First Do No Harm: Unintended Consequences of Vaccinating Children Against COVID-19

There follows a guest post by Dr. Simon M. Fox, a Consultant in Infectious Diseases and Internal Medicine in an NHS hospital.

COVID-19 vaccination is now to be offered to all five to 11 year olds across the United Kingdom. This follows an extraordinary Government-led push to vaccinate older children and young adults.

It is difficult to imagine a scenario where caution and careful consideration would be more necessary than vaccinating healthy children against an illness that poses such a low risk of serious illness and death to them.

When I began at medical school, I remember being somewhat bemused that the ancient Greek physician Hippocrates was best known for his dictum “first do no harm”. It just seemed so trite, even obvious. If this man was the father of modern medicine, surely there must be a more profound primary insight that had been passed down from generation to generation of physicians.

The more I have gone on in the medical profession, the more I have come to understand and respect the importance of this simple but profound injunction. I suspect that any doctor that has spent time treating patients will agree. It is deceptively easy to worsen a situation one is trying to help. The problem, simply put, is unintended consequences. Human beings are extraordinarily complex: physiologically, psychologically and sociologically. And unfortunately we, as physicians, are not as good as we would like to be, despite astonishing advances in modern medicine. It is therefore something of a natural law, that when dealing with complexity, it is very much easier to make things worse than to make things better. This was the genius of Hippocrates’ powerful insight.

While many of these unintended consequences fall into the category of ‘unknown unknowns’ (to quote an unlikely source), others derive from our earnest desire to do something, even if we don’t know the effect. This is particularly problematic when a serious and often tragic calamity occurs and in our sincere desire to help, one can overreact and paradoxically worsen the outcome in the long-run. There is also a much more insidious problem: that of dismissing inconvenient truths or ‘wilful blindness’. The motivations behind this are often complicated and not always nefarious, but the results are serious.

It may be unpopular, but there are inconvenient facts here that require careful consideration. COVID-19 is a mild illness in the vast majority of children and young adults. It is simply the case that the virus is endemic now, and while vaccination has mercifully made an impact in reducing disease severity and mortality in those at risk, it has not been able to interrupt transmission in a manner that would terminate the circulation of the virus. This has removed much of the rationale for vaccinating children.

We ignore these issues at our peril as there are significant side-effects associated with these vaccines; they may not be common, but they are there. Myocarditis and cardiac arrhythmias, neurological side-effects and thrombotic complications are issues that cannot be ignored. Furthermore, there are still unknowns associated with the COVID-19 vaccines, particularly the novel mRNA and DNA platforms, as these platforms simply do not have safety data longer in duration than two years. The knock-on effects on public confidence in all vaccines if there is a bad outcome could be catastrophic.

Mandating medical therapies, particularly for those who are well, requires the most careful consideration and cannot be justified in my view except in extreme situations. In the case of children and young adults and COVID-19 vaccination, even the slender thread of justification was severed when it was clear that these vaccinations were not preventing children being infected and transmitting the virus.

The tale of the RMS Titanic that sank in 1912 following a collision with an iceberg may well be prescient. The hubris of its builders, who were so confident in its safety they dubbed it ‘unsinkable’, is well-known. Clearly, there were ‘unknown unknowns’ rendering this confidence misplaced. But perhaps more interesting was the reaction afterwards. Titanic had 20 lifeboats, able to accommodate 1,178 people, while it sailed with 2,223 passengers on board. Of course, this was not considered particularly problematic given the certainty in the minds of many that this ship was unsinkable. When the ship did sink, many died for lack of lifeboat space.

Having witnessed such a compelling tragedy, there was public clamour for reform – and why not? The loss of life had been horrific. The U.S. Federal Government reacted by mandating that all ships be retro-fitted with enough lifeboats to cater for every one of its passengers. The intent was an admirable one, except that in the rush to do good, warnings were ignored from ‘inconvenient’ experts explaining that this would dangerously overbalance ships and make the likelihood of a sinking higher. These voices were unwelcome to the Government and owners of the big ships as the alternative was to reduce the number of passengers to meet the available lifeboat space. The policy passed into federal law. Three years later, the SS Eastland, dangerously overbalanced by the added lifeboats, rolled and sank, resulting in 844 (avoidable) lost lives.

The lesson is clear. Children and young adults in general have very little to gain from COVID-19 vaccination in terms of severe disease or mortality reduction. At the same time there is every reason to be cautious so that we do not cause more harm than good. Those deciding to rush ahead with these policies despite the disappearing rationale will not pay the price; it is our children and young adults that will bear that risk. But let us not be in any doubt, the fault will be ours and it will not be good enough to say we had no way of knowing.