Regular readers might be getting tired of my pointing out how there’s nothing new under the antivax sun in terms of deceptive arguments, conspiracy theories, and tropes designed to argue against vaccinating. However, the COVID-19 pandemic introduced these talking points to a much large audience than had ever seen them before so I considered it my duty to educate our readers and to point out that none of the antivaccine misinformation that has hit us like a tsunami since COVID-19 vaccines first entered large clinical trials in the summer of 2020 is anything new. It just seems new if you haven’t seen it before. Examples include, of course, misinformation claiming that the vaccine kills based on misinterpretation of the VAERS database; that it sterilizes our womenfolk; that it “sheds” and endangers the unvaccinated; and that it causes cancer, none of which are anything new. Even the claim that it “permanently alters your DNA”, although it might appear like a new talking point based on the fact that Pfizer/BioNTech and Moderna COVID-19 vaccines were the first successful translations of mRNA technology into a clinical product, if you look really hard, is not a new claim. (Transhumanism, anyone?) As Charles Pierce likes to say, history is so cool. In this case, though, I’d add: It’s only cool and useful if you know about it and can use it to counter the pernicious misinformation about vaccines of the sort published by, for example, The Wall Street Journal and deconstructed by Jonathan Howard a week ago. What I didn’t expect was to see common antivaccine tropes weaponized in a bioethics journal, but that’s exactly what I saw almost two weeks ago.
Last week the journal Bioethics published another example of how everything old is new again in the form of an article titled “Against COVID-19 vaccination of healthy children“. It might as well have been titled “Against vaccination of healthy children”, because pretty much every one of the arguments presented could be used to argue against long-accepted childhood vaccines that have been mandated as a prerequisite for school enrollment in the US for decades. You’d think Bioethics editors would have realized that, but guess what? They didn’t!. I’ll explain in a moment, but, given that this is presented as piece of serious scholarship, I wondered who was behind this “bioethics” tour de force of recycling old antivax lies.
It turned out to be from a last-year graduate student named Steven R. Kraaijeveld at Wageningen University, the Netherlands, and Associate Fellow at the Research Consortium on the Ethics of Socially Disruptive Technologies. It’s noted in the Biographies section that his “PhD dissertation is on the ethics of vaccination. His research focuses on philosophy and ethics of technology, medical ethics, public health ethics, and moral psychology.” After reading this article, I’d say that he needs to go back to the drawing board, particularly given the Tweets with which he bragged about his Bioethics paper late last month:
In the thread, as he lists his reasons based on “bioethics” for arguing against the “both routine and mandatory COVID-19 vaccination of healthy children” he brags about all the data that back up his ethical conclusions, after, of course regurgitating the “health freedom” and “parental rights” arguments that have long been a staple of antivaccine activists going back decades:
Mr. Kraaijeveld’s Bioethics co-authors include Rachel Gur-Arie, PhD, MS, Hecht-Levi Postdoctoral Fellow in Ethics and Infectious Disease at the Berman Institute of Bioethics at Johns Hopkins University, and Euzebiusz Jamrozik, MD, PhD, practicing Internal Medicine Physician and fellow in Ethics and Infectious Diseases at Ethox and the Wellcome Centre for Ethics and Humanities at the University of Oxford, as well as Head of the Monash-WHO Collaborating Centre for bioethics at the Monash Bioethics Centre. You’d think that at least Dr. Jamrozik would be aware of the antivaccine tropes being recycled in this graduate student’s paper, but apparently not. I’ve found that, depressingly, a lot of academics who actually work on infectious diseases and vaccines are blissfully unaware of common antivaccine tropes, which leads them to regurgitate them inadvertently in a much more palatable, academic-seeming form. This is what this paper does. The same problem also must have applied to Bioethics editors and peer reviewers.
