Covid-19: Vaccination of Children

Miriam Cates Excerpts

Tuesday 21st September 2021 Westminster Hall

[Dame Angela Eagle (in the Chair)]

Before we begin, I encourage Members to wear masks when they are not speaking. This is line with current Government guidance and that of the House of Commons Commission. Please also give each other and members of staff space when seated, and when entering and leaving the Chamber.

[Miriam Cates (Penistone and Stocksbridge) (Con)]

I beg to move,

That this House has considered the vaccination of children against covid-19.

It is a pleasure to serve under your chairmanship, Dame Angela. I thank the Backbench Business Committee for granting this important debate, and draw Members’ attention to the three e-petitions that relate to this topic, which have amassed more than 100,000 signatures between them.

Vaccination has transformed public health over the last two centuries. As a science teacher, I remember teaching students about the amazing work of Edward Jenner, who famously developed the smallpox inoculation. Two hundred and fifty years later, vaccinations have again ridden to our rescue with the rapid development and roll-out of covid vaccines across the UK. The phenomenal success of the vaccination programme can be seen clearly in the data. Of the 51,000 covid-related deaths from January to July this year, 76% were of unvaccinated people, and a further 14% had received only a single dose. Just 59 deaths—0.1%—were of double-vaccinated adults with no other risk factors, and 92% of adults now have covid antibodies.

Those figures are a ringing endorsement of the Joint Committee on Vaccination and Immunisation’s strategy to recommend vaccination based on the medical benefits and risks to the individuals concerned. The Government have repeatedly defended both this strategy and the independence of the JCVI, and resisted calls to prioritise the vaccination of teachers or police officers over those at higher risk of serious illness. That was the right approach, and the UK has led the world in falling rates of deaths and hospitalisations.

It was therefore surprising, to say the least, when the Government put political pressure on the JCVI to quickly reach a decision about the vaccination of children. On 3 September 2021, the JCVI announced that it was unable to recommend the mass vaccination of healthy 12 to 15-year-olds. The reason was that, although there are marginal health benefits of covid vaccination to children based on the known risks of the vaccine, there is considerable uncertainty regarding the magnitude of the potential harms, such as the long-term effects of myocarditis.

Paediatrician and JCVI member Adam Finn wrote in The Sunday Times that a high proportion of myocarditis patients showed

“significant changes of the heart. It is perfectly possible that these changes will resolve completely over time. But it is also possible that they may evolve into longer-term changes.

Until three to six months have passed, this remains uncertain, as does what impact on health any persistent changes may have.”

According to the JCVI, for every 1 million healthy children vaccinated, two intensive care unit admissions will be prevented, and three to 17 cases of myocarditis caused. With two doses, that rises to between 15 and 51 cases—finely balanced, indeed.

There is no rush to roll out the vaccine to children. We know that children are not at risk from covid; teachers are no more at risk than the rest of the population; the vast majority of vulnerable adults have been vaccinated; over half of children already have antibodies; and there is no evidence that schools drive transmission.

[Fiona Bruce (Congleton) (Con)]

My hon. Friend the Member for Penistone and Stocksbridge (Miriam Cates) is making an excellent speech, and she is quite right that the Government’s vaccination roll-out programme has been very positive. However, does she share my concerns about the message it sends out regarding parental authority if children as young as 12 are allowed to challenge their parents’ decision regarding their vaccination?

[Miriam Cates]

I agree with my hon. Friend: there are some very difficult issues around parental consent and the vaccine, and whether any child can know enough about the potential benefits and risks. This is going to be a very difficult question for schools, health authorities and parents. I will say more about that later on.

[Chris Green (Bolton West) (Con)]

The advice being given out on consent forms states that you get to see your family doctor. However, when I and my hon. Friend the Member for Winchester (Steve Brine) challenged the former vaccines Minister, my right hon. Friend the Member for Stratford-on-Avon (Nadhim Zahawi), on the ability of families to access their family doctor to get advice about vaccines, he could not and would not give an assurance that families could have that advice. Is not such access necessary, especially if the Government are stating on the vaccine form that you do have that access?

