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What is the risk/benefit calculation for vaccinating adolescents?

Question: What is the risk/benefit calculation for vaccinating adolescents?

Answer: This was one of the exact questions CDC’s Advisory Committee on Immunization Practices addressed during its meeting earlier this week.  Using the Evidence to Recommendations Framework (Table 1), Dr. S. Oliver presented a grounded set of data and information to answer the question, “Should vaccination with Pfizer-BioNTech COVID-19 vaccine be recommended for persons 12-15 years of age?”  As you already know, ACIP concluded its meeting with an answer to this question.  Recognizing that desirable consequences clearly outweigh undesirable consequences in most settings (Table 2), ACIP recommended vaccination for younger adolescents.  Yesterday, I provided an overview of the study, and today I wanted to share a few more pieces of information that help inform the risk/benefit calculation, specifically:  

  1.  Adolescents are at risk of severe illness from COVID-19. Although the risk of severe illness is less than the risk to adults, it is still present.  There have been more than  1.5 million reported cases and >13,000 hospitalizations to date among adolescents.  The hospitalization rate is higher than recent flu seasons, including the 2009-10 flu season, which was particularly bad. (Figure 1) 
  2. Adolescents contribute to transmission in households and communities. As Dr. Oliver states in the ACIP presentation, “While transmission among students is relatively rare, several studies suggest transmission more likely within high school than elementary school settings.”  Furthermore, as described in an article Science recently published,  adults living in a household with an adolescent engaged in full-time in-person school had an increase in odds of reporting COVID-19 like illness, loss of taste/smell, or positive test, indicating that the risk of onward transmission increases with the child’s age. (Figure 2)  
  3. The vaccine is highly effective and side effects are minimal. (as described in yesterday’s Q&A)

Table 1. Evidence to Recommendations Framework (from ACIP)

Table 2. Evidence to Recommendations Outcomes (from ACIP)

Figure 1. Cumulative hospitalization rates among adolescents: comparing COVID and influenza (from ACIP)

Figure 2. Risk of COVID increases among adults living in households with older children attended full-time, in-person school (from Science)