The recycling of antivax tropes as “bioethics” begins
In fairness, I will give the authors a modicum of credit in that they seem to realize that their arguments could be used to argue against other childhood vaccines. They even say so in the introduction, claiming that they’ll show you why the arguments in favor of routine vaccination of children against COVID-19, arguments that they find compelling for other childhood vaccines, don’t hold up for COVID-19 vaccines. In fact, as I’ll show, the arguments they make against the key pillars of the case for vaccinating children against COVID-19, far from being good bioethics, could just as easily be deployed against many, if not most, childhood vaccines currently in use and long accepted.
This article presents an analysis of the ethics of vaccinating healthy children against COVID-19 by responding to the strongest arguments that might favor such an approach.5 In particular, we present three arguments that might justify routine6 COVID-19 vaccination of children, based on (a) an argument from paternalism, (b) an argument from indirect protection and altruism, and (c) an argument from the global public health aim of COVID-19 eradication.7 We offer a series of objections to each respective argument to show that, given the best available data, none of them is tenable. These arguments, which might be compelling for childhood vaccination against other diseases and in different circumstances,8do not appear to hold in the case of COVID-19 with the currently available vaccines. Given the present state of affairs and all things considered, COVID-19 vaccination of healthy children is ethically unjustified.
If one accepts our conclusion that routine vaccination of healthy children against COVID-19 is ethically unjustified, then it follows that coercion, which is an ethically problematic issue in itself, is even less warranted. Nonetheless, mandatory vaccination of healthy children against COVID-19 is already being considered—and, in some places, implemented—as a way of increasing vaccine uptake.9 We therefore also provide two objections specifically against making COVID-19 vaccination mandatory for children, which center on additional ethical concerns about overriding the autonomy of parents and legal guardians and of children who are capable of making autonomous decisions. If vaccinating healthy children against COVID-19 is ethically problematic, then coercing vaccination is even less acceptable—but even if vaccinating healthy children against COVID-19 should at some future point be considered more defensible (e.g., should a much more favorable cost–benefit analysis emerge), important ethical objections against coercive mandates will still remain.
As I said before, Mr. Kraaijeveld is recycling the “health freedom” and “parental rights” arguments that portray any attempt to require vaccines for children before entering public school or daycare facilities as an unacceptable fascistic assault of freedom. It’s a very old antivaccine argument that takes a reasonable debate about the limits of what can be mandated in the service of public health and turns it into a Manichean view that portrays any sort of mandate or even mild coercion as evil. One has only to look at the “Defeat the Mandates” rally held in Washington, DC in January (with a repeat scheduled for Los Angeles in April) to see this argument taken to an extreme.
Let’s look at Mr. Kraaijeveld’s main arguments one by one.
“Paternalism”: Same as it ever was
Mr. Kraaijeveld begins by characterizing the appeal to paternalism thusly:
The first argument in favor of childhood vaccination for COVID-19 derives from paternalistic considerations and holds that routine vaccination of healthy children is justified because it is in the best interests of the would-be vaccinated children. The argument from paternalism suggests that COVID-19 vaccination will, all things considered, benefit children the most (or cause them the least harm). Given that routine vaccination is the most effective way to ensure vaccine uptake, it is therefore justified for the sake of the health and well-being of children themselves.
