the #NHS" over the longer term, not just now.
Kids obviously play right into this debate, and

I can't put the argument anywhere near as eloquently as @chrischirp has done in her latest paper...excellent 🧵 here

https://twitter.com/chrischirp/status/1658466105164443648?s=20

Now, this is not supposed to constitute "scaremongering" or misinformation as some have absurdly said. The individual risk of infection for kids is, as often stated, lower than in adults.
However, this same argument is also used for adults in the vax era, with various refs to flu

that just aren't helpful, both bc flu ought not to be trivialised in this way, and they are NOT the same thing!
Risk needs to be scaled by prevalence. The risk from something that isn't there =0. SARS2 remains a pandemic, with exponential waves relentlessly crashing ashore as a

result of viral variation and replenishing of the susceptible pool by young kids and waning immunity/evasiveness.
I've said it before, it's fine for many of us to focus on individual risks AS LONG AS POPULATION SCALE RISK IS MITIGATED BY GOVERNMENT AND PUBLIC HEALTH. This is the

issue at the end of the day...
12. So we, and kids, are infected, reinfected, and this incurs risk. The GBD crowd must have been delighted at the scale of CYP infections during 22 that led to clear population immunity in this group towards autumn...the problem is the price paid,

and the fact that this is transient...
Omicron and the lack of mitigations has led to far more sick kids, plus coincidence with flu, RSV etc doesn't help.
There is a U-shaped risk for kids, with u5s higher than primary/secondary ages, but, scale this by prevalence. Ht @jneill

Importantly, kids under 5 are way less likely to see multiple infections than older kids...

So, when might be a good time to intervene? Which age groups do we know are least likely to suffer vaccine reactions, and where we can ensure their first experience of SARS2 is vaccination, not variolation? Hmmm...
13. How, aside from infections, will we achieve popln immunity

now that vaccines have effectively been withdrawn from anyone under 50 if born after 2017? Do we do this for other diseases? Measles was responsible for fewer paediatric deaths than COVID when the vaccine was introduced...
14. To end, I urge the public, press, and politicians to

familiarise themselves with @LongCovidKids . These guys are involved with @covidinquiryuk , and support literally 1000s of families whose kids have sometimes been suffering since 2020 💔.
This issue doesn't need overplaying, I'm not a numbers guru, but whether it's 1/10 or 1/100

this should be enough to prompt action. If you believe that anxiety can put kids in wheelchairs, well...not entirely sure what to say on that...other than I strongly disagree.
Let's employ diligence over convenience, let's act compassionately and protect those most precious. 💙