The vaccination campaign against Covid in rich countries, including Italy, is proceeding quickly and the vaccination coverage of the groups most at risk is quite advanced, so much so that the question arises whether to vaccinate even the groups at lower risk, especially children and adolescents. Experts are divided between for and against. In medicine it often happens that important decisions have to be made on the basis of less complete data than would be desirable, and this explains the diversity of views of experts.
Vaccines against Covid, whatever the manufacturer and the technology used, have rare unwanted side effects, potentially fatal: for example thrombosis and myocarditis. As these diseases are registered in the medical records of hospitals, ma they are not the subject of a specific report if not for their potential relationship with the vaccine, their statistical processing is laborious and generally incomplete: it is not easy to know exactly to what extent a vaccine increases the risk of thrombosis or myocarditis.
For this reason, a simplified discourse will prefer mortality statistics, which are accurate. If the Covid epidemic had been left free to run its course, to the point of extinguishing itself due to the immunity acquired by the population, it would probably have struck about the 70% of the general population with a lethality of 0.7% about. The product of these two estimates suggests a Covid mortality of about 0.5% or 5,000 deaths per million inhabitants (it should be borne in mind that general mortality in non-epidemic periods is in the order of 10,000 per million per year). Vaccine mortality is in the order of 1-2 deaths per million population, so the benefit of vaccination for the general population is very big.
When we move from the evaluation of the general population to evaluate categories of citizens, the analysis becomes complicated because the lethality of Covid depends very strongly on theage. L’epidemiologa Sara Gandini in a recent interview he claimed that: “The mortality between 0 and 20 years for Covid-19 corresponds to 0.17 per 100,000 inhabitants”, ie 1.7 per million. This value is of the same order of magnitude as vaccine mortality, therefore children and adolescents would not benefit from vaccination, at least as long as the only risk of death is considered.
Note that when the event considered is so infrequent, even huge case histories give somewhat risk estimates approximate. All scientists and doctors who express doubts about the validity of vaccination of children and adolescents rely on reasoning and estimates of this type; for example theRobert Koch Institute in Berlin for these age groups it recommends vaccination only in children suffering from chronic diseases such as diabetes, obesity or heart disease.
Also Andrea Crisanti in Italy he made similar considerations. The Director-General of the WHO, Tedros Adhanom Ghebreyesus, called on rich countries to donate vaccine doses for children and adolescents to adults in poor countries, who are obviously much more at risk. Indeed, the fight against the pandemic is global and it is naive to apply the priority criteria in vaccinations locally rather than overall.
Other scientists and doctors have suggested instead carpet vaccinating the population, including children and adolescents, in order to accelerate the achievement of population immunity. This practice would be ethically acceptable only if the risk of complications (including fatal ones) for the considered class of vaccine and Covid were, at best, equal: in fact it is not ethically acceptable. artificially increase the risk of a class of citizens with the vaccine (children and adolescents) in order to decrease that of another class (adults and seniors).
The first aim of a medical act is always the benefit, at least probabilistic, of the patient; the benefit of the population is an additional benefit that cannot be achieved to the detriment of the patient (remember that in this simplified discussion harm and benefit are related only to the risk of death). Furthermore, causing harm to children and adolescents impairs a much longer life expectancy than that of adults and the elderly. At what age does the benefit of vaccination certainly outweigh the risk? According to the data of the Istituto Superiore di Sanità, in Italy only it 0,25% of deaths from Covid hit the range 0-39 years and most of the deceased were carriers of serious chronic diseases. From these data it can be very roughly estimated that the vaccine it begins to agree with certainty at an age between 30 and 40 years.
Ultimately, at the moment there do not seem to be strong indications in favor of vaccinating children and adolescents, while indications in favor of vaccinating children adults and seniors they are very strong and both the position of the Koch Institute and the indications of the WHO Director General appear reasonable.