OF all the dilemmas facing public health experts and policymakers, the one seemingly tying them is knots is whether or not to extend Covid jags to all 12 to 17 year olds.

Five weeks have elapsed since the UK's Medicines and Healthcare products Regulatory Agency (MHRA) issued its stamp of approval saying that the Pfizer vaccine was "safe and effective" for use in teenagers.

"The benefits outweigh any risk," said its chief executive, June Raine.

And yet we remain in limbo, awaiting the final verdict of the dozen or so immunologists, epidemiologists, paediatricians and social scientists who sit on the Joint Committee on Vaccination and Immunisation and guide governments' rollout priorities.

First Minister Nicola Sturgeon says she is "anxiously awaiting that advice", while critics of the UK government's plan to scrap all restrictions on England's July 19 'Freedom Day' have accused ministers of "turning children into epidemiological guinea pigs" as part of a herd immunity gamble which rests on "allowing the virus to rip" through the unvaccinated young.

It can seem all the more puzzling given the growing number of countries worldwide who are already routinely inoculating over-12s.

In Singapore, Japan, the UAE, Israel, China, Canada, and the Philippines, vaccinations are already underway, with the US having administered first and second doses of the Pfizer or Moderna vaccines to around 30 per cent of 12 to 15-year-olds by the end of June.

READ MORE: Why are infections still rising when 85% of Scots had antibodies by mid-June? 

In Europe, Spain, France, Germany, Italy, Switzerland, Denmark, and Austria are among the countries already vaccinating secondary school-age children or confirming plans to do so before classes resume after summer.

Against this backdrop it may seem strange that the UK - currently engulfed by the highest rates of confirmed Covid in the world at 410 cases per million per day - would not want to urgently maximise vaccine coverage.

The Herald: The UK has the highest confirmed rates in the world, though country comparisons are affected by varying testing rates (Our World in Data)The UK has the highest confirmed rates in the world, though country comparisons are affected by varying testing rates (Our World in Data)

A study from England, published yesterday, highlights one of the obstacles UK advisors are agonising over: that children have nearly zero risk of dying from Covid.

In the year to February 2021, 25 children and young people died as a direct result of the virus - equivalent to 0.005% of those infected and putting the odds of a healthy under-18 suffering fatal complications at one in 1.6 million.

Of the 25 patients, however, 19 had an underlying health condition - most commonly a complex neurodisability - which increased their risk. In this cohort, the risk of death was as little as one in 1,125 or between one in 100,000 to one in 158,000 for underlying conditions generally.

The Herald: Infection rates per 100,000 have been rising rapidly in the 15 to 19 age group (Graphs by @TravellingTabby)Infection rates per 100,000 have been rising rapidly in the 15 to 19 age group (Graphs by @TravellingTabby)

In the UK, Covid vaccines can already be given to children over 16 who are considered "clinically extremely vulnerable" and to children over 12 with severe neuro-disabilities or respiratory problems which mean they require specialised residential care.

This latest data,however, has led scientists to speculate that JCVI may expand their criteria to recommend vaccinating the more vulnerable 12 to 17-year-olds - but not their healthy peers.

Dr Elizabeth Whittaker, one of the researchers and a consultant in paediatric infectious diseases at Imperial College London, said: "This data would suggest you have to have a very low risk of the vaccine to justify giving it to all healthy children."

READ MORE: Why the Delta variant has left immunity through vaccination mathematically impossible

The decision would be simpler if the vaccines were zero risk - but no medication ever is. In the US, a reported 518 cases of myocarditis (heart inflammation) have occurred among around six million children vaccinated, mainly in adolescent boys after a second dose.

Physicians insist the side effects are "very mild" and easily treated with over-the-counter antinflammatories, and that the Covid risks to children have to be gauged not just by deaths but the potential for Long Covid and hospitalisation.

Since the beginning of the pandemic in Scotland, 163 children aged 15 to 19 with Covid have been treated in hospital - though it is unclear how many were there because of the infection, or simply tested positive while undergoing treatment for other reasons.

But could vaccinating teenagers be based on other factors, such as safeguarding their education?

In the final two weeks of the Scottish school term, 35,000 pupils were self-isolating but one in four had actually tested positive.

The Herald:

From September, the UK Government is ending self-isolation for schoolchildren in England, but critics say this is dangerous unless replaced by vaccinations, continued use of face coverings and improved ventilation to mitigate spread of the virus. The Scottish Government is still to set out its policy.

The issue also splits scientists. Some believe that children mainly signal what is happening in the community, and are much more likely to be infected by adults in their own household than to be catching the virus from one another - though this is less true of older teenagers.

Others believe the highly transmissible Delta variant has made children more infectious than they were with previous strains of Covid, meaning that if we leave them unvaccinated they will become "the source of most infections to vulnerable adults".

READ MORE: Travel certificate frustration as fully-vaccinated Ayrshire man told there is 'no record' of his jags 

We already vaccinate toddlers against flu, for example, not because it really endangers them but because they are "superspreaders" liable to infect elderly grandparents.

The Delta variant has also changed the equation on herd immunity. Taking an estimated R number of six and Pfizer vaccine efficacy against symptomatic infection to be 83% after two doses, you would have to vaccinate 100% of the entire population to achieve it - but uptake will never be that high and, in any case, we are also using AstraZeneca.

Vaccinating 12 to 17-year-olds cannot solve that problem, but it would bring us closer, faster, to the new goal of reducing infections to low, endemic levels that we can "live with". Plus immunity from vaccination is more robust than that gained through natural infections.

Whatever the JCVI ultimately decide will no doubt divide the experts - but they urgently need to end the uncertainty.