Unsurprisingly, his objections are twofold:
- Low risk of COVID-19 morbidity and mortality to children
- Known risks and unknown long-term vaccine safety profile for children
Both Dr. Jonathan Howard and I have been repeating for months now how these claims are not only wrong, but echo the same claims made by antivaxxers about the MMR vaccine. Whenever the argument that we shouldn’t vaccinate children against COVID-19 because the disease isn’t that dangerous to children (i.e., quite literally, “doesn’t kill that many children”), I’m reminded of the appeal to the Brady Bunch commonly repeated by antivaxxers in 2015. I’ll discuss that more in a moment, but first let’s see what Mr. Kraaijeveld actually argues:
According to the best available data, healthy children are at a much lower risk of severe illness from COVID-19 and are less susceptible to infection than older adults.10In contrast to many other vaccine-preventable diseases, healthy children are at low risk of severe COVID-19 infection, morbidity, and mortality.11 Hospitalization of children with COVID-19 is rare, although emerging data suggest that children with severe underlying comorbidities are at higher risk.12 Deaths among healthy children due to COVID-19 are very rare; for example, a large study in Germany found no deaths among children aged 5–11 without comorbidities.13 We agree with the assessment that COVID-19 is not a pediatric public health emergency.14
That last citation (#14) is to an article by Drs. Wesley Pegden, Vinay Prasad, and Stefan Baral published in May 2021 arguing that COVID vaccines for children should not receive emergency use authorization. Dr. Howard recently discussed that article and its many flaws in great detail in follow-up to his original discussion of the article last year, which means I don’t have to repeat his analysis. Read the articles for the details, but, in brief, Pegden et al. presented a case that made COVID-19 appear essentially harmless to “healthy” children (much as antivaxxers had long claimed that measles, chickenpox, and the like are essentially harmless to “healthy” children for years before) while leaving out information about how effective the vaccines were in children. Let’s just echo what Dr. Howard said by listing again some of his key bullet points (remember, this was May 2021 and lots more children have been hospitalized and died since then in the US):
- 482-582 children have died of COVID-19 in the US.
- A non-trivial percentage of children who contract COVID-19 will need to be hospitalized.
- One-third of hospitalized children require ICU level, care and 6% require invasive mechanical ventilation.
- Over half of children hospitalized with COVID-19 had no underlying health condition.
- 19% of American children are obese and therefore “high-risk.”
- COVID-19 may cause long-term complications in children.
- Tens of thousands of children have lost a parent due to COVID-19.
- Millions of teenagers older than 16-years have been safely vaccinated so far.
- A highly successful trial of the COVID-19 vaccine has been completed in adolescents. (Another successful trial has also been completed, with preliminary data just released).
- Further vaccine trials (and presumed approvals) are proceeding in a purposeful, stepwise fashion by age.
- Vaccine side-effects almost never emerge after two months. (This is relevant to the second part of Mr. Kraaijeveld’s argument.)
That sounds serious to me, and, remember, the Pegden et al. article was published almost 11 months ago, and, as our very own Dr. Howard pointed out, there was definitely some cherry picking going on here:
And also, others pointed out how cherry picked Mr. Kraaijeveld’s citations were:
Actually, it wasn’t just cherry picking; it was misrepresentation, too:
I’d also suggest that Mr. Kraaijeveld look at who is leaping to his defense. Personally, I’d be embarrassed if I had people like this defending me:
If you want to see how bad Mr. Kraaijeveld’s arguments are, look no further than this passage:
Overall, the burden of COVID-19 in children appears to be similar to or lower than that of typical seasonal influenza in the winter (unlike the much higher disease burden of COVID-19 in adults).16 In 2020, 198 children aged <17 officially died of COVID-19 in the United States.17 In 2021, with Delta being the predominant variant, that number increased to 378,18 which is comparable to the official number of children aged <17 who died in the 2018–2019 influenza season in the United States (i.e., 372).19
Notice how every time the claim is made that COVID-19 is much less deadly (or at least no more deadly) than the flu in children (even, as I note, routine yearly vaccination against the flu is recommended for children), it’s always the 2018-2019 flu season that’s cited, Always. Of course, that was the last complete flu season before the pandemic, which means that citing it is citing a season with zero mitigations of the likes that the pandemic brought us. There were no mask mandates, no business shutdowns, no virtual schooling, and no social distancing. It’s an intellectually dishonest comparison of apples to oranges worthy of antivaccine activists (which is why Mr. Kraaijeveld really shouldn’t have used it), and, as Dr. Howard put it, 1,200 is more than six. Basically, in the same environment, with mask mandates and mitigations, COVID-19 was much more deadly to children than the flu. Mr. Kraaijeveld’s argument boils down to the same argument antivaxxers make, namely that routine (or even mandated) vaccination of children against COVID-19 is unnecessary because it’s more or less harmless to “healthy” children and “not that many children” die of it. Again, it used to be accepted that children aren’t supposed to die if we can reasonably prevent it (which we can with COVID-19 vaccines), but arguments like Mr. Kraaijeveld’s amount to a shrugging of the shoulders over a level of child death that used to be considered unthinkable, even though 20% of COVID-19 deaths occur in children with no underlying conditions. Some ethics!
