Children can still suffer under long COVID[1] and other complications that can occur with COVID.

[1] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7927578/

Sure, but now we're talking about the rate of complications from the vaccine vs. COVID among younger populations, and how deadly those complications are. Have you heard any of this nuanced debate, or have you just heard screaming to get everyone vaccinated with no nuance at all?

Which nuance do you think is missing for example from them FDA press release about the EUA for the BioNTech/Pfizer vaccine for children? https://www.fda.gov/news-events/press-announcements/fda-auth...

Nuance: Touting high effectiveness agains infection, which degrades over time. This has been explained elsewhere in this thread, the original vaccine claims were similar and later morphed into "but the vaccine was always designed to protect against severe infection".

Nuance: Not mentioning that their own full application estimates saving one in a million children, under the best circumstances. See Table 14 on page 34.

The difficult ethical question: on one hand there is 1 child you may save given the information available today. On the other hand you don't know which one ahead of time, you need to inoculate 1 million children with a vaccine for which you don't have any longterm data on.

https://www.fda.gov/media/153447/download

Ok, let's have a look what the vaccine manufacturers claimed in their phase 3 study papers about the durability of the protection:

BioNTech/Pfizer [1]: "This report includes 2 months of follow-up after the second dose of vaccine for half the trial participants and up to 14 weeks’ maximum follow-up for a smaller subset. Therefore, both the occurrence of adverse events more than 2 to 3.5 months after the second dose and more comprehensive information on the duration of protection remain to be determined."

Moderna [2]: "Another limitation is the lack of an identified correlate of protection, a critical tool for future bridging studies. As of the data cutoff, 11 cases of Covid-19 had occurred in the mRNA-1273 group, a finding that limits our ability to detect a correlate of protection. As cases accrue and immunity wanes, it may become possible to determine such a correlate."

AstraZeneca [3]: "In this interim analysis, we have not been able to assess duration of protection, since the first trials were initiated in April, 2020, such that all disease episodes have accrued within 6 months of the first dose being administered. Further evidence will be required to determine duration of protection and the need for additional booster doses of vaccine."

Johnson & Johnson [4]: "A limitation of the trial is the relatively short follow-up, which was necessitated, as in other Covid-19 vaccine trials, by the urgent need for vaccine. The data do not suggest a waning of protection."

[1] https://www.nejm.org/doi/full/10.1056/nejmoa2034577 [2] https://www.nejm.org/doi/full/10.1056/nejmoa2035389 [3] https://www.thelancet.com/journals/lancet/article/PIIS0140-6... [4] https://www.nejm.org/doi/full/10.1056/NEJMoa2101544

Speaking of protection (vaccine effectiveness against infection) durability, I have to admit there is a certain level of disappointment seeing charts like Figure 1 in a US veteran study, which flat out contradicts the J&J claims (VEaI 3%) and partly invalidates the Pfizer claims (VEaI 56%). Or a Qatar study. Or a Sweden study.

There is also the official reaction. Aug 18, 2021: "CDC Director Says Coronavirus Vaccines Less Effective For Delta But Still Prevent Severe Infection".

Possible all of these studies are flawed. And perhaps I'm accidentally misquoting Rachel Walensky. Given that the original trials were closed by vaccinating the control arm of the studies, not even sure where to look for credible longterm tracking of VE against infection data.

On the other hand, possibly the manufacturer original studies were flawed. Or the virus evolved, Delta, duh. These conversations are difficult to carry partly because we are supposed to take the original studies, created with (acceptable) conflict of interest as gold standard, and summarily dismiss any independent verification thereof.

https://www.medrxiv.org/content/10.1101/2021.10.13.21264966v...

https://www.nejm.org/doi/full/10.1056/NEJMoa2114114

https://papers.ssrn.com/sol3/papers.cfm?abstract_id=3949410

https://www.forbes.com/sites/andrewsolender/2021/08/18/cdc-d...

