Convincing the Unconvinced

"You want kids to get vaccinated not just for herd immunity, but [for] their own health."

"Parents may do a different kind of cost-benefit calculus when they are thinking about vaccinating their children."

"[Evidence from some jurisdictions show that] ethically justified legal mechanisms [have an impact on vaccination rates]."

"Get vaccinated and you have access to a 'public good' -- such as a school".

Timothy Caulfield, Canada research chair, health law and policy, University of Alberta

 

"What has changed is those that were unsure. Among those that were unsure in the early days of the pandemic, about half have said they now plan to vaccinate, while the other half remains unsure."

"So, we can expect that while acceptance may have improved somewhat since the early stages of the pandemic, it's likely that this is lower for children than [for] the general population."

Erin Hetherington, social epidemiologist, lead author of study

 

"We have a much more human-rights-based view of children as persons with value unto themselves who are afforded human rights [in Canada]."

"Most 12-year-olds really are quite well informed."

"Sometimes the answer is to say, 'Let's not do it this week. But let's think about it next week'."

"As far as kids are concerned, if it will get them back to normal life, then it's a good thing. We do know that children are struggling with loneliness, depression and anxiety."

Michelle Mullen, bioethicist, Children's Hospital of Eastern Ontario 

Mae Smith, 13, gets her first dose of the Pfizer-BioNTech COVID-19 vaccine at a clinic held at Don Bosco Catholic Secondary School in Toronto on Wednesday. (Evan Mitsui/CBC)

 

Now that anti-COVID vaccination doses are relatively flush in Canada, the gradual opening to age groups for inoculation has finally resulted in most provinces opening their vaccination clinics to all age groups, including children over age 12. Everyone is anxious to see life graduate back to the kind of social routine that is customary. Health professionals worry in particular about people's mental health, struggling with isolation and loneliness. And children are no exception. Schools closed to in-person learning, pivoting to remote learning has been a difficult transition for most children.

They miss the company of their peers, they miss the routine discipline, they miss the casual-by-comparison lives they left behind a year-and-a-half ago through no fault of their own. Other than the fact that transmission of the SARS-CoV-2 virus causing COVID-19, among the young gathered together in school classrooms, despite the exceptional care given to try to maintain distance and to remain in discrete bubbles and to wear masks and observe necessary hand-washing hygiene, remains high. And while children tend to become less ill with COVID, variants arise and transmission from schools to community accounts for a fairly high percentage of COVID cases.

Now that teens are being invited to make appointments for vaccinations, the question arises; how many will respond affirmatively. Initially there was a rush of those committed to gaining vaccine coverage making appointments as recommended. What remains open to speculation is how many teens, including the parents of those teens, will continue to book those appointments? Acknowledged as being key to prevention of the virus spread, plus the variants, it is of great importance that young people be vaccinated. It is also the very way that they will themselves benefit more directly by returning to school, to sports and to normal social activities, to ensure sound mental health.

 

Young people in the 12-16 age cohort got their first doses of the Pfizer vaccine at the vaccine clinic at Don Bosco Catholic Secondary School in Toronto this week. (Evan Mitsui/CBC)

 

While it's true that the COVID experience has demonstrated that children tend not to have serious symptoms of the virus, thus have far less reason to be hospitalized, much less die, if seriously infected, an estimated 83,000 young people under age 20 have tested positive for COVID in Ontario alone since the advent of the pandemic. Four of them have died of COVID-19. Some parents vacillate over vaccination for their children; many are prepared to have their children inoculated, others plan not to, but there is a middling number who remain uncommitted, preferring to 'wait and see'.

A survey was undertaken of 1,321 mothers in Alberta with children aged between nine and twelve who were asked whether they intended to vaccinate their children. Of the total, 60 percent stated their unhesitating intention to vaccinate, and nine percent that they had no intention of doing so, leaving 31 percent who felt uncertain. What did crop up as an anomaly was that only 60 percent of families whose children had complete infant routine vaccinations, agreeing they intended to vaccinate against COVID.

The Centers for Disease Control and Prevention in the United States recommended everyone over age 12 be vaccinated, leading to reports of teens who have been placed in the position of waiting until they turn 18 years of age when they are deemed legally able to make their own decisions independent of parents who will not agree to permit their children to be vaccinated. The legal position of teens in Canada is not the same. Under Ontario's Health Care Consent Act, no age of consent is stipulated; a presumption of capacity rules. The patient is held to understand the nature of the medical treatment under proposal in a way that is appropriate and accessible.

The patient is held to comprehend consequences, positive and negative; the vaccine will prevent serious illness and hospitalization, even while there may be some side-effects and rare reactions. Also understood must be the decision to accept a medical treatment be informed and voluntary. Even should parents reject vaccination, no young person seeking vaccination will be denied. On the other hand, any young person who clearly states they have no wish to be vaccinated, cannot be coerced into inoculation.

In this Wednesday, March 24, 2021 image from video provided by Duke Health, Alejandra Gerardo, 9, looks up to her mom, Dr. Susanna Naggie, as she gets the first of two Pfizer COVID-19 vaccinations during a clinical trial for children at Duke Health in Durham, N.C. (Shawn Rocco/Duke Health via AP)