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A common question I get asked is whether it is truly necessary to vaccinate children against COVID-19. Many people have heard that the disease is less severe in the young and may have even seen their children catch COVID-19 and recover without issue. Parents, many of whom got vaccinated themselves, are nevertheless worried about vaccinating their kids for fear that the vaccine could do them harm. They argue that if COVID-19 is relatively harmless in children, then why not simply let them get sick and recover.
This argument is not new. Of course, it ignores the reality that sick children can infect their parents and grandparents who are at much higher risk. But it has been used many times when talking about other diseases, like chickenpox or measles. Chickenpox especially was often seen as relatively harmless in kids to the point where people would have chickenpox parties to expose their children deliberately. But, even if children were less likely to be hospitalized than adults, and most recovered without incident, some did not. Prior to the introduction of the vaccine, there were more than  every year for chickenpox-related complications. With vaccination, hospitalization rates for chickenpox  percent in one- to four-year-olds.
It is true that the number of hospitalizations was small relative to the total number of infections. Before the vaccine, there were more than 350,000 cases of chickenpox every year in Canada. But we have to remember to keep in mind both the relative risk and the absolute burden of disease because the total number of people getting sick was still very high. After the universal vaccination program was introduced, the number of people winding up in hospital dropped like a stone.
Recently, many people on the internet have been comparing COVID-19 to the flu and have argued that more children died of the flu than they did from the pandemic. That is simply not true. As was  recently by Dr. Jonathan Howard, since the start of the pandemic, COVID-19 has claimed more than 1,200 young lives in the United States, compared to six deaths from the flu. The mortality risk from both diseases is low. In fact, it is very low. But that is still 1,200 young lives lost, and I would hope that we would not easily dismiss that loss as trivial.
The risk of a serious complication from COVID was recently characterized by . In it, researchers analyzed data from the National COVID Cohort Collaboration. They looked at all pediatric COVID-19 tests done at 56 facilities in the United States up to September 2021. Researchers documented more than 167,000 cases of COVID-19, with a median age of 12. Of these positive cases, about 10,000 individuals, or 6.1 percent, needed to be hospitalized, and among them, 796 needed to be put on ventilators, and 131 died.
Is that burden of disease significant enough to motivate a parent to vaccinate their child? Some will see the risk as small and prefer to take their chances. Some are worried about vaccine side effects . Some have sadly believed that all this COVID-19 talk is fear-mongering.
The reality is that, much like chickenpox, when it comes to COVID-19, most children will be okay. But it is also true that some will not. The risk of a severe illness and serious complications is low. But a low risk, when applied over a whole population, translates into large absolute numbers of sick people.
So while the risk is indeed low, much like chickenpox, vaccination can make that risk even lower. And that matters, because even a low-risk infection, when combined with a very transmissible virus that infects thousands of people every day, will lead to a lot of very sick children.