PS. One more recent VE study picked from the comments, https://www.nature.com/articles/s41591-021-01548-7/tables/3

UK, VE vs delta over 90 days

  days  VEaPCRI  VEaSI
  after
  2nd
  dose

  14    85%      93%
  30    83%      92%
  60    80%      86%
  90    75%      78%

The trend makes me fairly intrigued to see the follow up at 180, 270 etc. days after 2nd dose.

Watch this till the end : https://www.youtube.com/watch?v=TSZMtSPX3iE

To be fair, before we get carried away, VE against severe infection persists much better given the limited data we have and considering the in-the-field hospitalization & death rates. For adults, especially older, the vaccine is a big net positive.

I don't get what point you are trying to make. Yes, the vaccine efficacy drops over time. This is expected since the antibody levels in the blood drop over time. The manufacturers have pointed out from the beginning that this drop and the potential need for a third shot have to be determined from real-world data, as was done in many studies.

Now the picture seems to be that vaccine effectiveness does indeed drop over time, but protection against severe disease remains pretty strong, with the possible exception of old people who tend to have a weak immune response. Most governments have reacted by recommending third shots to this group in order to further improve the protection.

I really can't see any controversy here. This is precisely the procedure one expects when a new vaccine is introduced.

It is also worth pointing out, that even without boosters the vaccines vastly outperform any medication tested against COVID so far. And they do that much cheaper and with lower side effects.

"Yes, the vaccine efficacy drops over time." That's it. Pfizer made their core of their argument to FDA for 5-11 age group based on VE against infection numbers that we agree do not hold over time. They should take their time to conduct a real study and demonstrate real clinical benefits. There is no rush.

Is the chance of long covid higher than the chance of myocarditis? Is one more dangerous than the other?

Myocarditis is very serious. Any child with it will need cardiology visits for most of their life.

Covid can also case myocarditis and at a higher rate[1] than after the vaccine.

[1] https://www.newscientist.com/article/mg25133462-800-myocardi...

Yes, but I thought we were talking about the push to vaccinate children, which is under say 14 years old. The younger you are, the less likely you are to have symptoms from COVID, so of the numbers listed in that article it's not clear what proportion of those complications from COVID came from the upper age brackets rather than the 12-15 year olds.

And how stupid is it that these articles talk about studies but still don't actually link to them?

> And how stupid is it that these articles talk about studies but still don't actually link to them?

Well, the middle-man doesn't want you going to the source. What's his job gonna be if you do?

As I understand it, precisely because they may then pass the infection on to those who may then end up with a severe illness (either because they're unvaccinated or because their protection is waning).

> As I understand it, precisely because they may then pass the infection on to those who may then end up with a severe illness

But we've already established that the vaccine doesn't prevent transmission. It may slightly attenuate transmission, but nowhere near enough to stop the spread. Given these facts, the vaccine is mainly so the vulnerable populations can protect themselves, but most children aren't among those populations (obviously immunocompromised children are).

If the vaccine isn’t very effective in stopping transmission then how does the vaccine address this?

I don't think I've seen anyone suggest that there is absolutely no impact on transmission. Teenagers were previously a population in which the virus could freely circulate where now there's at least some limited curtailment.

It wasn't my point, but others in this thread have also noted with sources that the level of impact on that younger population (and even small children), including long covid, also appears to be generally underestimated by the general population.

I've heard other people say this and in addition to the common response of helping to reduce spread, I wonder: won't those children grow up to become adults who might experience more serious infection/symptoms? Isn't this like the Chicken Pox vaccine that is commonly given to infants because the disease can be more severe when contracted as an adult?

> I've heard other people say this and in addition to the common response of helping to reduce spread, I wonder: won't those children grow up to become adults who might experience more serious infection/symptoms?

Children exposed to COVID develop strong immunity even if they have no symptoms [1], so the vaccine likely wouldn't convey any more protection than they've already developed.

