More than 8% of children in secondary school—ages 11 to 16—tested positive for the coronavirus in the week ending Oct. 9, according to the most recent government figures. That number is eight times higher than the rate for adults and has risen from about 2% in early September before schools restarted.

While the U.S. and most European countries started inoculating young people in late spring and summer, the U.K. didn’t roll out vaccines for 12- to 15-year-olds until late September. Adding to that, the government had already decided in the summer to abandon preventative measures in schools such as self-isolation for children in contact with an infected person. 

Even after the vaccine was rolled out, the government’s muddled communications about its efficacy and safety did little to quell any doubts. At the same time, access has been limited to school-based facilities. On Tuesday, National Health Service head Amanda Pritchard reversed that policy, saying children would now be able to access vaccination centers through the national booking system.

The level of “COVID in children at the minute is currently completely unacceptable,” said Martin McKee, a professor of European public health at the London School of Hygiene & Tropical Medicine. “While other countries are moving to vaccinate 5- to 11-year-olds, we’re still dithering around 12- to 15-year-olds.”

U.S. rollout

The U.S. looks poised to start rolling out vaccines for kids ages 5 to 11 in the coming weeks, and Europe’s drug regulator said Monday it had started reviewing Pfizer’s trial data for this age group. It’s unclear when such a move will be made in the U.K., where infection rates are at their highest since mid-July and outpacing other major western European nations.

As of now, only about 15% of those ages 12 to 15 in the U.K. have gotten a shot, according to data from the U.K. Health Security Agency. In the U.S. 46% of children in that age group have been fully vaccinated—meaning two doses—and 56% have had at least one shot. Of those ages 12 to 17, about 70% in France and 39% in Germany are fully vaccinated.

“As throughout we always want to see vaccinations carried out as efficiently and safely as possible,” Max Blain, spokesman for Prime Minister Boris Johnson, told reporters on Tuesday. “That’s what we will continue to do and the whole of government is working with the NHS and others to that end.”

While children as a group have been the least affected by COVID-19—often only contracting the disease mildly or asymptomatically—thousands have been hospitalized and are reporting cases of so-called long COVID, with symptoms including fatigue and headaches that persist long after the actual infection period. Beyond physical health, the pandemic has disrupted their educational and social needs.

“There’s been confusion throughout because this disease does affect children and is transmitted by children,” McKee said.

The surge also raises concerns that parents—who have already spent months away from jobs, dragging on the economy—could once again be forced to spend more time at home to look after sick or isolating kids.

Single dose

In addition to its late rollout, the U.K. has differed from neighbors by offering only a single dose of the vaccine over concern that the risk of side effects such as myocarditis—heart inflammation—increase after the second dose of messenger RNA shots. That policy could complicate travel for families, as most other countries have followed the two-dose regimen and don’t recognize people with one shot as fully vaccinated. 

The U.K. government’s vaccine advisory panel—the Joint Committee on Vaccination and Immunisation—based the decision on data showing that a first dose of Pfizer’s shot prevents 87 COVID-related hospital admissions per million children but comes with a risk of 3 to 17 cases of vaccine-induced myocarditis. A second dose prevents a further six hospitalizations per million but risks an additional 12 to 34 cases of myocarditis.

In September, the panel declined to recommend the vaccine for adolescents, instead passing the decision to Britain’s chief medical officers and saying that the benefit of the shots for healthy 12-to-15 year olds was “marginally greater” than the potential known harms. The government later went ahead.

“The messaging around it has been extremely confusing and has encouraged vaccine hesitancy,” said McKee. The single dose strategy is also “incomprehensible. JCVI have not provided a shred of evidence to justify their decision.”

Cautious approach

A spokesperson for the UKHSA, which represents the JCVI, declined to immediately comment.

Still, some have been encouraged by the cautious approach on children.

“Almost inevitably when a vaccination program is rolled out,” there is a point that more infections and disease could have been prevented had it started earlier, said Christl Donnelly, a professor of statistical epidemiology at Imperial College London and the University of Oxford. “As the mother of a 15-year-old, I was reassured that considerable attention was taken to consider the potential benefits and risks.” 

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• COVID-19 vaccine makers could inoculate the world by the end of 2022, says J&J CEO Alex Gorsky
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