Should COVID Shots for Teens Go to Developing Countries?

Lindsay Kalter

May 06, 2021

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U.S. officials are poised to authorize the Pfizer COVID-19 vaccine for children 12 to 15 years old, while some countries still struggle to vaccinate health care workers risking their lives daily.

The move to immunize teenagers has spurred an ethical debate among medical professionals: Should those doses set for American teens go abroad instead?

"I think the answer is quite clear," says Craig Spencer, MD, director of global health in emergency medicine at Columbia University Medical Center. "If I were to ask, 'Who should be vaccinated first: a healthy 12-year-old or a 57-year-old health care working taking care of COVID-19 patients?' most people would say the health care worker."

"Why should it matter if these two people are in different countries?"

Pfizer CEO Albert Bourla, PhD, said in a conference call with investors Tuesday morning that the FDA could give the green light early next week -- welcome news to parents nationwide as coronavirus rates continue to rise among adolescents. On March 31, Pfizer announced that the vaccine "demonstrated 100% efficacy" in 12- to 15-year-olds.

According to a joint report from the American Academy of Pediatrics and the Children's Hospital Association, children made up 22.4% of new cases reported during the week of April 29.

The vaccination program in the United States is moving quickly, and President Joe Biden aims to have 70% of Americans with at least one shot before July 4. Meanwhile, in India, the vaccination rates hover around 11%, and less than half of India's health care workers are immunized.

"It's like we have a massive buffet feast and bought an extra one to keep in the freezer, while other people are outside starving," Spencer says.

The administration announced plans in late April to send 60 million doses of the AstraZeneca vaccine to countries in need. But that won't be enough to help resolve the humanitarian crisis, he says.

Spencer is just one of many voices in the public health realm pushing for more international help from the U.S. University of Florida College of Medicine biostatistician Natalie Dean, PhD, says although the logistics of redirecting doses would be complex -- factoring in supply chains, refrigeration needs, and regulations -- "the optics of vaccinating teenagers while vaccination rates in developing nations are so low are notable."

"There are many pathways the U.S. government could pursue to reduce these inequities."

The situation presents a moral dilemma over "vaccine nationalism" -- a principle rooted in the idea that a country should vaccinate its own population before moving on to other populations, says David Beyda, MD, chair of the Department of Bioethics and Medical Humanism at the University of Arizona College of Medicine in Phoenix.

"Giving it to kids is going to move us toward herd immunity. From an ethical perspective, the primary concern is getting as many people vaccinated here as possible," he says.

But herd immunity is no longer an integral part of the administration's rhetoric. Presidential adviser Anthony Fauci, MD, has called the concept "mystical" and "elusive" because it is still unclear how many people must be vaccinated to reach it.

But Beyda says the effort to achieve herd immunity should continue.

"If we reach herd immunity, we do; if we don't, we've given it our best try," he says.

On the same call in which Bourla told participants about the upcoming approval, he also said data from a trial for 2- to 5-year-olds and 5- to 11-year-olds will be ready to submit to the FDA by September.

But that may be harder to justify if other countries are still struggling, says Arnold Monto, MD, an epidemiologist at the University of Michigan School of Public Health and acting chair of the FDA's Vaccines and Related Biological Products Advisory Committee.

"The issue of getting even younger people vaccinated is a tougher one. There might be some debate there because they've not been that involved in infection rates," he says. "The key element to get this working is that you really need to get disseminated vaccination or immunity through infection, and to do that, it's important to get into the 12-15 age group."


Children's Hospital Association and American Academy of Pediatrics: "Children and COVID-19: State Data Report."

Pfizer: "First-Quarter 2021 Earnings Conference Call Prepared Remarks May 4, 2021," "Pfizer-BioNTech Announce Positive Topline Results of Pivotal Covid-19 Vaccine Study in Adolescents."

Times of India: "Only 37% of 3 crore health, frontline workers fully vaccinated."

Craig Spencer, MD, director, global health in emergency medicine, Columbia University Medical Center.

Natalie Dean, PhD, biostatistician, University of Florida College of Medicine.

David Beyda, MD, chair, Department of Bioethics and Medical Humanism, University of Arizona College of Medicine, Phoenix.

Arnold Monto, MD, epidemiologist, University of Michigan School of Public Health; acting chair, FDA Vaccines and Related Biological Products Advisory