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A healthcare worker prepares a dose of the Pfizer/BioNTech COVID-19 vaccine at Woodbine Racetrack pop-up vaccine clinic in Toronto on May 5, 2021.CARLOS OSORIO/Reuters

As provinces open up COVID-19 vaccinations to children, some health professionals are debating whether it’s the right move – not because of safety, but because others are in greater need.

While children tend to be at considerably lower risk of severe COVID-19, many Canadians at high risk of death and hospitalization are still awaiting their second doses, some health experts say. And in other parts of the world, deaths are skyrocketing in countries with large unvaccinated populations.

“It feels tough to be vaccinating folks who are really at low risk of an adverse outcome, when you can’t avoid seeing on television how horrific it is in some parts of the world,” said Stefan Baral, a family and population health physician in Toronto and associate professor in the department of epidemiology at Johns Hopkins Bloomberg School of Public Health in Baltimore.

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Starting Monday, Albertans 12 and older will be eligible to book their COVID-19 vaccinations, and in Manitoba, those 12 and up may be able to start booking by May 21. This move to lower the age of eligibility follows Health Canada’s approval last week of the Pfizer vaccine for those 12 and older. Meanwhile, trials are under way among children under 12. But as more vaccines become available to younger age groups, health professionals are debating when and how children should be vaccinated.

While some say vaccinating children is necessary to protect the rest of the population and ensure their safe return to school, others say the risks and benefits must be weighed for each child, instead of vaccinating them as a matter of course.

For children with underlying health conditions at risk of severe clinical outcomes related to COVID-19, “it makes perfect sense” to vaccinate them, Dr. Baral said. But, he said even though he believes the vaccine is safe for those 12 and up, as approved in Canada, he questions the argument for vaccinating children to achieve herd immunity. In a recent opinion piece in The BMJ, he and his co-authors said the benefits of COVID-19 vaccines are enormous for adults, but relatively minor for children.

“We don’t give medications to people for often population-level benefits. It still needs to make sense at the level of the individual,” he said.

As such, instead of holding mass immunization clinics for children, Dr. Baral said it would be a good idea to offer vaccines to them in settings where family doctors, nurse practitioners, pediatricians or pharmacists can have discussions with parents and children so they can make an educated and informed decision.

COVID-19 is not benign in children, but it is much less dangerous to those 12 to 16 than older age groups, said Zain Chagla, an associate professor of medicine at McMaster University in Hamilton. Like Dr. Baral, he said children 12 and up with immune deficiencies, those on dialysis, cancer patients and those with respiratory and neuromuscular issues should be added to the queue for vaccines for their personal protection.

But, he said, vaccinating adults aggressively will have a much greater effect on preventing the health care system from becoming overwhelmed than vaccinating children – and there are still many adults in Canada who have not received vaccines. Moreover, Canada must consider the vaccination needs of other countries, he added.

“We, as a global partner, have to start looking at when is too much. Like when are we starting to go too deep into our population for the sake of making ourselves feel better for very tiny risks?” he said, especially when countries, like India, are experiencing mass devastation.

For parents such as Lisa Johnson-Adams in Toronto, there are no easy choices. Ms. Johnson-Adams said she is very much in favour of vaccines, in general. Her 15-year-old son, whom she has kept home from school for the past year to protect him from COVID-19, has received all his previous vaccines, and she herself has received her first dose of a COVID-19 vaccine. But for his sake, she’s worried COVID-19 vaccines may have long-term side effects that have yet to come to light.

“I don’t feel safe with either one, neither the vaccine nor the virus,” she said.

Safety is among the top concerns Vancouver pediatrician Ran Goldman hears from parents and adolescents about COVID-19 vaccines. Dr. Goldman, a professor in the department of pediatrics at the University of British Columbia, said he responds to their queries by telling them Health Canada has reviewed the studies very carefully, and has approved the vaccines based on the existing evidence. He added that work on mRNA vaccines, like Pfizer’s and Moderna’s, has been going on for many years, and did not start with the pandemic.

Kelly Grindrod, a pharmacist and associate professor at the University of Waterloo’s school of pharmacy, said even though children don’t tend to get the sickest from COVID-19, they can pass it on. And the harms of the coronavirus to children go beyond the risk of illness, including loss of learning and unsafe home environments when schools are closed, Dr. Grindrod said.

“Kids may not get COVID in the same way,” she said. “But kids have had probably some of the greatest losses in this pandemic.”

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