A few weeks ago, I posted a video highlighting my concern for parents who will have to make difficult COVID-19 vaccination decisions for their children. My central point was that the pressure and judgment placed upon mothers and fathers who are hesitant to vaccinate their kids are unfair and unjust. Especially when you consider upcoming approval for vaccinations in younger demographics (5 years to 11 years and 6 months to 5 years), the risk vs. reward of individual vaccination becomes less clear. We know that as age decreases, disease risk typically decreases as well.
A few interesting research papers and statements have emerged this week which further complicate matters.
First, the Ontario government made a statement suggesting that further vaccination in males aged 18-24 with Moderna may have greater risk than reward. In a recent FDA committee discussion, one of the panel members indicated that the demographic of men who should consider forgoing vaccination is 40 and under. As more people become vaccinated and more time passes, I assume we will see an expansion of demographics where vaccination benefits are less straightforward. Although the risks of side-effects like myocarditis remain low-if in the at-risk male population- acknowledgements like these should open the door to further demographic consideration, which brings us back to kids.
The critical piece of information that emerged this week is confirmation that a significant number of COVID-19 hospitalizations in children counted in the provincial data are wholly incidental. Incidental meaning that children admitted to hospital for non-covid reasons (like a fracture, for example) who test positive during general admission bloodwork are recorded as hospitalized from COVID-19. Just how inaccurate are the hospitalization numbers? Every study conducted in North America has shown that around 1/2 of all documented COVID hospitalizations in children are incidental. This was reported by the CMAJ which is an apex journal distributed to physicians across the country for best practices and current evidence. The same basic ratio was reported earlier in the United States in the Journal of the American Academy of Pediatrics (here, and here), but I could not confirm the trend locally in my last video. Now it appears as though the inflation of childhood hospitalization data is standard practice.
Why does the failure to make the distinction between causal and incidental admissions matter? It is manipulative and dishonest, which has been the disturbing trend in the narrative. Public health and government agencies know that when a parent reads the COVID-19 hospitalization numbers in children, they view it as the most accurate and meaningful data to assess the seriousness of the effect of the disease in youths. A parent’s understanding of this data is what helps them decide whether to move forward with a medical intervention for their child or not. If only 1/2 of the reported hospitalizations are a result of COVID-19, it should be publicly understood. But provincial public health authorities would rather muddy the distinction between hospitalizations ’caused by’ COVID-19 vs. ‘incidental’ events as it allows them to perpetuate the fear that will lead to faster and more compliant immunizations (as the approved age gets lower).
Originally, parents were supposed to fear that their child would die from COVID-19. When the data no longer supported the claim, our government shifted to “well, even though children are not dying from COVID-19, they’re going to get very sick from it.” The delta variant was the boogeyman for children. And while the speed of transmissibility is more significant in the Delta variant, the danger toward children has not increased. As a result, hospitalization rates became the new driver of fear-mongering and compliance. But if only 50% of recorded COVID hospital admissions are actually caused by the virus, the claim that parents need to fear severe illness for their kids holds even less water than it did a few months ago.
I predict you’ll see the narrative change to “we need to vaccinate all children who qualify to protect the vulnerable and reach herd immunity.” I’m not going to dive into the slippery slope of herd immunity, but I’ll speak candidly on the topic of vaccinated kids to protect others from my perspective. I have a 1.5, and 3.5, and a 5.5-year-old. I will never give my child a medical intervention to protect other people. If the medical merits of an intervention prove more beneficial than the associated risk, I will move forward with that decision with my child. If there is even a slight amount of controversy in the data, or if the associated risk is even slightly greater than the reward, I won’t. A toddler shouldn’t take risk from a novel medical intervention to protect others from a disease, especially one with a median mortality of over 8o years of age. COVID-19 is not polio, and the COVID-19 Vaccines are not polio vaccines. Only a person who is psychologically unwell or thinking unclearly would increase a child’s risk to decrease risk in an aging adult.
I don’t want my point of view to be taken out of context. The current rate of adverse events across all available age data is meager. The short-term (up to 6 months) protection to COVID-19 from the vaccines is very high. Many, if not most of the population, should consider vaccination and will fair better with the side effects from the vaccine than the effects of the disease. The elderly and metabolically ill make up the vast majority of our communities. But even if the chances of a significant adverse reaction to the vaccine in children is low, once you vaccinate 100M children, you will have thousands who suffer; each coming with a set of parents who will live in regret, shame, anger, and permanent distrust of the public health system. On this note, I find it odd how anecdotes and individual experiences matter when it comes to COVID-19 deaths, but when we turn to vaccination side effects we only talk about the statistics.
My issue with the path we have taken- and remain on- is one of ethics and rights. Parents should have the right to deny a medical intervention for their child (unless you can definitively prove that to forgo the intervention would cause the child great harm). Strong evidence to suggest the danger of not immunizing a child against COVID-19 is not what is happening here. Children have consistently proven to be incredibly resilient to the disease; they’ve also shown a low instance of spreading the disease to both children and adults while infected. Not to mention the fact that over 1/2 of all severe hospital admissions in children are a result of co-morbidities; primarily obesity and non-asthma respiratory issues. The chances of death or severe illness in otherwise healthy kids is so low that it doesn’t even make it onto the top 10 causes of death in the demographic for 2020. Even when you include children with one or more co-morbidities, COVID-19 is tenth on the list and a stat which assumes all of those children died from and not with COVID-19; another slippery slope that likely isn’t worth going down. Yet we are treating the situation as though children are dropping all around us.
The side effects of the proposed medical intervention, while small, are still present. The only remaining justification to forcibly vaccinate kids (which is essentially what you are doing by revoking a child’s right to attend school, sports, or other activities in which others have the option to participate) is to protect others. I already mentioned my personal opinion on immunizing your child for the sole purpose of protecting others, but it should also be acknowledged that we know that breakthrough cases and the rates at which they are happening are increasing. While transmission and infection appears to be reduced, vaccinated people can still clearly contract and spread COVID-19.
The data could change. Future variants could make a stronger case for vaccinated kids. I, and all other parents should reserve our right to adapt their positions as the data changes. But as of now, mandatory vaccination of children is not necessarily the right decision for all children, and parents must retain the right to choose without consequence.
I want to mention that I’m not suggesting vaccinating your child is wrong or that you made a mistake if you vaccinated your 13-year-old. As I said, the chances of a negative outcome from vaccination are meager, and you need to decide what specific circumstances your family must consider while making the decision. Perhaps one of your children has a respiratory illness or you are caretakers of a vulnerable grandparent. Or you are feeling the unjust pressure to vaccinate you child just so s/he can “have their lives back.” I don’t sit in judgement of your reason for quickly vaccinating your child against COVID-19, and others shouldn’t either. But you also need to respect other parent’s decision to be hesitant, take their time, and forgo the decision to vaccinate their kids (if a parent is more concerned about the risk of intervention than the risk of disease). Lastly, if you’re confident in the power of the immunization, someone else’s status should almost be a non-factor for you. Not only is a certain level of empathy and understanding warranted by fellow parents, but as it stands, either side of the vaccination decision is justified by the current data. Your judgment of others is an emotional reaction, not a rational concern.
Be well, be respectful, and take care of each other. And if you know a parent who struggling with this issue, feel free to share this piece with them.
Additional References not linked directly in the article