The COVID-19 pandemic in children and young people during 2020-2021: a complex discussion on vaccination

In this, second of the two editorials on children and young people (CYP) in the COVID-19 pandemic, we focus on the complex discussion on vaccination of minors against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Vaccination of children and young people (CYP) against COVID-19 remains highly debated, with considerable policy divergence internationally. Vaccinating younger age groups was not an initial plan when the original variant of the SARS-CoV-2 virus emerged, because CYP seemed mildly affected by COVID-19 when compared to adults, as discussed in the first editorial. However, new mutations led to increased transmission of SARS-CoV-2. This led to an increase in the population threshold of vaccination coverage required for prevention of viral spread, possibly to levels above 80% vaccine uptake in the whole population. Also, due to the successful roll-out of vaccination to older and at-risk populations, the virus began to circulate in greater numbers amongst younger populations, which became a new concern. An important element was also the issue of broader harms, such as educational disruption, which can also become a determinant of long-term health. A broader perspective weighted the long-term impact across multiple dimensions of human life and shorter-term health concerns. In addition, increasing awareness of the possible rare complications of COVID-19 in CYP, such as Multisystem Inflammatory Syndrome in Children (MIS-C), and the "long COVID" syndrome prompted the scientific study and comparison of the risks of disease vs the safety of vaccination, even among the very young