text: Crossing the Rubicon A fine line between waiting and vaccinating adolescents against COVID 19 Several countries with advanced adult COVID 19 immunisation programmes have already started vaccinating adolescents with an mRNA vaccine that recently received emergency use authorisation for 12 15 year olds The decision to vaccinate adolescents remains highly divisive among parents clinicians politicians and policy makers There are very few downsides to immunising adolescents with a safe and effective COVID 19 vaccine because that would significantly reduce their risk of COVID 19 and all its complications Based on current evidence however adolescents have a very low risk of severe or fatal COVID 19 even among those with comorbidities or rare complications such as long COVID or Paediatric Multisystem Inflammatory Syndrome PIMS TS a hyperinflammatory syndrome temporally associated with SARS CoV 2 Additionally currently authorised vaccines are very reactogenic and have limited post marketing population level safety data in adolescents and young adults but these are emerging from countries that have forged ahead with vaccinating adolescents Countries that have yet to make a recommendation can afford to wait until there is sufficient information to make informed decisions on the risk benefits of vaccinating adolescents with current and future COVID 19 vaccines Alternatives to two dose vaccination in adolescents may include a single dose or a reduced dose schedule as is currently being trialled in younger children 