Written by Lisa Forsberg and Anthony Skelton
Mandating COVID-19 vaccination for children is cross-posted from the Practical Ethics blog, of the University of Oxford. 

In many countries vaccine rollouts are now well underway. Vaccine programmes in Israel, the United Kingdom, Chile, United Arab Emirates, Bahrain and the United States have been particularly successful. Mass vaccination is vital to ending the pandemic. However, at present, vaccines are typically not approved for children under the age of 16. Full protection from COVID-19 at a population level will not be achieved until most children and adolescents are inoculated against the deadly disease. A number of pharmaceutical companies have started or will soon start clinical trials to test the safety and efficacy of COVID-19 vaccinations in children and adolescents. Initial results of clinical trials seem promising (see also here and here).

There are strong reasons to inoculate children. COVID-19 may harm or kill them. It disproportionately affects already disadvantaged populations. For example, a CDC study published in August 2020 found the hospitalisation rate to be five times higher for Black children and eight times higher for Latino children than it is for white children. In addition, inoculating children is necessary for establishing herd immunity and (perhaps more importantly), as Jeremy Samuel Faust and Angela L. Rasmussen explained in the New York Times, preventing the virus from spreading and mutating ‘into more dangerous variants, including ones that could harm both children and adults’.

Once a vaccine is approved for use in children a number of ethical issues will arise. One especially salient issue is whether vaccination of children should be mandatory, that is, whether failure to vaccinate ought to be subject to some sanction, such as a fine or exclusion from social environments or activities. In many jurisdictions (including Australia, Italy, Ontario, and West Virginia) the vaccination of children for a range of diseases is mandatory: children must be vaccinated in order to attend public school and/or take advantage of various social benefits. The European Court of Human Rights has recently held that policies mandating routine childhood vaccination can be consistent with member states’ obligations under human rights law (Vavřička and Others v the Czech Republic (2021); see analysis by Dolores Utrilla).

We offer three arguments for mandating the vaccination of children for COVID-19 (building on previous work published in The Ethics of Pandemics). We think these arguments are especially compelling due to the fact that the vaccination of children is key to preventing the spread of new variants of COVID-19, especially variants with the potential to render current vaccines ineffective. Leaving children unvaccinated or delaying vaccinations for children leaves all of us vulnerable, for unvaccinated populations are an opportunity for COVID-19 to mutate and continue to wreak havoc.

The first argument (adapted from Pierik, 2018, 2020) takes the following form: if there is an easy, low risk way for parents or guardians to avoid exposing their children to substantial risk of harm and death,  they ought to do so. COVID-19 presents a substantial risk of harm and death to at least some proportion of children. It may cause long-term health complications, including organ damage, long COVID-19 or multisystem inflammatory syndrome (MIS-C) in children. We do not know whether and to what extent these conditions are treatable. If the COVID-19 vaccine is likely to be as safe and effective as, say, the measles vaccine, it would provide parents and guardians with an easy, low-risk way to avoid an infection that may cause serious harm or death. The state, then, has an obligation to protect children from parents and guardians who might expose them to easily avoidable risk of harm and death. Therefore, the state ought to mandate that parents vaccinate their children against COVID-19.

We accept that the state protects children from adults (including parents) in other contexts by imposing obligations on adults to, for example, use car seats and seat belts for their children when driving.

The second argument runs as follows: if, by vaccinating their children, parents and guardians can easily and safely avoid imposing a significant risk of harm and death on others, they ought to vaccinate their children. The threat to all of us from COVID-19 is significant. The risk unvaccinated children pose to all of us is especially great. Children contribute to the spread of the virus through social mixing, often in large groups (e.g. in classrooms). Moreover, the longer children remain unvaccinated the more time exists for a new more potent variant of COVID-19 to emerge and threaten us all.  If the COVID-19 vaccine is as safe, effective and available as vaccines routinely given to children, it would provide parents and guardians with an easy and safe way to vaccinate their children against COVID-19. The state has an obligation, as most agree, to adopt strong measures to protect populations from exposure to easily and safely avoidable risk of harm and death. Therefore, the state ought to mandate that parents vaccinate their children.

We accept that the state protects populations from easily and safely avoidable risk of harm and death in other contexts, for example, by imposing speed limits and vision requirements for driving. We also already accept that the state imposes obligations on parents to take measures to avoid the risk their children pose to others in many contexts. Childhood vaccinations are already mandatory in some liberal democracies, and most liberal democracies mandate that children attend school to provide them with a civic education, and prohibit children from carrying weapons, for similar reasons.

A third argument for mandating the vaccination of children turns on unique features of children’s well-being. Children might fare well in a different way than adults (Skelton, 2015, 2018; Skelton, Forsberg, and Black, forthcoming; Tomlin, 2018; Wendler, 2012). It is plausible that what matters most to the well-being of adults is reflectively endorsed values (e.g. authentic happiness or rational desires). This may not be true of (especially young) children. Children may lack the capacity to reflect on a full range or inventory of stable values. While happiness and the satisfaction of desires matter to children’s well-being, these might not be all that matters. It seems like objective goods (things that make one better off without satisfying a desire or making one happier) play a significant role in children’s well-being, for example, loving, supportive relationships, various forms of play, learning and intellectual development.

We need to end the pandemic to protect children from the mental and physical effects of lockdown and other restrictions, or effects of insufficient restrictions, such as school closures due to infection spread. Restrictions and effects of infection spread lead to decreased opportunities for the pursuit of well-being. Impacts on education alone are considerable, especially amongst the least well off. In addition, ending the pandemic is essential to enabling children to enjoy the so-called ‘goods of childhood’, including valuable relationships with friends and extended family (especially older adults), various forms of unstructured play, exploration and intellectual development, and to do so in a carefree way (without worries about risk) (Brennan, 2014, Gheaus, 2015).

Childhood is a relatively short period in an individual’s life. It is important for the purpose of preparing children to meet the challenges of adulthood. But it is also a time in which to enjoy particular goods in a unique way. An effective way to secure this for all children is to mandate their vaccination.

Pictured above: A person receives a COVID-19 vaccination. Image by Gustavo Fring via Pexels.