[Dame Angela Eagle (in the Chair)]

Order. Before I call Miriam to continue, Members ought to realise that when they say “you” they are referring to the Chair. Can we please try to get the formalities right? I know that it is less important on Zoom, but we are now back.

[Miriam Cates]

My hon. Friend is right. It is widely known that access to GPs is challenging at the moment, and that presents challenges in this situation. It is widely understood that if a child can consent, contrary to parental consent, that is not a tick-box exercise; it is a matter for a medical professional to assess whether the child is competent to consent. If there are problems accessing GPs, there are clear issues here.

There is no rush to roll out the vaccine, and there is no evidence that schools drive transmission. Indeed, recorded covid cases are now at their lowest level since June, despite schools having been open for two weeks. It is also unlikely that vaccinating children will have a major impact on infection rates in the population as a whole, with the JCVI saying that

“the committee is of the view that any impact on transmission may be relatively small, given the lower effectiveness of the vaccine against infection with the Delta variant.”

However, instead of accepting the JCVI’s assessment and waiting for more evidence to emerge, the Government asked the chief medical officer urgently to review the decision based on the wider benefits to children, including from education. Last week, the CMO announced that he would recommend child vaccinations on the basis of these wider benefits.

That decision is a marked departure from the principle of vaccinating people for their own medical benefit, because those wider issues—educational disruption and concerns around mental health—are the consequences of policy decisions and are not scientific inevitabilities. Children in the UK have already missed more education than children in almost any other country in Europe, despite comparable death rates. Since January 2020, British children have lost on average 44% of school days to lockdown and isolation. That is not a consequence of covid infections in children, but rather a result of policy decisions to close schools and isolate healthy children.

According to the Government’s modelling, vaccinating children could save 41 days of schooling per 1,000 children between October and March. That equates to an average of just 15 minutes of education saved per child over this period—surely an insignificant amount, and negligible when we account for the time it takes to vaccinate and the subsequent days off school to recover from potential side effects. There is a much simpler way to stop harmful educational disruption, and that is to follow the advice of the Royal College of Paediatrics and Child Health and end the mass testing of asymptomatic children. This unevidenced and unethical policy is costing tens of millions of pounds a week—I would be grateful if the Minister could confirm the exact cost—and is continuing to disrupt education. Even the CMO acknowledges that a vaccination programme alone will not stop school closures. Perhaps the Minister could clarify how the Government intend to end educational disruption.

On the potential mental health benefits from reducing the fear of covid, it is not covid infection that is making children fearful; it is the uncertainty, frustration, loneliness and anxiety that they experience as a result of lockdowns and harmful messages such as, “Don’t kill granny.” Children need not fear catching covid, but they have every right to fear policy decisions that cause them significant harm, and sadly we cannot vaccinate against those.

Nonetheless, the decision has been made, and we have to be very clear that the risks to children, both from covid and from vaccines, are tiny. Concerns should now focus on making sure that the necessary safeguards are put in place as vaccination is rolled out. The previous vaccines Minister, my right hon. Friend the Member for Stratford-on-Avon (Nadhim Zahawi), assured MPs that there will be no differential treatment of children in schools on the basis of their vaccination status. That is crucial, because any suggestion that unvaccinated young people may be denied education or be subjected to social disadvantage will inhibit the ability of both parents and children to make a free and objective decision. While I appreciate Ministers’ commitments, children already face discrimination in some schools over mask wearing and testing.

We must also make sure that travel rules that differentiate between vaccinated and unvaccinated children do not amount to coercion when parents are making a decision. Can the Minister say how we will ensure that there is no discrimination in practice as well as in theory?

Vaccination must be a free and informed decision. Choosing to have or not to have the vaccine are both perfectly reasonable and sensible decisions where children are concerned. We must ensure that correct and impartial information is communicated and, as my hon. Friend the Member for Congleton (Fiona Bruce) said, that there is access to health professionals where necessary. Parental consent must also be respected. Much has been said on this subject, but the heart of the matter is that parental responsibility and authority are foundational to society.

