Israel Faces Next Major COVID Challenge: Vaccinating 600,000 Teens Under 16

Israeli officials and experts agree herd immunity can't be achieved without vaccinating under-16s. Clinical trials on Pfizer's COVID-19 vaccine are still not completed, but that's far from being the trickiest part of it

Ido Efrati
Ido Efrati
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High school in Jerusalem last week.
High school in Jerusalem last week.Credit: Emil Salman
Ido Efrati
Ido Efrati

This article was originally published March 18th, 2021. Pfizer announced on March 31st that its COVID-19 vaccine was safe and effective and produced robust antibody responses in 12 to 15-year olds.


In a few months, if everything goes as planned, Israel’s public health system is expected to enter a new phase in its vaccination campaign against the coronavirus and begin vaccinating about 600,000 young people ages 12 through 15.

Following the campaign to vaccinate those 16 and over, this time the challenge isn’t a logistical one and doesn’t involve any uncertainly regarding the availability of the vaccine. Instead, what’s ahead is a public relations effort to explain the importance of getting vaccinated to the recipients, or in this case, to their parents.

The Health Ministry hasn’t yet geared up for vaccinating youngsters between 12 and 15 as it awaits the end of Pfizer’s clinical trials on the age group, as well as the approval of its use for this younger age group by the U.S. Food and Drug Administration. Pfizer’s initial clinical trials on the vaccine against COVID-19 did not include patients under 16.

The experts are in agreement that vaccinating this younger cohort will require targeted preparation and a public information effort. First of all, that’s because Israel, which has led the world in vaccinating its population against the coronavirus, will be the first country to begin vaccinating those under 16 at a time when most of the rest of the world is still focusing on older people. That is expected to prompt some concern among parents.

In addition, experience over the past several months has shown that, as the age groups eligible for vaccination have been expanded to younger people whose risk of serious illness is lower, they have tended to be less eager to get vaccinated. The falling rate of infection among the Israeli population as a whole may also lead some parents to believe that they can wait to have their children vaccinated.

Young Israelis getting vaccinated in Holon last week. Credit: Hadas Parush

Public health officials are in agreement, however, that if Israel is to achieve herd immunity against the virus, it will have to include vaccinating the country’s younger people, who represent a third of the total population. And beyond considerations involving herd immunity and social solidarity, the vaccination program among those under 16 is seen as important if schools are to return to their pre-pandemic routines, to an era before smaller classroom pods and distance learning on Zoom became the norm and before schools had to deal with coronavirus outbreaks, quarantine and COVID testing.

The return to normal can only come with a high rate of vaccination of students. In high schools where at least 90 percent of 11th and 12th grade students have been vaccinated have already returned to normal classes.

In the meantime, it’s difficult to predict how the vaccination of 12-to-15-year-olds will be received. Ironically, the vaccination of the population, which began in December with the elderly and then expanded, cuts both ways. In recent months, a large body of information has been amassed from millions of patients demonstrating the high degree of safety and effectiveness of the vaccine among those 16 and over in Israel and abroad. In addition, before the vaccine is administered to those 12 to 15, the results from Pfizer’s clinical trials on that age group will be available. That in turn, should make the expansion of the vaccination campaign a natural extension of what has already been happening.

As the number of Israelis who have been vaccinated rises, so does its positive effect on the rate of infection and death, but that also tends to feed a false sense that the pandemic is not dangerous or that it is behind us. It is therefore reasonable to assume that there will be parents who won’t feel the necessity or urgency to have their children vaccinated at this point, particularly since the risk of serious cases of the coronavirus among children is very low.

But the Health Ministry has the means at its disposal to encourage parents to have their adolescent children vaccinated. And once the public relations campaign has had whatever impact it will, it can be assumed there will be incentives such as the use of Israel’s green passport program, which could grant young people admission to performances and events – limited to those who have been vaccinated.

At this stage, no one is mentioning possibly imposing sanctions on 12-to-15-year-olds who fail to get vaccinated. “We know that there will be varying opinions among parents,” said Dr. Boaz Lev, who heads the panel monitoring the vaccination program in Israel. “Apparently this campaign is going to be no less difficult than the one for the general population, maybe even more so, since among children and adolescents the disease is a lot milder.”

Hundreds already inoculated

Dr. Michal Stein, director of the infectious disease department at Hillel Yaffe Medical Center in Hadera and chairwoman of Israel’s Society of Pediatric Infectious Diseases, called the vaccination of children essential to return to normal in Israel, including the country’s schools. “Granted that the risk of serious illness among children is not widespread, but it exists,” said Stein, a member of Lev’s vaccination committee.

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“I think after a year of a pandemic, both the parents and children are tired of having the school system shut down and sending entire classes into quarantine,” she said, adding that it is only the vaccine that can restore a normal routine to children. “I believe there will be a [positive] response to vaccinating children under 16 once it’s approved.”

Stein also responded to concerns regarding the possibility of unknown long-term effects of the vaccine. “The safety of the vaccine,” she said, “has been proven up to now and in large numbers. We know from our experience with vaccines in general that if there are side effects or a reaction from a vaccine, they appear around the time of the vaccination or at most during the following weeks.”

In addition, hundreds of Israeli children from 12 to 15 have already received inoculations, even though Pfizer’s clinical trials have not yet concluded and vaccine for that age group has not gotten full approval. The recipients have gotten the vaccine with special approval from the Health Ministry on an individual basis for various reasons, including an underlying medical condition or the presence of someone at particularly high risk in the child’s household.

“So far we have approved about 600 requests for coronavirus vaccine for children under 16, of whom fewer than 400 have actually received the vaccination,” Lev said, adding that most of the requests have been approved. “So far, we haven’t received any special reports or anything conspicuous or different than in other people who have been vaccinated,” he said. “The monitoring for side effects in such cases is similar to other monitoring of side effects among the general population of those being vaccinated in Israel, but it’s stricter, and in such cases the treating physician and family doctor pay greater attention to it.”

While some parents may be hesitant about having children under 16 vaccinated, things looked different from the perspective of April of last year, when, at the height of the first wave of the pandemic, researchers from Western Galilee Hospital in Nahariya and Bar Ilan University’s medical school in Safed conducted a survey. At the time, there was no prospect of a vaccine on the horizon but interest in it was high.

Eighty percent of those who said they intended to get vaccinated against COVID-19 said they would have their children vaccinated if and when there was a vaccine appropriate for children. More than 90 percent of those who had their children vaccinated against the seasonal flu said they would also do so against the coronavirus.

“The name of the game is the safety of the vaccine,” said Dr. Amiel Dror, who directed the opinion survey. “More than 5 million people in Israel and more than 100 million in the U.S. have been vaccinated, and the bottom line is that side effects are mild and pass.”

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