Corona vaccination for adolescents: «We're not going for speed»
Mr Berger, following your commission's recommendation that 12 to 15-year-olds should also be vaccinated against Covid-19, the response so far has been rather lukewarm: According to recent media reports, only around 10 per cent of young people have signed up for vaccination. Disappointed?
We have expressly stated that we do not have a vaccination coverage target and that we see the need for vaccination as decreasing with age. The ratio of benefit to risk is of course different for a 60-year-old than for a 30-year-old and quite different again for a 14-year-old. We're not pacing ourselves at all with young people. Those who want to be vaccinated now should do so. And the others can wait until we have more data for this age group. Of course, this group is also part of the population, but it is not essential for achieving herd immunity. It is more important that we make it clear that the importance of vaccination also decreases with age.
According to the Swiss vaccination plan, vaccination is only recommended if «the benefits of preventing the disease and its complications outweigh the risks associated with the vaccination many times over». Does this also apply to the Covid-19 vaccination for adolescents?
That depends on the individual case. Our vaccination recommendation states that young people should carry out an individual risk-benefit analysis and that the benefits should outweigh the risks in the individual case. We emphasise this very strongly: It is a recommendation, but absolutely without pressure.
Is it possible that the unclear vaccination recommendation of the Federal Commission for Vaccination Issues (EKIF) is also a reason for young people's hesitation? The «Tages-Anzeiger» wrote: «The EKIF recommends the corona vaccination for all young people.» And the NZZ: «No general vaccination recommendation for young people». So what is true?
In Germany, for example, the Vaccination Commission does not make a general vaccination recommendation for young people, but only recommends it for those with previous illnesses and those who live with immunocompromised people. In Switzerland we say: Vaccination is recommended for all 12 to 15-year-olds who want to be vaccinated now, and especially for those who belong to the two groups just mentioned. Vaccination is recommended firstly for direct protection. And secondly, to prevent the effects of infection, namely isolation and quarantine. This is a general recommendation with all its consequences.
Why didn't you formulate them more strongly?
We have formulated the recommendation in this way because, on the one hand, the ratio of benefits to risks of this vaccination is really lower in adolescents than in older people - not because the risks are greater, but because the benefits are lower. And because, on the other hand, we don't yet have a lot of data on safety from this group. Adolescents are now being vaccinated in many countries and we will soon be able to determine the risks of the vaccination more precisely from this.
Speaking of safety data, the World Health Organisation (WHO) says that more scientific evidence is needed before general vaccination recommendations can be made for children. Why do you come to a different conclusion?
Our recommendation is in line with the WHO's assessment. It is clearly too early to recommend the vaccination for children under 12 years of age, but not for adolescents aged 12 and over.
For adults, the Vaccination Commission uses the risk-benefit analysis as the basis for its vaccination recommendation. Why should adolescents, of all people, carry out this demanding analysis themselves?
They should make this assessment together with their parents or a trusted person. But they can also do it themselves. Regardless of age, every person should make this assessment.
To assess the health benefits, a comparison with seasonal flu may be helpful: your colleague Thomas Mertens, Chairman of the Standing Committee on Vaccination (STIKO) in Germany, said inan interview with the «TAZ» newspaper that the burden of disease due to influenza infections among young people has been higher every year than during the coronavirus pandemic. How do you rate this comparison?
It's difficult to say, as we haven't compared these figures. Let's start with Covid-19: we have many infections among 12 to 15-year-olds, few serious infections and perhaps 20 to 25 cases of PIMS (a new type of illness in minors associated with a Covid-19 infection, editor's note) across Switzerland. Then there's the flu: the disease burden is probably roughly comparable or lower. One major difference: with Covid-19, we have significantly better protection from the vaccine than with the flu jab. The body's reactions to the vaccination are stronger with the Covid vaccine, and we are still looking very closely at the side effects. These reactions, such as fever and headaches, are not dangerous, but can be very unpleasant, especially after the second vaccination. This is much less common with the flu jab.
If the flu virus is about as dangerous for young people as the new coronavirus, why do you recommend the Covid-19 vaccination for minors and the flu vaccination only from the age of 65?
There are also the indirect effects of corona. Young people are suffering greatly from the pandemic, not because of the virus - which is not causing them much harm - but because of the measures being taken among the population. There has been an extreme increase in depressive moods among young people due to school absences or cancelled exams and work placements as a result of the ban on social interaction. Child psychologists are hopelessly overworked. This effect is difficult to weigh up. But these young people have now spent over a year protecting themselves for the adults and the elderly and they want to get out of it. Now they can get vaccinated, and those who want to should do so now.
