Kids, COVID, Vaccines and School – Q&A with Dr Phoebe Williams

By James Hutton and Nicola Smith on October 28, 2021 in News

Dr Williams working in Mombasa, Kenya back in 2017. Photo: Hamish Gregory

With NSW coming out of lockdown, and a large part of our COVID-19 strategy going forward dependent on vaccination rates, many of us are wondering how safe it is for our kids to be going back to school, whether they should be vaccinated and why every country seems to have a different set of rules around vaccinating children.
Rather than asking our yoga teacher or the local barista, we thought we’d ask Clovelly local Dr Phoebe Williams, a paediatrician and infectious diseases physician, for some informed advice. Dr Williams completed her PhD with the Oxford Tropical Medicine Network and currently works as a clinician and researcher in Sydney.

Many Eastern Suburbs parents are concerned about sending their kids back to school too soon; is now the right time? We’ve made kids put a lot of their lives on hold for an infectious disease that really predominantly affects adults, and we’re starting to see the mental health burden of lockdown in kids. Getting kids back into classrooms as soon as we can through lots of different strategies – like safe returns to school and getting kids vaccinated and, most importantly, getting their parents vaccinated, which we know is the number one way to prevent kids from getting COVID – is very important.

Are cases going to skyrocket with unvaccinated kids all mingling at school? We can expect there to be more COVID in the community with kids going back to school, but that’s not necessarily due to transmission in children, which is where getting people’s heads around COVID and kids is really tricky. What has shocked us as doctors is that, unlike most viruses, kids don’t seem to get severe COVID, and they’re also not good transmitters of the virus. When schools open up we are likely to see more COVID, but that’s largely because adults will be moving about more as part of that process.
The National Centre for Immunisation Research and Surveillance (NCIRS) has done a really fantastic study looking at how COVID transmits within a school. We know that when kids have COVID in a classroom environment they’re not actually that good at passing it on, but when a staff member comes into a school environment with COVID it can more readily spread between adult staff members, or from adults to children. So vaccinating adults is really important.
Even with the delta strain, which we say is five times more transmissible in school environments, we see less than five per cent onward transmission from index cases to others. When you weigh that very small transmission risk against the benefits of getting kids back to school, the balance is clear.

What is the Australian health advice on vaccinating children, and how does it compare to the advice in other countries? Because COVID is frequently such a mild illness in kids, it’s been a challenge for policy makers to weigh up the practicalities of broad vaccine roll outs, alongside the rare (yet often mild) side effects vaccines may cause, like myocarditis or pericarditis. Alongside the local levels of population immunity (or lack thereof), these are the sort of considerations vaccine regulators weigh up in decisions about vaccinating younger and younger age groups. There’s also the ethical question of using more vaccines to protect children who frequently have a mild illness, when only two per cent of adults in low and middle-income countries are vaccinated to date. Unless we have equity with our vaccine distribution, we could also see more variants of concern emerge across the globe.
Why do the UK, US and Australia all have different policies on vaccinating children? In
England, the initial recommendation of the Joint Committee on Vaccination and Immunisation (JCVI) was to not vaccinate healthy teenagers, because when they looked at blood tests at a population level it was clear that two thirds of children had already been exposed to COVID. So when they weighed up the risks and benefits, the cost and the diversion of health resources to vaccinate their children when the vast majority were already immune to COVID, the advice was that for the majority of kids, the benefits weren’t there. Subsequently, their government has changed that policy to provide one dose of vaccination to adolescents. Then we have other countries like the US who want to vaccinate as young as they can, as quickly as they possibly can.
Australia has met somewhere in the middle. The Australian Technical Advisory Group on Immunisation (ATAGI) has advised that teenagers do get vaccinated, which I think is a really important strategy to get kids back to school because teenagers are better spreaders of COVID than younger kids, and if there is a group that are more likely to end up in hospital with symptoms, it is that age group.
Even though the clinical risk for an individual teenager with COVID is very small, from a societal perspective, to be able to get them back in the classroom and get society opening up again, and for kids to be socialising and playing sport again, it’s well and truly worthwhile.
We have lots of safety data around vaccines, and what we know when we look at most of the vaccines that have been created over the last few hundred years is that there’s really no evidence to suggest that vaccines suddenly cause harm many years or months down the track. Most of the safety concerns around vaccines or adverse effects happen very soon after vaccination and those concerns have been identified.

What advice do you have for parents who are worried about vaccinating their kids or sending them back to school? My advice for parents is that while it’s really hard to find good reputable resources, I would just avoid clickbait headlines and instead look for clear resources like NCIRS.org.au who have an FAQ page that is updated every week in response to things that come up in the media. None of us are experts in the shifting sands of a pandemic, and we need to be flexible and adjust to new info as it comes in.