I am optimistic that these protections can and will be put in place. None the less, the way that the decision to vaccinate healthy 12 to 15-year-olds has been made should give us pause for thought. For no other cohort have the Government questioned the JCVI’s advice. Why have we departed from this stance when it comes to children and looked for reasons other than direct medical benefit to press ahead? When there are concerns about the future health of our children, why have we not waited for more evidence to emerge? I fear that this situation, rather than being an isolated incident, epitomises a worrying attitude to children that has been evident since the start of the pandemic.

Throughout the past 18 months, “protect the vulnerable” has been our clarion call. We have rightly made significant efforts to protect elderly people and those who are particularly susceptible to covid, but children, who cannot speak out, do not own property, and have no legal agency, are also very vulnerable. Yet during the pandemic, we have asked this group of vulnerable people to make huge sacrifices to protect the rest of us. The harms of lockdown for our children are significant and, for many, will be irreversible: lost education, missed opportunities, abuse and horrific online harms. The number of children presenting in A&E with acute mental health conditions has risen by 50% since the start of the pandemic.

A climate of fear and uncertainty has robbed children of the structure, routine and security that they need to thrive and has placed on them a heavy emotional burden from inferring that they may be responsible for the deaths of those they love. We have pretended that online learning is somehow a substitute for being in schools, and closed our eyes to the consequences of social isolation for children and young people.

Of course, we should raise our children to take responsibility for their actions, but as adults we should always shoulder the greater burden. We have imposed absurd rules on our young people, right down to deciding whom they can play with at playtime and whether they are allowed to change for PE.

However, we have not seen that much action to urge adults to take responsibility for their own covid risk by, for example, losing weight or exercising—something that would have had a far greater impact on our rates of hospitalisation and death.

[Chris Green]

Does my hon. Friend recognise that the Government, in their approach to lockdown, are creating some of the problems they believe make the situation worse? Weight Watchers and other organisations have said that people coming to them have put on an average of about 6 to 8 lb in weight, and are therefore physically more vulnerable now to covid and other health problems than they were before the pandemic.

[Miriam Cates]

My hon. Friend is absolutely right and I am sure we can all empathise with those who have put on some lockdown pounds. A study, I think last week, showed that countries where over 50% of the adult population is overweight have experienced 10 times the death rate. A really effective way of reducing our risk in future would be to divert some of the money we are spending on testing asymptomatic people into drives against obesity and for exercise. That is an excellent point.

Even now, as adults, we are able to move freely from home to work, to Parliament and to the pub with no restrictions, yet children are still subject to asymptomatic testing, and many are being forced to wear masks in school and are missing out on important opportunities. We cannot expect our children to face greater restrictions than we ourselves are willing to bear. As a mother, I have despaired as I have watched the impact of those restrictions on my children and others. The stories that I have heard from constituents, particularly the parents of disabled children and those with additional needs, are horrifying. Millions of families have had to endure this. I pay tribute to UsforThem, which is working tirelessly to stand up for children and campaign for their lives to be allowed to return to normal.

What has saddened me most is the negative attitude to children that seems to have pervaded so much of our public discourse—especially the view that teenagers have behaved irresponsibly throughout the pandemic. That view is just not borne out by evidence. A study by King’s College London shows that, despite half of adults saying that young people have been selfish by ignoring restrictions, all age groups have been “remarkably compliant” and perceptions of selfishness are driven by “fake stereotypes”.

We seem to have forgotten what it means to be a child. We have forgotten that playing with other children, taking risks, feeling valued and enjoying physical contact with others are vital to healthy development. As a society, I fear that we are becoming a bit like Grandma from Roald Dahl’s “George’s Marvellous Medicine”:

“‘You know what’s the matter with you?’ the old woman said, staring at George over the rim of the teacup with those bright wicked little eyes. ‘You’re growing too fast. Boys who grow too fast become stupid and lazy.’

‘But I can’t help it if I’m growing fast, Grandma,’ George said.

‘Of course you can,’ she snapped. ‘Growing’s a nasty childish habit.’”

Things did not end well for Grandma, and things do not bode well for us if we fail to understand the nature and importance of childhood. Children are not disease spreaders, they are not a buffer for our healthcare system, and they are not an economic inconvenience. They are a blessing, they are our hope for the future, and their nurture and welfare should be our primary responsibility.