This brings us back to the Brady Bunch.
I last discussed the Brady Bunch gambit…three weeks ago. It was basically an antivax trope pioneered several years ago by antivaxxers about the measles. They’d point to a 1969 episode of the classic sitcom The Brady Bunch in which all six kids (and, ultimately, Mike and Alice, who, it turns out, had never had the measles as children) caught the measles. The whole situation was played for laughs, with the kids—who didn’t look ill at all—happily staying home and playing games, the only evidence that they were ill being phony-looking red spots painted on their faces and limbs. It wasn’t just The Brady Bunch either. Even though it’s only three weeks since I last cited it, here’s a 2014 YouTube video that was making the rounds then:
You get the idea, I think. I consider Mr. Kraaijeveld’s paper to be an academic version of the Brady Bunch gambit, which is why I’ll take this opportunity to point out yet again that according to the CDC, before the vaccine, 48,000 people a year were hospitalized for the measles; 4,000 developed measles-associated encephalitis; and 400 to 500 died. By any stretch of the imagination that was a significant public health problem, and the introduction of the measles vaccine in 1963, followed by the MMR in 1971, made it much less so, bringing measles under such control that it became very uncommon and deaths from it rare. As Dr. John Snyder reminded us nearly 13 years ago in his response to Dr. Sears making the same arguments in his vaccine book that touted an “alternative vaccination schedule”, measles is not a benign disease, regardless of what popular culture thought of it 50 or 60 years ago. (More recent data show that a severe complication of measles, subacute sclerosing panencephalitis (SSPE), is more common than we used to think.) Meanwhile, over 13 years ago Dr. Sears was claiming that the risk of fatality from measles is “as close to zero as you can get without actually being zero”. Sound familiar? This is basically the same argument that Mr. Kraaijeveld is making for COVID-19, which has killed over 1,300 children in the US since the pandemic hit, arguably more than the average yearly toll of measles before the vaccine.
Mr. Kraaijeveld also invokes another common antivax argument:
Furthermore, post-infection immunity has been found to be at least as effective as vaccination at protecting against disease due to reinfection with COVID-19.24 An increasingly large body of evidence suggests that immunity after previous severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection is at least as robust as vaccine-induced immunity.25 Childhood exposure to SARS-CoV-2, which, as previously discussed, is generally associated with mild viral illness, may offer protection against more severe illness in adulthood.26 To date, hundreds of millions of children have already been infected with COVID-19. For children with immunity from previous infection, the potential benefits of vaccination are likely to be lower than for children without immunity…
I’ll give Mr. Kraaijeveld credit for using the preferred term “post-infection immunity” rather than “natural immunity”, but this, too, is an old antivax argument, namely that “natural immunity” is better than (or at least as good as) vaccine-induced immunity. It’s an argument that I first encountered over 20 years ago, which was when I first started taking a serious interest in the antivaccine movement. Sometimes it got really ridiculous too. Does anyone remember the book Melanie’s Marvelous Measles 11 years ago? It was a children’s book that argued that measles was not only not harmful but that it was good for children because it built “natural immunity.” Indeed, its blurb read:
This book takes children aged 4 – 10 years on a journey of discovering about the ineffectiveness of vaccinations, while teaching them to embrace childhood disease, heal if they get a disease, and build their immune systems naturally.
