California Gov. Gavin Newsom’s COVID-19 vaccination mandate for schoolchildren age 12 and older — and other similar mandates popping up around the country — raises the question: For a patient population that predominately suffers only mild to no symptoms, is it ethical to coerce them to receive a vaccine that provides little benefit and causes rare but significant side effects?
Why COVID-19 and Polio Aren’t The Same
During the early 1950s, my parents waited and hoped that polio, an incurable, highly infectious disease that primarily afflicts children under five years of age, would not strike. The transmission of the disease was poorly understood and one in 200 patients suffered irreversible paralysis, with 5-10 percent of that group dying due to involvement of the respiratory muscles.
The availability of the Salk injectable polio vaccine in 1955 and the Sabin oral formulation in 1963 was hailed as a godsend. Vaccine development spanned years with 1.6 million children involved in clinical trials before full-scale implementation. The administration of these vaccines garnered widespread public support, with caseloads dropping precipitously. The disease has been eradicated in the United States since 1979.
The acclaimed polio vaccination program illustrates that health interventions are most successful when implemented with full public trust and directed against lethal or severely debilitating diseases for which the immunization provides longstanding protection. This example furnishes a stark contrast to compulsory COVID-19 vaccinations of children and adolescents, who rarely suffer adverse effects from that disease.
Yet, earlier this month, Newsom announced COVID-19 vaccine requirements for all students 12 and older who attend school in person, expected to go into effect next year after approval by the U.S. Food and Drug Administration. Full FDA approval for even younger students, Newsom has said, will expand the requirements further. Recently, Pfizer submitted an application to U.S. drug regulators to authorize the use of the vaccine in children in the kindergarten and grade school cohort.
Strict Ethical Rules of Consent
The 1931 German Guidelines on Human Experimentation, a predecessor to the Nuremberg Code that was woefully disregarded when the Nazis came to power in Germany only a few years later, demonstrate the need for caution in providing “innovative therapy.”
Point 5 specifies that “Innovative therapy may be carried out only after the subject or his legal representative has unambiguously consented to the procedure. … Where consent is refused, innovative therapy may be initiated only if it constitutes an urgent procedure to preserve life or prevent serious damage to health.” Point 6 speaks directly to interventions applied to minors: “The question of whether to use innovative therapy must be examined with particular care where the subject is a child or a person under 18 years of age.”
In the 1970s, revelations about the atrocious Tuskegee syphilis experiments led to the Belmont Report. The Belmont Report highlighted the concepts of “respect for persons,” which underscored a patient’s bodily autonomy and a medical researcher’s need to obtain informed consent. These stipulations are supported in the Declaration of Geneva Physician’s Oath that “The health and well-being of my patient will be my first consideration” and in that statement’s subsequent inclusion in the Helsinki Declaration.
The World Health Organization (WHO) establishes parameters by which vaccinations can be administered to minor patients. “Informed consent is required for medical interventions, including vaccination,” it says, noting consent may only be waived under narrowly defined circumstances such as life-threatening emergencies.
Since a child or adolescent cannot provide consent to vaccination, it is normally required from a parent or legal guardian. However, the WHO adds a caveat that the “public good” or the goal of disease elimination may supersede consent, justify medical mandates, and deny noncompliant children access to school.
Why Most Children Don’t Need COVID-19 Vaccines
According to a report from BBC News, there is a 1 in 500,000 absolute risk of death in children due to COVID-19, and those rare cases generally involve children with chronic medical conditions, including obesity. The Centers for Disease Control and Prevention (CDC) likewise confirm that the vast majority of children and adolescents, again excepting for severe preexisting medical conditions, are spared COVID-19-induced morbidity and mortality.
COVID-19 vaccines do not confer sterilizing immunity, and the salutary effects are short-lived, since coronavirus vaccine-induced antibody titers wane rapidly. The vaccine minimally mitigates transmission, and even that mitigation declines rapidly three months after the second shot. Viral spike protein antigens constantly mutate, rendering vaccines less effective and necessitating booster shots. Natural immunity, on the other hand, confers prolonged protection as a result of an immunologic response to multiple viral antigens.
The risks of administering a vaccine early in its development are uncertain. There has been insufficient time to assess the long-term safety profile of these injections. If the vaccine proves to be unsafe, a 60-year-old man will deal with the ramifications for an average of 15 years, but a five-year-old may be exposed for 70 or 80 years unless the vaccine is discovered to have more serious consequences that affect longevity.
Depriving a child of his education for not receiving a vaccine of uncertain benefit is the essence of coercion. The threat violates the WHO suggestion that such measures can only be employed to eliminate disease — an impossible goal with current vaccine technology.
A physician’s utmost duty is premum non nocere — first, do no harm. Forcing patients who are not at risk for serious illness to receive a vaccine of marginal benefit undermines public confidence in legitimate vaccine programs and the medical establishment. Mandatory, nonselective COVID-19 vaccination of children is a line in the sand, and too many politicians and government agencies have stepped over it.
