Throughout the pandemic, Anna has worked for the NHS. She has seen the effects of Covid-19 first-hand and, although she worked remotely because she was in a vulnerable group, other colleagues – she is a physiotherapist – were deployed to Covid wards at the height of hospital admissions. “At the trust I work for, they’re setting up a long-Covid service,” she says. She comes home and her son Sam, 16, listens to her talk about it – and yet he is adamant that the coronavirus isn’t happening or that, if it is, it’s not serious. “You know: ‘Covid is a load of rubbish – it’s all about control’,” she says. “It’s all very conspiracy theory, a lot of his stuff.” He was adamant from the start that he wouldn’t be having the vaccine if and when it became available for his age group, and he has stuck to it. “He is very resistant,” says Anna. “He is pretty determined not to conform anyway. Part of it, I think, is him being a teenager, and the other bit of it is conspiracy theory: ‘It’s all a big con.’” His main source of information since the start of the pandemic has been social media, says Anna. “He watches a lot of YouTube.”
Just over a month ago, YouTube announced it would remove videos that spread misinformation about all vaccines, and would ban the accounts of anti-vax activists; it had already banned content with false claims about Covid vaccines last year. Facebook did the same in February this year, though a quick search reveals misinformation is still easy to find (one post I found within minutes claimed 80% of vaccinated women had miscarriages). On TikTok, “unvaxxed” content racks up hundreds of thousands of views. Last month, NewsGuard, an organisation that rates the credibility of news organisations and monitors misinformation, found Covid conspiracy theories were being viewed by millions on TikTok, and, in its research, children under 13 – the lower age limit – were able to access the app.
Even if children have avoided anti-vaccine misinformation on social media, they may have come across it at the school gate. There have been demonstrations outside schools across the UK; some protesters have loudhailers, and give alarming leaflets to children, or point them in the direction of websites with misinformation. At least one school was targeted by protesters showing images of what appeared to be dead children, falsely claiming they had been killed by the vaccine, which unsurprisingly distressed children. The Association of School and College Leaders union found nearly 80% of British schools had been targeted in some way – mainly emails threatening legal action – and 13% had reported seeing anti-vax demonstrators directly outside the school gates; 18 schools said protesters had actually got inside.
In September, the UK’s chief medical officers recommended children between the ages of 12 and 15 be offered a single dose of a Covid vaccine, to join the 16- and 17-year-olds, who have been offered a jab since August. So far about 21% of 12- to 15-year-olds in England have had the vaccine; for the older age group, 56% have come forward. There are many reasons for the relatively low uptake – and it was always expected to be lower for children than much older people – such as issues with the rollout. In Scotland – where children are largely vaccinated in drop-in centres, rather than schools – take-up is about 53% in the 12- to 15-year-old age group.
But there is also hesitancy. In a survey of nearly 28,000 pupils in England, published at the end of September, researchers found 51% of 13-year-olds were willing to have the vaccine, compared with 78% of 17-year-olds. For nine-year-olds, the figure drops to 36% (while no vaccine has been approved for under-12s in the UK, last week, regulators in the US last week approved Pfizer’s vaccine for children over the age of five).
When Lily, 13, had her vaccine at school, she was one of only about five from her class of 30 to have it. None of her close friends did. “We had conversations about it, when we were trying to make up our minds about what we would do,” she says. “They would tell me their reasons about why they didn’t want to have it, like they’d seen online about people having seizures when you get it. And also there was stuff about the vaccine making you infertile, and just making you very ill as well, apparently.” They showed her videos they had seen on social media, mostly on TikTok.
“There’s definitely a kind of feeling of: ‘Oh, maybe it’s not a good idea then. Why am I the only one who thinks it’s a good idea to get it?’” she says. “I made, like, 10 different decisions. The night before, I decided I wasn’t going to get it. I ended up changing my mind because I researched it.”
Lily had spoken to her parents about having the vaccine, and although she says they didn’t put any pressure on her either way, “they did point out some reasons why it would be a good idea to get it. I think the main reason I actually changed my mind and got the vaccine was because most of the reasons that my friends had for not getting the vaccine were because of themselves. But my parents’ point was that the main reason I should get it is because of my grandparents and people like that.”
Hesitancy doesn’t mean teenagers are anti-vaxxers, says Russell Viner, a paediatrician and professor of adolescent health at the UCL Institute of Child Health, and one of the authors of the study of English pupils. “There’s an element to which to hesitate and think is entirely appropriate, rather than just rushing in,” he says. “I think the research shows that much of the hesitancy is about a lack of information, certainly at the time [they did the survey].” He has a 15-year-old, “and so we’re going through all of these issues. Young people are saying: ‘Do I really need it? How much will it benefit me?’ I think we absolutely have to be transparent and honest in our response, which is that the chief medical officers have looked at this, and the balance of risks is in favour of vaccination but it isn’t an overwhelming balance. So a level of thinking about it is appropriate in teenagers. That’s the transparent, we-need-to-be-honest-about-the-science side of things.