Actually, measles is worse than we thought in that it causes “immune amnesia” that suppresses immune memory and makes one susceptible to other infections for 2-3 years. You know why “natural immunity” isn’t better than vaccine-induced immunity? It’s because achieving “natural immunity” requires that one actually suffer through the disease and risk its complications, up to and including death.
I like to ask everyone, including Mr. Kraaijeveld, who argues against routine vaccination of children against COVID-19 because it isn’t that dangerous to them: Why aren’t you arguing against routine vaccination against measles? The death toll among children due to COVID-19 over the last two years (>1,300) translates to a higher yearly death toll than the measles produced in the years right before the vaccine. What about chickenpox, which used to kill “only” around 100 children a year before the vaccine? Why aren’t you arguing against the varicella vaccine?
Oh, that’s right. It’s because the COVID-19 vaccine is supposedly so much more “dangerous”:
The case for vaccinating healthy children against COVID-19 for their own sake is undermined by uncertainty; that is, by the currently poorly characterized potential for rare, harmful outcomes associated with the vaccines in children. Public safety data from the Pfizer-BioNTech clinical trials in children included 2,260 participants aged 12 to 15, of which 1,131 received the vaccine.37 In addition to a small sample size, the trial follow up period was of short duration; therefore, no reliable data presently exist for rare or longer-term vaccine-related harms.38 Though common adverse events occurring less than 6 months after vaccination may be ruled out, the risks of rare or delayed adverse outcomes can simply not yet be evaluated.39 Should vaccine harms occur, they will be revealed in the general pediatric population only after thousands or millions of children are already vaccinated, which would also risk seriously undermining vaccine confidence. The restriction of AstraZeneca vaccines to older age groups due to blood clotting events early on in the COVID-19 vaccination rollout, as well as reports of increased rates of vaccine-related myocarditis among younger age groups illustrates that rare risks are sometimes more common in younger age groups and might sometimes outweigh benefits in children.40 Severe cardiac manifestations such as myocarditis and pericarditis are now recognized as rare risks of the COVID-19 vaccines.41 Myocarditis-induced deaths following COVID-19 vaccination have been documented in adolescents as well as in adults.42
This is a classic antivax argument, namely that the vaccine is more dangerous than the disease. Of course, if the vaccine truly is more dangerous than the disease, then that is a compelling argument. However, as we’ve discussed many times (particularly Dr. Howard), this is not the case with COVID-19 vaccines. Even the cases of two adolescent deaths after vaccination cited by Mr. Kraaijeveld are not nearly as clearcut as portrayed, as pediatric cardiologist Dr. Frank Han discussed, noting that dilation of the heart (found in one boy) doesn’t occur within days and the autopsy findings were missing some key pieces of information that would definitively suggest the vaccine as the cause.
The speculation about potential “long term effects” is also a common antivaccine trope. Antivaxxers, failing to be able to make the case that routine childhood vaccines are more dangerous than the diseases that they vaccinated against, often pivot to handwaving about unknown (and undescribed and unproven) “long term” effects. Before COVID-19, those “long term” adverse events were autism, autoimmune disease, cancer (still a favorite for COVID-19 vaccines), and pretty much every major chronic illness. (Indeed, antivaxxer Robert F. Kennedy, Jr. came up with the false claim that the current generation of children is the “sickest generation“, largely due to—you guessed it!—vaccines.) The last time I dealt with the claim of “long term” adverse events (i.e., greater than a few weeks to six months after vaccination), I noted that they were very rare, so rare that Paul Thacker, for instance, had to do incredible contortions to find very rare cases that occurred only in the special case of immunosuppressed children and cite narcolepsy after the H1N1 vaccine Pandemrix, which actually occurred within weeks after vaccination—hardly “long term”.