I am heartened by the care that has so far been taken by the JCVI, the chief medical officer and Ministers to reassure children and parents about the decision to vaccinate our young people, but looking forward we must recommit to putting the genuine and long-term interests of our youngest and most vulnerable citizens at the front and centre of policy making and prioritise their welfare as we recover from the pandemic.

--- Later in debate ---

[Chris Green]

My right hon. Friend makes exactly the right point. In school settings, it will be incredibly difficult to do this, and it will be variable. It will depend on the culture of the school and the school leadership. Some schools will be open and objective, and will say, “We will respect you, the family, for the decisions you make on behalf of your family,” but I am pretty certain that other schools will have a very difficult and challenging atmosphere for those 12-year-old children and their families if they do not comply.

I think that is a very dangerous route for us to go down and will cause so much pressure. That leads on to an immensely important point. Traditionally in the United Kingdom, our approach to vaccinations has been one of non-compulsion. Our vaccination take-up across the board has been very high because people trust the vaccination programme and that these things, which we can take voluntarily, are there for our own good. We do not need coercion to take them; they are there for our good so we will take them. What repercussions will we face in years to come now that there is a toxification due to the imposition of these vaccines?

What, furthermore, do we see? We see that the first and second waves had a huge impact on us, but the third wave is far less impactful. All our vaccines are effective against all variants of concern. We see compulsory vaccination in the care sector, no doubt shortly to be rolled out into the national health service, and therefore after that to other sectors in society. We see the establishment of the idea of vaccine IDs and domestic ID cards. There is a pause at the moment in England, but those causes are being advanced in Scotland and Wales. In many ways, we can objectively say that we are almost through the worst of the pandemic, yet the more draconian or authoritarian measures are being introduced at this stage. It is perverse.

[Miriam Cates]

My hon. Friend is making an excellent speech. He makes a very good point about trust in vaccinations, because we have an outstanding system of child vaccinations in this country, with very high uptake and no compulsion at all. That is predicated on the fact that parents know that those vaccines are without doubt in their children’s best interests. Polio, measles and all those other diseases are child killers and life-altering. Even if the risks are low, they are considerably higher than the vaccine. Therefore, understanding and trust are vital. Does he agree that it is very important to have transparency around the concerns now so that parents make a free decision and it does not impact on the outstanding roll-out of other vaccines that are very much in our children’s best interest and vital for continued public health?

[Chris Green]

I absolutely agree with my hon. Friend. Confidence needs to be restored in the wider vaccine programme. There needs to be a renewal of focus, because vaccinations for infants have dipped—slightly, but they have dipped. For older children and teenagers, the wider vaccine programme has dipped more substantially, so we need a significant catch-up in our broader vaccine programme.

We will also see increased concerns as drug companies seek approval to get the age for covid vaccines reduced to five years old. We therefore see the potential for an undefined point at which we can declare our position a success. If we do not have a clear understanding of what success means, will Government advisers say, “We now have approval for drugs to be given to five-year-olds, and that is the next step”? That question is for my hon. Friend the vaccines Minister, whom I welcome to the Front Bench. Will she clarify a couple of points? We here, broader society and health professionals outside the scope of Government can understand the end point. Professor Whitty said that at a certain point we will be able to treat the coronavirus as we treat influenza. What are the objective criteria by which we and others can judge that?

I asked the Minister’s predecessor, my right hon. Friend the Member for Stratford-on-Avon (Nadhim Zahawi), about the transition point when we as a society understand that we have moved from a pandemic disease where we need restrictions and other lockdown measures, and when we move to an endemic disease where we treat coronavirus as we treat influenza and other diseases, many of which are incredibly dangerous to people who are vulnerable—influenza is very dangerous for vulnerable people. We need to know when coronavirus goes from pandemic to endemic. We need objective criteria, because when the previous vaccines Minister replied to me, I could define what he said as, “We come out of pandemic status tomorrow” or, “We come out in 10 years’ time.” I do not think that is good enough when schools and families need more certainty.

--- Later in debate ---

[Liz Kendall (Leicester West) (Lab)]

It is a pleasure to serve under your chairmanship, Dame Angela. I welcome this timely and important debate, which has been secured by the hon. Member for Penistone and Stocksbridge (Miriam Cates).

