Should the Flu Vaccine Be Non-Selectively Administered to Children During the COVID-19 Pandemic?

It is a logical scientific and clinical question to ask whether the 2020 seasonal Flu vaccine might cause children and young adults to lose their “tolerance” to the SARS-CoV-2 virus (Photo by Jim Weber/Daily Memphian/AP)

I am the father of six kids ranging in age from 7 to 18 years old.

In the midst of the many thousands of tragedies the COVID-19 pandemic has caused, a silver lining is that our children are less susceptible to the critical illnesses that the SARS-CoV-2 virus triggers in adults.

Imagine the disaster, if our young were as susceptible as adults.

But, as a physician and immunologist, I’ve wondered if it is safe to assume that this relative sparing of the young is a stable feature of the COVID-19 pandemic.

Before I say anything further, let me state emphatically that I am NOT a so-called “anti-vaxxer”. My children have all followed CDC guidelines for childhood vaccination, they are all up to date on their immunizations and they all get the seasonal flu shot. So I ask the reader not to assume that I am making an argument against pediatric vaccinations in this article. As a physician and immunologist, I am very well aware of the key importance of vaccines for protection of public health, globally.

But the COVID-19 pandemic has created a concern for me.

Because I think it might be a dangerous assumption that the relative “tolerance” of children and young adults to COVID-19 disease is a stable phenomenon. After all, we know that children can not only be carriers of the SARS-CoV2 virus, but many also seem to mount clinically visible immune responses to the virus. Yet it is true that children and younger adults seem to be “tolerant” to the SARS-CoV-2 virus and do not mount the same intense immunological response that adult do.

But what if an environmental factor (or factors) can trigger severe COVID-19 disease in children? What if “tolerance” to the SARS-CoV-2 virus can be broken in younger persons and the intense immunological reaction that causes COVID-19 disease can be unleashed in our children too?

I ask this question not to fear monger — but rather as a concerned parent and physician who understands that we ought not make ANY assumptions about the epidemiology of COVID-19 disease — as the SARS-CoV-2 virus, hopefully, becomes an endemic virus on the planet within the next 2 years.

What I am very specifically concerned about is that within the next 6–8 months millions of children (and young adults) are going to be undergoing vaccinations against the Influenza virus. Most people in the US are immunized against the Flu by November of each year, in anticipation of a peak flu season in the January-February time frame.

But what if the Flu vaccine triggers a more aggressive “bystander immunological response” to SARS-CoV-2? This phenomenon of “bystander immunological activation” is not a theoretical thing. Most immunologists are quite well aware of it. In fact, there are some very prominent examples of vaccine or viral infections breaking immunological “tolerance” and causing intense immune reactions.

Of course, it’s become increasingly clear that too intense an immune response to SARS-CoV-2 virus is a main reason why many adults are getting critically ill or dying. So, we ought to ask if a similar intense reaction can be induced in younger persons and what environmental or immunological parameters may be able to induce a loss of immunological “tolerance” to SARS-CoV-2 in younger persons.

As for my part, as a parent, I plan to take the risk of the Flu vaccine triggering COVID-19 disease in my children seriously — even though it’s only a scientific and clinical hypothesis. Because in the face of this catastrophic pandemic, our incorrect assumptions could spell death.

Here is my plan to mitigate against the possibility that the seasonal Flu vaccine might trigger COVID-19 disease in my children, by breaking their immunological “Tolerance” to SARS-CoV-2:

1. I will delay my kids’ vaccination until the latter half of November or early December to determine if the seasonal Flu vaccine is triggering COVID-19 disease at the population level.
2. I will obtain COVID-19 antigen screening swabs for my kids prior to their receiving the Flu vaccine. If they are SARS-CoV-2 carriers, we will skip the seasonal 2020 Flu vaccine.
3. If my children continue remote learning from home and strict social distancing practices remain in effect, I may consider skipping the 2020 Flu vaccine altogether.

I am by no means advocating that the reader adopt my strategy. It is my plan as a parent and a physician with serious concern about whether the epidemiology of the COVID-19 can shift to adversely affect the pediatric population — specifically based on an environmental factors that could activate an intense “bystander immune response” against SARS-CoV-2.

In the near future, I will be writing more about “bystander immune responses” and how immunological “tolerance” can be broken to cause hyperimmune disease flares — like the one we are observing in the case of COVID-19 disease.

Of course, I will also be formally alerting our public health officials at CDC and FDA of my concern regarding the possibility that the 2020 seasonal Flu vaccine might trigger COVID-19 disease in younger persons who seem to be “tolerant” to SARS-CoV-2.

I do believe that it is reasonable for US public health agencies to take the following steps to ensure that the seasonal Flu vaccine does not trigger some children and young adults to developed severe COVID-19 disease:

1. Require that the vast majority of adults over age 30 be vaccinated prior to children and young adults — specifically between the end of August 2020 and mid-November 2020. This, in order to determine if the Flu Vaccine might trigger COVID-19 disease on a population level. If it does not, then we can proceed with vaccinating the majority of children starting in the Last week of November 2020 through December 2020, prior to the peak of the Flu season. On the other hand, if it does so, then we ought to cancel the 2020 Flu vaccine program for the vast majority of immunocompetent children and young adults and adhere to social distancing practices to protect against the spread of the Flu.

AND/OR

2. Swab all children and young adults prior to administering a Flu Vaccine in order to mitigate against exposing SARS-CoV-2 carriers to the possibility of an immunological hyperimmune response following Flu vaccination.

This second approach may also be a prudent one to consider in the pediatric population undergoing the routine pediatric vaccination schedule.

Again, I want to emphasize that “bystander immunological activation” is a real phenomenon in immunology. It is scientifically and clinically legitimate to question whether the seasonal Flu vaccination of millions of children and young adults world-wide might trigger COVID-19 disease in younger patients whose immune system’s seem “tolerant” to the SARS-CoV-2 virus.

Reader, I ask that you consider this possibility with me — and to ask your pediatrician and/or public health officials to consider this potential upcoming danger to our children during this COVID-19 pandemic in Fall season, 2020.