So this section is basically one antivax argument—disguised as “bioethics,” of course!—that the “vaccine is more dangerous than the disease.” It’s not; so Mr. Kraaijeveld’s ethical argument falls apart. Next up, he appeals to a lack of sterilizing immunity.
The next arguments for vaccination against COVID-19 that Mr. Kraaijeveld takes are all based on the observation that COVID-19 vaccines do not produce “sterilizing immunity”; i.e., they do not completely prevent infection and transmission, although he does concede that they are quite effective at preventing severe disease, hospitalization, and death. Based on this observation (primarily), he takes on the argument from indirect protection and altruism and the argument from global eradication. I’ll start with the latter first, because in its service he makes an argument that caused me, literally—and I do mean literally—to facepalm as I read it. Specifically, he objects to claims that ongoing transmission will:
- lead to the evolution of viral variants that are more harmful, perhaps also for children;
- make the virus more likely to evolve to evade vaccine-derived immunity; and/or
- ceteris paribus make the long-term cost-effectiveness of eradication more favorable than control
Mr. Kraaijeveld objects to the first argument by pointing out that evolutionary fitness of an infectious virus is determined more by increased transmissibility rather than virulence, which is true as far as it goes, although he cites a 2020 paper making the argument that there was not yet evidence of SARS-CoV-2 variants with increased transmissibility. (Those would arrive a few months later in the form of the Delta and Omicron variants, the Delta variant being more transmissible than the original Wuhan strain and the Omicron variant being more transmissible than the Delta variant.) However—and here’s where the facepalm came in as I read—that is actually a strong argument, both from a scientific and bioethics standpoint, for doing everything reasonable, especially vaccination, to decrease the level of transmission to as low a level as is feasible, in order to decrease the likelihood of more transmissible variants arising. Again, as people making these arguments always seem to do, Mr. Kraaijeveld is falling prey to the Nirvana fallacy, in which an imperfect intervention is portrayed as a useless one. When someone like this argues that COVID-19 vaccines “do not prevent infection or transmission”, it implies that the vaccines don’t prevent infection or transmission at all, which is nonsense. Of course they do; they’re just not 100% effective (or, since the rise of Delta and Omicron even close to it).) The way to look at it is that the vaccines are “less good” at preventing infection and transmission than they are at preventing serious disease and death, not that they don’t prevent transmission or infection at all.
What flows from Mr. Kraaijeveld’s Nirvana fallacy is predictable. He argues, as I mentioned above, that mass vaccination of children will not contribute to preventing the development of more “harmful” variants. I note that, even as he observes that virulence and transmissibility are often incorrectly conflated, Mr. Kraaijeveld himself seems to be doing the same thing as he in essence argues against a straw man of the real argument, that decreasing transmission is useful in terms of controlling the disease, even if the vaccines don’t produce anything near sterilizing immunity. He also argues:
The notion that unbridled transmission would make the virus more likely to escape vaccine-derived immunity makes the eradication argument either self-defeating or incredibly costly. Aside from the fact that current vaccines do not prevent infection or transmission, if certain variants really are highly efficient at evading vaccine-derived immunity—or, worse still, if more variants continuously evolve to evade vaccines more efficiently—then attempts at eradication through global vaccination, and the strong evolutionary selection pressures this entails, will be met with diminishing returns for the costs of such a program.
It’s also rather funny how Mr. Kraaijeveld fails to note that these new variants are also pretty good at evading post-infection “natural” immunity as well—possibly even as good as they are at evading vaccine-induced immunity—to the point where it’s increasingly being concluded that, while it’s better to prevent COVID-19 with vaccination, if you do get it “hybrid immunity” (a combination of infection-induced and vaccine-induced immunity from getting the vaccine after you’ve recovered) is better at preventing the disease than either alone. I also note that there are few areas in the world where the vaccination rate among adults (much less among children) is anywhere near high enough to result in significant selection for variants that evade the immune response; what we are seeing is primarily a selection for increased transmissibility due to wide and largely uncontrolled circulation of the coronavirus among large populations.
