There are many questions surrounding children's role in the coronavirus pandemic but one thing is clear: they'll need a vaccine, just like adults.
That means injecting dozens of kids with an experimental product - a prospect that makes many parents nervous. The University of Oxford and AstraZeneca Plc plan to start testing their jab in 5- to 12-year-olds as schools and nurseries reopen in the UK.
Children appear to be less affected by COVID-19, though their role in transmission of the virus remains unclear. A vaccine would protect them and ensure they don't infect others who are more at risk, like teachers or grandparents. But the pandemic has struck at a time of growing defiance against mass immunizations.
"These are of course very personal decisions, but everybody needs to ask themselves: Would I want the vaccine for my child later on, when other people have contributed to making it safe?" said Beate Kampmann, professor of pediatric infection and immunity and director of the London School of Hygiene & Tropical Medicine's vaccine center. "We have to be grateful to people who have taken that little bit of a punt."
Kids were excluded from Oxford's early research efforts. Their experimental jab, a front-runner in the global race to develop a vaccine, was tried on adults first, showing only transient side effects such as a temperature and a sore arm. When it moves into the more advanced stages of research in June, it will be administered to as many as 10,260 people, some of them children.
A spokesman for the Oxford COVID-19 vaccine team said more information on the child portion of the trial will be available when the group starts recruiting patients in the coming weeks. He declined to comment further.
As schools and nurseries move to restart in several countries, the U.K. government's committee of scientific advisers says there is "substantial uncertainty" about the impact on the pandemic. There is some evidence that children don't contract the virus as easily as adults and suffer milder symptoms. Only a handful of deaths in children under 15 have been linked to the disease in Britain, compared with more than 38,000 fatalities for grownups.
Recruitment for child vaccination trials in the U.K. is usually done through doctors' offices and health-care workers. Trials tend to work their way down the age range, so it would be unusual for a child to test a vaccine before an adult. The jabs are often given at home and parents are asked to take regular temperature readings and a diary of their child's reaction, with follow-up visits for blood tests.
One perk of taking part can be that the clinical trial team will give the child their other routine immunizations on home visits for the length of the study. There's no financial incentive to join, and parents can withdraw their child at any point.
Even so, child vaccines are controversial, with a vocal community of opponents globally raising concern about purported links to conditions such as autism. Though reports of a connection have been discredited, they've had an impact on uptake by parents. There have also been legitimate problems, such as a small 2010 uptick in narcolepsy cases that was found to be related to a swine flu vaccine.
For most parents, inoculations aren't a concern. When Karla Coletta became a new mother in 2006, she was invited to enroll her baby daughter, Carys, in a vaccine trial for meningitis B.
"When you become a mum you suddenly become aware of your own mortality and meningitis was on everyone's lips," Coletta, whose daughter is now 13, said in a telephone interview. "I just thought, why would I not be interested in that, why would I not want her to be vaccinated against that. I knew they had to start somewhere."
Coletta said that if her children were in the right age bracket she would ask them if they wanted to participate in the COVID-19 vaccine trials.
Personal gain and the greater good are the two most common reasons parents participate, according to Shamez Ladhani, a pediatric infectious disease consultant at St. George's Hospital in London, and consultant epidemiologist for Public Health England. And while there are risks, adverse reactions are rare - so much so that they often don't get noticed until the vaccine goes on sale and is given to many more patients, Ladhani said.
"Some side effects you actually don't find out until you have given 100,000 doses - that's always a worry," said Ladhani, who is frequently involved in vaccine trials. "But there isn't a clinical trial that's big enough that can pick that up."