Roscommon-based family doctor, and mother of five, Madeleine Ní Dhálaigh’s biggest worry is that there will be a mutation of the Covid-19 virus that will make it more dangerous to children.
“The less virus in the community, the less transmutation,” says Dr Ní Dhálaigh. “The mutation is the big worry. We could have to go back to the drawing board.”
When asked if she would vaccinate her own children, she says, “Oh, yeah, definitely. As soon as possible for the 12- to 15-year-olds and hopefully, the primary school children after that.”
The issue divides opinion internationally, largely due to concerns about rare heart inflammation cases , and the moral quandary raised by jabbing children for a disease which, for the most part, does not seriously affect them.
The Health Service Executive suggested on Thursday that mass vaccination of children is necessary for so-called herd immunity. Earlier this week, however, the United Kingdom ruled out vaccines for the over 12s, bar the extremely vulnerable, or those living with extremely vulnerable people.
But the US is ploughing ahead with jabbing children 12. By mid-winter, it could be offerings jabs to the under-12s.
Complex
"It is a complex," says Paul Moynagh, professor of immunology at Maynooth University.
“It is not immediately clear to me one way or the other, which way we should go. “There is an ethical issue there in terms of vaccinating children for the benefit of those, for example, who choose not to be vaccinated.”
While there is clear evidence of the benefits outweighing the risks in other age groups “that becomes less clear for me when it comes to children,” he says.
He is particularly concerned about myocarditis – an inflammation of the heart – which the European Medicines Agency (EMA) says is a very rare side effect of the Pfizer and Moderna jabs, particularly for young boys.
“Most of them resolve, but we are not quite sure whether there will be any lasting effects. The risks can’t be ignored” he says.
When pressed, he says the UK approach is “probably” sensible given the existing data.
The vast majority of children who have died of Covid-19 had some underlying conditions.
“It’s not completely clear cut,” says Moynagh. “There are only trade-offs in any decisions that are made.”
‘Delta has changed everything’
But Christine Loscher, Dublin City University professor of immunology, is "appalled" by the UK approach. saying that there are 1m people there with Long Covid, and it already left room for a new variant with bad choices last year.
Prof Loscher is satisfied with the approval given by three separate medicines regulatory authorities; the EMA, the FDA in the US and the MHRA in the UK, for giving the Pfizer vaccine to 12- to 15-year-olds.
“The safety data is very strong and many countries are already vaccinating children with no significant issues,” she says.
There is no moral issue, in her view, if the vaccine is deemed safe as long as parents are allowed to make informed choices.
“Delta has changed everything,” she says, adding that leaving out children means potentially increased exposure to Delta for vaccinated adults.”
Prof Loscher insists it is a myth to say Covid has little impact on children.
“We don’t know enough about Covid to know its long term impact,” she says.
Long Covid
UK data suggests that 13 per cent of under-11s and about 15 per cent of 12-to-16-year-olds suffered at least one Covid-19 symptom five weeks after testing positive.
Experts are at odds about the real threat of long Covid facing children.
“Some might say we don’t know if there are long term effects of the vaccine too,” says Ms Loscher. “But there’s no evidence to suggest that to be the case. Vaccines in general in children are safe.”
Leaving Covid “to its own devices” among children will increase the risk of vaccine-resistant mutant strains, she adds, adding that it may be necessary to jab toddlers once clinical trials are done.
“I don’t expect there will be significant issues,” she says. “But it’s too early to tell.”
Public health expert prof Anthony Staines says countries "are going to have to vaccinate damn near everyone" to bring the Delta variant under control.
Some US evidence suggests that there “a lot more seriously ill children with Delta” than with previous variants, so “it is not impossible”it affects them differently than it does adults.
On the threat of long Covid, he says the “jury is still out” and little is known on whether children will experience symptoms more or less severe than adults.
“There is no doubt in my mind we should be vaccinating 12- to 18-year-olds,” he adds. Simply, the risks of vaccination are “really low” and the risks of Covid “are not really low”.
‘High price’
“It looks like everybody will either be vaccinated or get Delta. The choice is not between the chance of something happening to you and being vaccinated, it is between getting the virus and being vaccinated.”
Cliona O'Farrelly, a professor of comparative immunology at Trinity College Dublin, says other ethical questions are raised. Should Ireland use "precious vaccines" on children, while poor countries go without.
A lot of parents are “understandably worried”, she says, but the data is very strong that vaccines are very safe and that the benefits “far outweighs any potential problem”, she says.