Mr. Kraaijeveld also argues that children are not a major driver of COVID-19 transmission, thus making vaccinating “healthy” children pointless, because, according to him, COVID-19 is not dangerous to “healthy” children. One notes that there is more cherry picking here, given that all the studies he cites are pre-Delta and pre-Omicron. Moreover, more recent studies showing that mask mandates significantly decreased transmission suggest that schools are not as insignificant a source of COVID-19 circulation as Mr. Kraaijeveld would argue.
“Defeat the mandates!”
The last part of Mr. Kraaijeveld’s Bioethics paper opposes any sort of mandates for COVID-19 vaccines for children that are straight from the antivax playbook. First, the appeal to “parental rights”:
Mandates for children to be vaccinated against COVID-19 would limit and, depending on their nature, even override the autonomy of parents and guardians to make decisions about the health of their children. This requires ethical justification as such, but it demands stronger justification in proportion to the level of coercion that mandates would involve.100 When mandates are in place, the actors who make decisions for the health and well-being of children de facto become governments and public health officials rather than parents, although less coercive measures (e.g., small fines) might allow some parents to opt out and thereby retain decisional autonomy.101
I have to wonder right here if Mr. Kraaijeveld understands how mandates work for children, in the US at least, either from a legal or bioethics standpoint. Here, the mandate is that children require certain vaccines to attend school, but there is no legal penalty for not vaccinating one’s children other than not being allowed to enroll them in school. Certainly, there are no fines, and it’s pretty rare that parents are investigated by child protective services for not vaccinating their children. (Usually, such investigations involve far more than just not vaccinating.) He also seems unaware that most states allow religious and philosophical exemptions to these mandates, in addition to medical exemptions. In the US, at least, the “coercion” that he decries isn’t much in the way of coercion at all, which makes me wonder why he doesn’t think that, in the US at least, mandating COVID-19 vaccines for school is acceptable. Oh, wait. As discussed above, he echoes—unknowingly, I hope, but possibly knowingly I fear—antivaccine talking points about them, such as the claims that COVID-19 doesn’t harm “healthy” children, that the vaccine is more dangerous than the disease, that it doesn’t produce “sterilizing immunity” and is therefore useless in contributing to herd immunity, and other arguments. He then marshals such old bogus antivax tropes as “bioethics.”
For COVID-19, vaccines are safe and effective in higher-risk groups, including older adults and the immunocompromised,59 and significantly reduce the risk of severe illness even when vaccinated groups are exposed to substantial community transmission.60 While there are some people for whom the current COVID-19 vaccines are contraindicated (e.g., those with severe allergies), this group appears to be small.61 It is therefore not the case that vulnerable groups cannot protect themselves, which would make routine vaccination of less vulnerable groups—children, in this case—more compelling. Moreover, as argued above, children are not major drivers of COVID-19 transmission. As such, there is no strong ethical justification for COVID-19 vaccination of healthy children for the sake of vulnerable groups.
This is, in essence, the same argument that Great Barrington Declaration authors make about all interventions to prevent the spread of COVID-19—including masks, “lockdowns,” and vaccines—namely that it’s possible to protect the “vulnerable” (“focused protection”) and that no intervention should be permitted that is not completely voluntary. Unsurprisingly, consistent with this Mr. Kraaijeveld is apparently not a fan of nonpharmaceutical interventions, such as masks and “lockdowns,” to slow the spread of COVID-19 either, viewing them as ethically problematic as well.
Bioethics? More like antivaccine tropes recycled!