My Labour and I colleagues strongly welcome the fact that children aged between 12 and 15 are now being offered their first dose of a covid vaccine, following advice from all four of the UK’s chief medical officers. That is something we have been calling for since June. It will have both direct and indirect health benefits for children, and it will help to keep them in school, which is vital after all the face-to-face learning they have missed out on and the impact that it could have on their long-term life chances. Vaccinating 12 to 15-year-olds will also help their families and the wider community by helping to keep infection rates down.

The latest figures show that there were 36,000 new infections in the last 24 hours. There are 7,847 people in hospital with covid-19. The average number of daily deaths over the last week has risen to a tragic 142. In my own city of Leicester, rates remain highest among 11 to 16-year-olds, with a considerable increase over the last month, so there is not a moment to waste.

We have been calling on the Government since the start of the summer to press ahead with a vaccination programme for children. Back in June, the shadow Minister for Schools, my hon. Friend the Member for Hove (Peter Kyle), argued that if covid vaccinations for children were found to be safe, as the Medicines and Healthcare Products Regulatory Agency clearly says they are, they should be rolled out over the summer holidays, before the beginning of the new academic year, to help to keep disruption in schools to a minimum.

In July, the shadow Health Secretary, my right hon. Friend the Member for Leicester South (Jonathan Ashworth), pressed the Health Secretary on why covid-19 vaccinations were being given to children in the United States, Canada, Israel, France, Austria, Spain and Hong Kong, but not here in the UK. I am sad to say that, at that stage, the Government failed to act. Although we are rightly proud of the amazing vaccination programme delivered by our NHS, the truth is that we are now being overtaken by other countries, and that is due in no small part to the vaccination of children.

France was one of the first to offer vaccines to children, back in June, and now 68% of children aged 12 to 18 have received a single dose. In Italy, the figure is 62% and in Spain 79%. Israel, the United States, Canada, Sweden, Poland and Switzerland have also raced ahead. While our Government spent months delaying on this vital issue, countries across the world acted, and they are now streets ahead of us in protecting children, their education and the wider community. It is vital that we catch up.

[Miriam Cates]

I thank the hon. Member for the important points that she is making. Does she believe that it is important to follow what other countries are doing, and to roll out the vaccine almost on the basis of an international competition, or is it more important to be safe? Does she not think that the fact that we were in advance of many other countries, and we broke the link between case rates and deaths early on, gives us more space to breathe and allows us to take longer to make finely balanced decisions about vaccinating children?

[Liz Kendall]

I am sure the hon. Lady is not suggesting that all those other countries have made decisions that are not based on the evidence, because to say so would be insulting to them. I believe that we should base our decisions on evidence and advice from the experts, and I will come on to say more about that. That is what has happened in other countries. I just wish we had done it earlier in this country.

[Miriam Cates]

The hon. Lady is absolutely right; I am not saying that other countries are not basing decisions on their own evidence. I am saying that the success of our programme was based on the JCVI’s advice and its particular method of offering vaccination based on individual medical benefit, which gave us an incredible advantage that could have allowed us to wait a further six or nine months to make this decision.

[Dame Angela Eagle (in the Chair)]

Prior to the hon. Lady responding, the hon. Member for Penistone and Stocksbridge must remember that she has to put questions.

--- Later in debate ---

[Maggie Throup]

I thank my hon. Friend for his intervention, and I reassure him that the evidence is continually being observed and recorded. Further advice will be taken on whether a second dose is needed for the younger age range. Evidence is being gathered all the time.

I appreciate that there are questions about how the process of consent will work in circumstances where parents and children disagree. I reassure my hon. Friend the Member for St Ives (Derek Thomas) that, as with all vaccinations for children, parental consent will be sought. The consent process is being handled by each school in its usual way and provides sufficiently for parents to give their consent. Children aged 12 to 15 will also be provided with information, usually in the form of a leaflet for their own use and to share and discuss with parents prior to the date on which the immunisation is scheduled.

