Gérald Kierzek is an emergency physician and health columnist, Medical Director of Doctissimo, and author in particular of
Coronavirus, how to protect yourself?
(Éditions de l'Archipel, March 2020).
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FIGAROVOX. - While children and adolescents have little risk of severe forms, is the benefit-risk balance for vaccination favorable to vaccination?
Gerald KIERZEK. -
This is a crucial question both medically and ethically.
Medically, any intervention must respect the famous benefit-risk balance.
As the National Consultative Ethics Committee (CCNE) reminds us in its last very critical opinion of this enlargement, the implementation of a vaccine policy is built on the search for a double benefit: for person themselves to protect them against infection and the onset of serious forms and for the community, the vaccinated person being less likely to transmit the infection to others.
The individual benefit derived from vaccination is therefore limited, if not zero, for the health of those under 18 years of age.
Gerald Kierzek
However, serious forms of infection are very rare in those under 18; they are much less likely than adults to be hospitalized or to have a fatal outcome, and only 0.2% of deaths have been reported in people under the age of 20, most often from severe co-morbidities. The individual benefit from vaccination is therefore limited if not zero for their health. From an ethical standpoint, CCNE underlines that on a collective level, children and adolescents have already “fully participated in the collective effort intended to protect their elders and the most vulnerable”; placing the burden of responsibility for contamination once again on the youngest is debatable. In addition to being scientifically false. As the World Health Organization reports,Children and adolescents under 18 only represent around 8% of cases in 2020, while they constitute almost 30% of the world's population! The link between reopening of schools and peaks of the virus has never been established and schools are not "places of super propagation" either.
Can we achieve collective immunity by vaccinating minors?
Collective immunity is a complex issue.
No one knows how to measure it.
Dosing the antibodies as we routinely do is a false approximation: some antibodies are protective, others are not.
In summary, we don't know what we are measuring and whether it really reflects immunity.
Cellular immunity, which is important to protect us against the virus, has never been explored, for example.
In addition, it should never be forgotten that a population is certainly immunized by a vaccine but also by a previous infection.
The challenge is therefore not so much to achieve a supposed collective immunity as to protect the most vulnerable and at risk. 94% of COVID-related deaths occur in those over 65: everyone over 65 and over 50 with comorbidities must be vaccinated. Nearly one in two patients in intensive care is obese: obese patients must be vaccinated regardless of age because they are vulnerable.
Rather than quasi-marketing quantitative objectives of mass vaccination, it is better to target exhaustive vaccination of these at-risk patients and concentrate the means (and doses) on people at risk of a severe form of COVID.
Advertising campaign, celebrity engagements, health insurance reminders, the role of health professionals, everything has not been tried and we will have to seek out and convince the most recalcitrant.
To convince does not mean to oblige of course.
We have only a few months' perspective on vaccine safety.
Gerald Kierzek
Resuscitation colleagues report to us that they hardly see any more entries in sheaves of double vaccinated patients.
A study of intensive care admissions takes a day to complete with available, reliable and centralized vaccination data.
Why not communicate on these figures?
British Secretary of State for Health Hancock said only 2% of new admissions hospitalized are double vaccinated;
98% were not!
Good argument to communicate and convince recalcitrant at risk and who can by themselves saturate the hospital system at the start of the school year.
The current improvement potentially leads to a rise in end-of-epidemic rhetoric and a move away from vaccination.
Now is the battle for fall.
Isn't the vaccination obligation for children likely to further crystallize the debate?
Of course.
It is a risk of further radicalizing the antivax and of leaning on the wrong side of the undecided.
We have only a few months' perspective on vaccine safety.
Fortunately, these data are reassuring and make it possible to vaccinate 12-16 year olds.
However, only medium and long-term pharmacovigilance monitoring in vaccinated adolescents guarantees total safety.
Note that below this age, no data is currently available.
The law of March 4, 2002 stipulates that
"no medical act or treatment may be performed without the free and informed consent of the person"
. Balance of benefits and risks, uncertainties but also alternatives to vaccination are part of fair information from practitioners for adolescents and parents who must give their parental consent.
However, often the only motivation for a vaccination is a return to freedom and a normal life! Not only is the argument ethically questionable, but it is medically risky, resulting in a total abandonment of elementary barrier gestures and a low noise spread of the virus. Rather than vaccinating teens, offer them - and provide them with - self-tests. Like breathalyzers before getting back behind the wheel, self-tests before party nights would be an effective and safe way to live with the virus!