To summarize, Mr. Kraaijeveld argues that, because current COVID-19 vaccines do not produce sterilizing immunity, herd immunity is not achievable, and vaccinating children doesn’t protect others, nor would vaccinating them prevent the evolution of more harmful and/or immune-evading variants, and, as a result, vaccinating children is not ethically supportable, and vaccine mandates of any kind for COVID-19 are completely unjustifiable from an ethical standpoint. Of course, he fails to mention that most vaccines do not produce sterilizing immunity. It’s not as though this hadn’t been discussed at the time the vaccines were being rolled out or that scientists hadn’t recognized that COVID-19 vaccines were unlikely to produce true sterilizing immunity. It’s just plain incorrect to argue that you have to have sterilizing immunity for a vaccine to contribute to herd immunity or even the elimination of a disease. For example, the smallpox vaccine did not produce sterilizing immunity; yet, as has been observed, it was crucial in eradicating smallpox. Neither the Salk (inactivated) nor the Sabin (live attenuated) polio vaccine produces sterilizing immunity, but the global eradication of polio is within reach, thanks to the vaccines:
Also, while we’re on the topic of polio, it turns out that the same appeal to the “disease doesn’t kill that many children” argument can be made for polio (and was made for it by antivaxxers):
One wonders whether Mr. Kraaijeveld similarly questions—on the basis of bioethics, of course—whether routine polio vaccination is advisable, as well. Just as most of his arguments could be used against routine measles vaccination, similarly most of them could also be used against polio.
The case of rotavirus—which causes severe vomiting and watery diarrhea and is especially dangerous to infants and young children—is fairly straightforward. Vaccination limits, but does not stop, the pathogen from replicating. As such, it does not protect against mild disease. By reducing an infected person’s viral load, however, it decreases transmission, providing substantial indirect protection. According to the Centers for Disease Control, four to 10 years after the 2006 introduction of a rotavirus vaccine in the U.S., the number of positive tests for the disease fell by as much as 74 to 90 percent.
In other words, it is not a prerequisite that COVID-19 vaccines prevent transmission completely for them to be very valuable in curbing the pandemic. Moreover, newer generations of COVID-19 vaccines might actually be able to achieve sterilizing immunity. I also note that it has long been a favorite antivaccine argument to cite one vaccine in particular that doesn’t provide sterilizing immunity, specifically the pertussis vaccine, whose immunity also wanes with time, like that from COVID-19 vaccines.
While issues of freedom and parental rights are issues of bioethics and law about which there will always be some subjectivity based on differing belief systems and about which reasonable people can disagree, accurate science and data are required to have reasonable debates about how much the state should be allowed to infringe upon individual freedom and autonomy as well as parental rights. By massively downplaying the severity of COVID-19 in children in a manner that is, quite frankly, eugenicist in its emphasis on the disease supposedly being pretty close harmless to healthy children—not to mention based on cherry picked data primarily from before the Delta and Omicron surges—and exaggerating the dangers of the vaccine, Mr. Kraaijeveld, whether he realizes it or not or will admit it or not, tilts the playing field in favor of his arguments in the same intellectually dishonest manner that antivaxxers have long done. He even recycles their arguments, as the way his appeal to the lack of sterilizing immunity due to COVID-19 vaccination and his claim that COVID-19 is close to harmless to most “healthy children,” both of which are old antivaccine claims used for a number of vaccines in the past, but particularly MMR, rotavirus, and varicella.
All of these reasons are why I now eagerly await Mr. Kraaijeveld’s next bioethics treatise arguing that we should not routinely vaccinate children against measles because the disease doesn’t kill that many kids and that we shouldn’t vaccinate against polio, pertussis, and most other childhood diseases because the vaccines don’t produce sterilizing immunity and therefore cannot produce herd immunity or contribute to the elimination of the disease. After all, if he’s going to recycle, he should go all-in and recycle everything. Surely another prominent Bioethics paper awaits!.
Meanwhile, people who like Mr. Kraaijeveld’s message have predictably gone all Humpty Dumpty about words and argue that an article titled “Against COVID-19 vaccination of healthy children” is not actually arguing against vaccinating children against COVID-19:
Same as it ever was.