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What was the covid death rate in healthy young people, was it necessary to vaccinate them?
Executive summary
Healthy young people faced a very low risk of death from COVID-19 compared with older adults: active surveillance in England estimated an infection fatality rate for under‑20s of about 0.70 per 100,000 infections and a mortality rate of 0.61 per 100,000 over March 2020–Dec 2021 [1]. Public health bodies and later pandemic guidance argued vaccines substantially reduced hospitalisation and death even in younger groups, while later policy shifted toward individual/shared decision‑making for young, healthy persons as population immunity rose [2] [3] [4].
1. Young and healthy = low mortality, but not zero
Epidemiologic studies during 2020–21 found COVID‑19 deaths in children and adolescents were rare: in England SARS‑CoV‑2 accounted for 1.2% of deaths in persons <20 years and produced an estimated infection fatality rate of ~0.70 per 100,000 infections (mortality 0.61/100,000) over a 22‑month surveillance period [1]. International reporting and age‑stratified mortality data consistently show risk rises sharply with age; young people are at far lower risk than the elderly, though they were not immune [5] [6].
2. Most fatal pediatric cases had underlying conditions
Detailed national surveillance concluded most fatalities in children and young people occurred in those with specific underlying health problems and that assessing cause of death can be complicated by asymptomatic or mild infections in this age group [1] [7]. Multiple outlets summarized that pediatric deaths remained “very low” and concentrated among medically vulnerable youths [7] [1].
3. Vaccines reduced severe outcomes — evidence and public‑health framing
Health authorities and statistical offices emphasized that vaccines were highly effective at preventing hospitalization and death, and that the risk of death increases after a positive SARS‑CoV‑2 test even in young people, so vaccine benefits needed weighing against risks (Office for National Statistics commentary) [2]. Independent reviews and studies through 2024–25 also reported vaccines provided additional protection against ED visits, hospitalisations and death, particularly for older adults and those with risk factors [8] [9].
4. Was it “necessary” to vaccinate healthy young people? Two competing perspectives
One public‑health rationale: vaccinating younger cohorts reduced severe outcomes, limited transmission chains, and protected vulnerable persons; authorities often recommended vaccination broadly early in the rollout and professional societies urged immunization for children at higher risk [2] [10]. The other view: as population immunity rose and absolute risk in healthy young people remained small, some policymakers and advisors moved toward individual/shared decision‑making rather than blanket recommendations for all young, healthy people — reflecting recalibration of benefit versus small absolute risk [3] [4].
5. Policy evolved as evidence and immunity landscape changed
By 2025, vaccine guidance shifted: federal advisory bodies endorsed individual decision‑making for COVID vaccination and some regulators limited routine approvals to high‑risk groups or older adults, while professional groups like AAP continued to recommend vaccination for certain pediatric age bands or high‑risk children — illustrating divergent expert views and changing risk calculus as immunity and treatments evolved [4] [10] [11].
6. Risks of vaccination — context and tradeoffs
Statistical offices acknowledged vaccination carries some risks that must be weighed against benefits; large linked‑data studies in England found no significant increase in cardiac or all‑cause death in 12–29‑year‑olds in the 12 weeks after vaccination, though signals for rare outcomes (and subgroup differences) were reported and investigated [2]. Independent evidence syntheses in 2025 continued to quantify rare adverse events and the incremental benefits of updated vaccines in a population with widespread prior immunity [12].
7. Practical takeaways for readers deciding now
If the question is about historical necessity: early in the pandemic broad vaccination of younger people was justified by the combination of preventing severe disease, reducing strain on health systems, and protecting vulnerable cohorts [2] [9]. If the question is about present‑day personal decisions: guidance shifted to shared clinical decision‑making for healthy young people in 2025, meaning benefits for preventing severe disease are smaller in absolute terms for the healthy young but vaccination still offers added protection and is recommended for higher‑risk children and those seeking extra protection [3] [4] [10].
Limitations: available sources do not provide a single universal “death rate for healthy young people” separated cleanly from those with comorbidities across all countries and variant eras — most large studies give age‑group or population estimates and note that underlying conditions drive most pediatric deaths [1] [7].