Parental, guardian or carer consent will be sought by the school age immunisation service prior to vaccination, in line with other school vaccination programmes. That service will carry out the vaccinations, and I trust that that reassures my hon. Friend the Member for Northampton South. The school age vaccination service has vast experience of dealing with a number of other vaccine roll-outs in secondary schools, such as the human papillomavirus vaccine and the three-in-one teenage booster that protects against tetanus, diphtheria and polio. The clinicians who work on these roll-outs are very well equipped and very well versed in dealing with vaccines in schools.

In their advice, the four CMOs have said it is essential that children and young people aged 12 to 15, and their parents, are supported in whatever decisions they take, and that they are not stigmatised for accepting or not accepting the vaccination offer. Individual choice should be respected. It is the opportunity to be vaccinated that is on offer, in a fair and equitable manner.

To those who remain undecided, I say this. The MHRA is the best medical regulator in the world. It has rigorously reviewed the safety of our vaccines, and it only authorises those that it concludes are safe. Vaccines for children and young people are no exception. We continue to have a comprehensive safety surveillance strategy in place across all age groups to monitor the safety of all covid-19 vaccines that are approved for use in the UK.

I will now address some of the interventions and questions from hon. Members. My hon. Friend the Member for Penistone and Stocksbridge asked a number of questions. I reiterate that the CMOs sought advice from experts in the field; it was not just the information they had themselves. It is only right that, based on that advice, 12 to 15-year-olds are able to take up the offer of the vaccine in a fair and equitable manner.

My hon. Friend asked about disruption to education from the programme. NHS England already has plans in place for the mop-up programme, which is not likely to be on school sites, to minimise disruption to education and the rest of the immunisation programme.

[Miriam Cates]

I very much appreciate the point and the reassurance the Minister is giving, but even the CMOs acknowledge that the vaccine programme in and of itself is not going to end disruption to schools. Whether people choose to have this vaccine or not—which absolutely should be a free decision, as the Minister says—what is more important is the policy making around having consistent rules in schools, as the hon. Member for Strangford (Jim Shannon) said, but also ending mass asymptomatic testing, which is picking up cases that it does not need to pick up and is itself causing disruption. How will the disruption to schools end, even if vaccination does go ahead and cover a wide population?

[Maggie Throup]

I thank my hon. Friend for that intervention. It is important that we do whatever we can—use whatever we have in our toolbox—to make sure that children are able to continue with their education, and vaccination is one part of that. I know my hon. Friend is passionate, as am I, about making sure that children get a full education, and that the pandemic does not affect their futures. My hon. Friend raised several other questions and, if she will allow me, I will write to her in response to any I do not answer in my speech.

My hon. Friend the Member for Lincoln (Karl MᶜCartney) raised questions about guidance for schools on the vaccination programme. How the programme will work has been set out very clearly, including in the formation of the consent process, most recently updated on 17 September 2021. I would like to reassure my hon. Friend, who highlighted the three words “do no harm”, that robust monitoring arrangements are in place for the vaccination of 12 to 15-year-olds, and that further data will be available shortly.

I join the hon. Member for Leicester West (Liz Kendall) in absolutely condemning the threats and intimidation of headteachers, school staff and anybody who enters school premises. That is a big issue, and my advice is that headteachers who have received such intimidation should rapidly contact the school age immunisation service, which is well versed in addressing it. They should not be afraid to speak to the police and the local authority too. I assure her that that issue is extremely high on my priority list, which, as she can imagine, is getting longer.

It is important that we remember that our teenagers have shown great public spirit at every point during the pandemic, and I thank them for that. They have stuck to the rules so that lives can be saved and people kept safe, and they have been some of the most enthusiastic proponents of vaccines.

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[Miriam Cates]

I thank all hon. Members who contributed to this important debate. I also thank the Minister and the shadow Minister for their speeches. We are united in our desire to get back to normal, in our desire for children to have normal education, and in our praise of the vaccine programme, which has protected so many adults across this country.

To finish, I reiterate the questions asked by my hon. Friend the Member for Bolton West (Chris Green): what is success? Where does this end? How do we get back to normal? I do not believe the vaccine roll-out among children will get us there. We need determined political leadership that puts the welfare of children front and centre, ends educational disruption and allows us to move forward with their future.

Question put and agreed to.

Resolved,

That this House has considered the vaccination of children against covid-19.