[1] https://pediatrics.duke.edu/news/children-mild-or-asymptomat...

>Study authors said the findings suggest vaccinating young children against COVID-19 could also elicit a similar or greater degree of protection than that of adults.

>Given similarities in the response to natural infection in children and adults, it is likely that vaccination against SARS-CoV-2 will also elicit a similar degree of protection across the full spectrum of age, as has recently been reported for the Pfizer-BioNTech vaccine in children 12–15 years of age (42). Though we cannot directly compare our results to the neutralizing antibody titers reported in vaccine trial studies, both the vaccine trial data and our results suggest that younger age may be associated with greater neutralizing antibody responses.

I'm not a doctor, but doesn't this actually suggest that the younger the age we can administer COVID-19 vaccines, the stronger the antibody response is likely to be?

First, those claims are speculative as they admit. Second, you cannot generalize from one or two small studies; for instance, other studies (the much-touted Israeli study) have found that natural immunity actually provides much greater protection.

We'll only figure out the truth long after it matters, so the question being debated is the risk of complications from the vaccine compared to the risk of complications from COVID. Given younger populations have very, very low risk from COVID, this is a subtle and complicated question to answer.

> Given younger populations have very, very low risk from COVID, this is a subtle and complicated question to answer.

Shouldn't we apply the precautionary principle to that question then ? From my primitive understanding of medical ethics there is duty of care versus do no harm.

As such, considering the slim percentages at play, there is IMHO no duty to administer preventive treatments children which are not infected, while harm may be caused.

It's getting ugly... The choice of newspaper section is telling...

"San Francisco says children 5 to 11 will have to comply with proof-of-vaccination mandate"

https://www.sfgate.com/bay-area-politics/article/San-Francis...

Ugly is the correct word indeed. Just imagine what attitudes this conditions for at such an age...

The vaccine develops a single antibody against a single spike protein. Natural immunity develops not only a spike protein antibody, but also antibodies against a bunch of other parts of the virus.

If the virus alters the spike protein (eg, the A.30 variant which is pretty much immune to the vaccine), all those other antibodies against the unchanged parts are likely still effective at slowing the virus while new antibodies are developed.

This appears to be changing with Delta, which is causing unprecedented pediatric ICU admission.

https://www.contagionlive.com/view/delta-variant-icauses-unp...

That article you linked (like literally every other one I've read) makes no mention of the numbers that recovered just fine. If they all made a recovery then this vaccine push is pointless.

While the risk of severe covid infection is lower in childred, it still exists and we would like to make it even smaller.

Children's deaths are tragic but extremely low risk for covid. 558 children under 18 died have died in the US, out of a population of 73 Million. How low of risk do you need it to be?

Here in Brazil we've had over 3500 deaths from people under 18, including over 320 babies under 1 year old. There have been cities where sick children were not able to get medical treatment because the pediatric ICU was over capacity. Most of these deaths could have been prevented if a vaccine were available.

At the other end of the spectrum, in British Columbia (population 5 million), there have been 0 deaths in age group 10-19 and 2 deaths in age group <10.

To further confound the issue, mortality rates in infants is significantly larger than in older kids, for US something like 500/100k vs 20/100k, reflecting a number of infants with congenital issues. Some of those end up counted as "death with covid", even if they were not going to make it either way. It is better to search for epi data for kids excluding 0-1 age group, if at all available.

http://www.bccdc.ca/Health-Info-Site/Documents/Week_41_2021_...

just to put numbers on that - 28M children[1] * $20/dose [2] * 2 doses >= $1.1 B

Considering you can't sue the vaccine manufactures for anything and the vaccines are being mandated in various venues, they are definitely a "safe and effective" way to make lots of money...

[1] https://www.usnews.com/news/health-news/articles/2021-10-20/...

[2] https://www.managedhealthcareexecutive.com/view/the-price-ta...