COVID infection or vaccination: Which was riskier for kids?

For children, the safer path during the COVID pandemic wasn’t a roll of the dice with infection – it was vaccination. 

A nationwide analysis of nearly 14 million youngsters found that rare but serious heart and blood vessel complications were more likely to follow a COVID-19 infection than a vaccine dose.

The absolute risks were small either way, but infection consistently carried the heavier odds.

Pandemic hazards for children

A team working with NHS England linked health records for everyone under 18 from January 2020 through December 2021. 

During that period, about 3.9 million children received a first dose of the Pfizer–BioNTech mRNA vaccine and roughly 3.4 million had their first documented COVID-19 infection.

By comparing each child’s risk in the six months after those events to other times, the team could chart how the hazards changed in the short term for the same population.

COVID infections in children

The study focused on inflammatory problems that can affect the heart and vessels, such as myocarditis and syndromes similar to Kawasaki disease. 

In children aged five to eighteen, the six months after a first infection brought more than 17 additional inflammatory cases per 100,000 compared with other periods.

In the six months after a first vaccine dose, that tally nudged down instead, with nearly two fewer cases per 100,000. 

For myocarditis specifically, infection was linked with just over two extra cases per 100,000. Vaccination added less than one.

Thus, the myocarditis risk was more than twice as high after infection compared to after a shot.

Settling a long-running concern

From early 2020, doctors saw myocarditis occurring after COVID-19. Once vaccines rolled out, they also saw occasional myocarditis after vaccination, especially in adolescent boys and young men, usually mild and short-lived. 

That rare side effect drew heavy attention and helped drive the UK’s slow start on routine vaccination for younger children. This new analysis puts both risks in the same field, across millions of kids.

Because most children ultimately encountered the virus, skipping vaccination didn’t mean skipping risk. It meant facing the higher one that comes with infection.

COVID complications were rare in children

These complications remained uncommon overall. The key insight isn’t that vaccination erases risk. It’s that the comparison between infection and vaccination favors the jab. 

When you anchor the numbers to the same six month window, the pattern holds for both myocarditis and broader vascular-inflammatory syndromes: infection raised the odds more than the vaccine did.

No observational study is flawless. The dataset didn’t show whether every child with a complication recovered fully. Many mild pediatric infections went untested and undiagnosed, especially later in 2021, which means some infections weren’t counted. 

The analysis also stops in December 2021, so it doesn’t reflect later variants or updated vaccine formulations. Despite those caveats, the breadth of linked NHS records and the within-period comparisons give the overall conclusions real weight.

The landscape has shifted since 2021

Two big changes shape how to apply these findings today. First, the variants circulating during the height of the pandemic aren’t identical to the ones in play now, so exact risk levels may differ.

Second, the immunity backdrop has changed dramatically. Outside of very young children, most people now carry some protection from prior vaccination, prior infection, or both.

That layered immunity alters responses to reinfections and boosters and probably trims the absolute risk of post-infection complications compared with the first phase of the pandemic.

None of that flips the core comparison. It just argues for repeating this kind of analysis as the virus and vaccines evolve.

What this means for families and policy

If you’re weighing choices for a child, the meaningful comparison isn’t vaccination versus nothing, it’s vaccination versus the near-inevitable encounter with the virus. 

In this massive dataset, the rarer but scarier heart-related outcomes were more likely after infection than after a dose of the Pfizer vaccine.

For health planners, the same logic applies at scale: reducing infections – vaccination included – does more to cut these complications than avoiding vaccination does.

Serious heart and vascular inflammation in kids was rare. But when it happened, it showed up more often after COVID-19 than after a shot. With nearly 14 million children in the frame, that signal is hard to dismiss.

The pandemic has moved on and immunity has deepened, yet the essential guidance remains steady: for children – vaccination tilts the odds toward safer outcomes.

The study is published in The Lancet: Child and Adolescent Health.

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