evidence: In children, it is not currently clear whether Omicron14,15,25,26,27 causes a higher severity of illness compared to earlier variants or if rising hospital admissions reflect increases in transmission in susceptible unvaccinated child cohorts. Further research is needed to determine the virulence and transmission characteristics of SARS-CoV-2 variants and implications for unvaccinated children. [...] There is also a significant risk for unvaccinated children once public health restrictions are eased and international travel restarts. This includes children travelling overseas with families, for educational placements, as well as local susceptibility to SARS-CoV-2 community transmission. Recently, as the Omicron variant spreads globally there has been a disproportionate number of child cohorts infected with the virus in settings where the elderly population, most at risk of hospitalisation and death, have been prioritised in early vaccine trials and subsequent national COVID-19 vaccination programmes.10 For example, in some LMIC settings yet to vaccinate children <12 years old, childhood cases are higher than in all three previous pandemic waves, and hospitalisation has increased uncharacteristically ahead of adult populations.15 Similarly, in some developing settings the very young 0–4 years old not eligible for COVID-19 vaccination (due to concerns of vaccine safety) are also affected.14