“On the other hand, at a population level, we want our teenagers to be vaccinated and get the vaccination levels as high as we can. I think the right thing to do is probably what the government has largely been doing, which is not making it compulsory, and being transparent about the benefits and the very unlikely and very rare risks.”
On balance, he says, “it’s the right thing to do to vaccinate teenagers. But it’s not an absolute no-brainer and that’s why Britain didn’t rush to it, unlike vaccinating over-80s. It’s a much more finely balanced position.”
This is how Clare and her 13-year-old son Jamie felt about it. Most of her family has been vaccinated (Clare wasn’t because of underlying conditions), but Jamie is sure that he won’t have the vaccine, and Clare supports his decision. “What influenced it was the JCVI report that didn’t recommend the vaccines for healthy children,” she says. Initially, the Joint Committee on Vaccination and Immunisation advised there were insufficient medical grounds to vaccinate healthy children between the ages of 12 and 15. And then “there was a swift turnaround from the government to suddenly say: ‘Children under 16 will be vaccinated.’” The chief medical officers’ decision took into account the benefits beyond the low individual health benefits, such as children losing fewer school days, and reducing transmission to older family members.
“We’d already started the conversation with our son and he was very clear that he didn’t want the vaccine,” says Clare. Jamie was concerned about the (very small) risk of heart inflammation, and particularly because it was found to be higher in boys – about 162 cases per million after two doses of a vaccine, compared with 13 per million in girls. “That scared him. He said: ‘What if that happens?’ And I said: ‘It’s treatable.’ But he was adamant that he didn’t want it. He wanted to know more about it, he wanted there to be a longer time of knowing what the vaccine might do – those were his words. That isn’t to say we can’t change our minds.”
She is sure he hasn’t been influenced by social media, as he has tight restrictions on his phone, and since he is home-educated, in preparation for taking up a place at a specialist school, she doesn’t think he has been exposed to much, if any, anti-vax misinformation. “We’ve talked about what anti-vax is,” says Clare. “In the home education community, I suppose it won’t surprise you, there’s lots of anti-vaxxers, but they’re not our tribe. Politically, we wouldn’t be in that group.”
Viner is concerned about online anti-vax messages, and says he is “appalled” at the school protests. “It’s irresponsible to target young people coming out of schools when they’re not with their parents; they’re being given information that they may not seek, that’s being pushed at them. I think that’s reprehensible behaviour by anybody.”
Social media, he points out, has given voice to an anti-vax agenda in general, not just Covid vaccines. “I think what we’ve seen is very strategic use of social media by those opposed to vaccination, and young people are part of that. Because they’re high consumers of social media, you could argue that they’re more vulnerable. However, I think, most young people, because they’re high consumers of social media, are pretty savvy about what they read. There is a worry, but I think we should also be reassured that young people frequently show relatively high ability to recognise when unsupported ‘facts’ are being pushed. But that’s not always true.”
This, says Anna, is what she believes her son has been exposed to online. Incorrect information, she says, is “a huge concern. Teenagers are really impressionable, despite the fact that he’d argue that he wasn’t.” Does she challenge him about it? “Yes. I say: ‘How can you argue against something that’s blatantly happening?’ We have open dialogue, and I just say that this is what I know, and what I understand. But he says the research is rubbish.” She knows the risk to him from a Covid infection is very low, but the concern is there. “I’d be frightened if he got it in case he was one of the unlucky ones that became seriously unwell.”
We should be thinking about the way to reach young people with good information, says Viner. “They absolutely respond to trusted advisers, such as the chief medical officers, but they also respond to peers. There are some extraordinarily powerful voices in the younger generation who are hugely respected by young people, and using those kinds of mechanisms to reach young people would also be helpful.” Again, he stresses that he doesn’t believe young people are particularly hardline anti-vaxxers. “The hesitancy [in the research] was mostly ‘don’t knows’, rather than teenagers who were strongly anti. And I think the message from young people was: ‘Convince us. Give us the information.’ My son said to me: ‘I’ll have the vaccine if you tell me it’s the right thing to do and it helps my life go back to normal.’”
For Anna and Sam, their exchanges are largely good-natured, she says, although he can become “a bit loud and more defiant” when she asks about his sources for his “conspiracy theories”. “I’ve said: ‘You’ve had all your vaccinations.’ I’ve talked about polio and MMR and all the vaccinations that he’s had to keep him healthy, and that this really is no different to that. And it’s about stopping other people from becoming unwell. I will keep chipping away, but I do pick my moments.” For now, Sam is ignoring his invitation. “I still feel optimistic,” says his mother, “that at some point that he will take it up.”
Names of parents and children have been changed.