But you said that it's not about achieving a certain vaccination rate for young people.
Not especially with young people. We don't put any pressure on them. And we're not setting a vaccination target for adults either. But the more of them there are, the better off we are as a population. And it's very important to emphasise this for young people: Under-16s do not need proof of vaccination to attend an event.
Young people should weigh up the risks and benefits for themselves. Are you planning a special information campaign?
We have decided not to organise a major campaign at the moment, but simply to let those who inform themselves go for the vaccination. However, there is a special information flyer from the FOPH for young people.
Both this flyer and the factsheet for healthcare professionals state that vaccination is recommended for adults and possible for adolescents. What does this distinction mean?
We say quite clearly: the vaccination is recommended for adolescents. This has the character of an official national vaccination recommendation with all its consequences. We had a good discussion in the commission about the exact wording: why are we slightly stronger than the Germans with our recommendation and where are we stronger? And what is written on the flyer for young people reflects this exactly. «Now you too can get vaccinated»: Those who want to inform themselves and get vaccinated now should do so. But we are not exerting any pressure!
Until now, paediatricians could simply look at the Swiss vaccination schedule and tell their patients whether a vaccination was recommended for them. How should they now handle such a «recommendation without pressure» in practice?
In the Swiss Paediatrics newsletter, we told paediatricians very clearly what they should do: Recommend the vaccination to the chronically ill and those who live with immunocompromised people. We want to support the other young people if they want the vaccination of their own accord and inform them if they have any questions. But the Covid-19 vaccination is not being actively addressed - unlike the vaccinations recommended in the Swiss vaccination plan.
The German STIKO excludes adolescents from its vaccination recommendation if the people at risk with whom they come into contact have been vaccinated.
We are talking here about contact with immunocompromised people at risk. Because there are people at risk who are not necessarily protected even with the vaccination because they may not develop a strong immune response. And if you look at the delta variant, we simply have no guarantee that the vaccination will provide sufficient protection.
So you would still recommend the vaccination to my 13-year-old daughter, who regularly meets her immunised grandma.
Generally yes, especially no. Or only if the grandmother is immunocompromised, for example because she is undergoing immunosuppressive therapy due to rheumatism. Or if the uncle has had a kidney transplant or is suffering from cancer.
Speaking of the risk of infection: According to current knowledge, the vaccination protects against coronavirus for at least 12 months. What about protection from others? How long does a vaccinated person pose no risk of infection for others?
We do not know. The aim of the national strategy is always to protect against serious infections. As far as I'm concerned, it's also good to protect against mild infections. But we can't prevent someone from having the virus and passing it on in the long term, even with vaccination. So that's not our goal. And that's why we say we want to protect people who are particularly at risk by vaccinating them and ensuring that they are exposed to the virus as little as possible. And we have far fewer viruses in the population if there are many people vaccinated.
Your commission's vaccination recommendations also have legal effects. For example, if the parents of a child who is not yet capable of judgement disagree on whether or not they should be vaccinated, the decision will be based on the official recommendation. If I want to vaccinate our child against Covid-19, but my wife doesn't, then she will be vaccinated as a result of your recommendation.
Yes, the rules are the same as for other vaccinations. Fortunately, the parents and the child are usually in agreement. I see many young people who come for immunisation together with a parent. There are some who turn up with a piece of paper on which the parents sign a consent form, so it's not a problem anyway, because they've discussed it with their parents. And then there are those who come alone and say: I want this. Then we have to determine the child's capacity for judgement.
How does this work in practice?
Firstly, they have already registered for an appointment, which they wouldn't do if they didn't want to. Here at the Children's Hospital Zurich, we then ask: Have you discussed this with your parents or a trusted person? And what was the outcome of the discussion? Then we also ask: Did you come alone or did someone bring you here? Because we don't want to vaccinate anyone who is brought to us under the condition that they are not allowed in: You won't come out until you've been vaccinated. And we ask: Do you know what this vaccination is all about? Do you know how many doses it takes? And do you know the side effects? What is your reason for wanting this vaccination? If a young person provides all this evidence and explains in conversation that they want to be vaccinated, then they have the capacity to make a judgement.
The Epidemics Act also provides for state liability for any damage caused by vaccination. However, this is linked to an official recommendation for vaccination. Does a young person who is vaccinated on the basis of your recommendation have a claim to this liability in the event of damage occurring later?
Yes, which is precisely why we expressly say: recommended.
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