Welcoming Covid-19 Vaccines for Children
Children can carry viruses and they can be shed within a fairly long time. Although the children don’t get sick, the people around them are of course in a dangerous state, particularly those in their advanced years.
The role of vaccines to overcome the Covid-19 pandemic is strengthening after the distribution of around half a billion vaccine doses throughout the world.
Israel and the U.S. have begun to discern a more concrete picture of the impact of vaccination on a large scale. Both countries are indeed the most aggressively engaged in vaccination compared with their populations.
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There are some paradoxes in the Covid-19 vaccination program, including its priority order. For the first time, vaccination has given no priority to children. Until April 2021, none of the vaccines have been licensed for the group of people under 16.
This can be understood in terms of the least number of child cases as well as the risk of severity and death. Pediatricians who normally work on the frontline now have a different position. The children as meant here are based on our understanding in Indonesia, denoting those aged under 18.
Why children need vaccination
Viewed from various aspects, there are several reasons why we also need to vaccinate children to overcome the Covid-19 pandemic. First, children infected with Covid-19, despite their relatively small percentage, cannot be trivialized in absolute terms. If the number of Covid-19 patients in April 2021 is close to 140 million, one percent of the total is 1.4 million, which is equivalent to the entire population of West Sulawesi province.
Second, in some countries like the US, India and Indonesia, the percentage of child patients is more than 12 percent, which is very high. Third, research findings in several countries have shown that the numbers of infected children may be far larger than those that have been announced. Most children in fact do not display clear symptoms so it’s rather difficult to detect their infection.
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Fourth, children are mostly involved in mass activities, especially in school. Such activity is a main source of infection so that all concerned need proper protection. Most parents are worried about letting their children join school activities without extra protection. Fifth, children aren’t as smart as adults in understanding the dynamism of virus transmission and the attempts to be made for its prevention. Their perception of health protocols and all the stuff needed is certainly different, which increases their vulnerability.
Sixth, teenagers who in the age division are categorized into the broader group of children are basically the most difficult to control. Forcing discipline in health protocol compliance will demand hard work. It’s far easier to protect them by means of vaccination instead of imposing tight control all the time.
Seventh, children also play a role in virus transmission. Several studies have proven that children can carry viruses in large quantities and they can be shed within a fairly long time. Although the children don’t get sick, the people around them are of course in a dangerous state, particularly those in their advanced years.
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Eighth, the total number of children under 18 is around 20 percent of the population. The effort to achieve herd immunity will be considerably supported if this group is also inoculated. For the various reasons described above, experts are preparing vaccines for children and a strategy for vaccination amid the existing difficulties as the mass endeavor is underway.
Latest clinical trials on children
To date, the only vaccine already licensed for children is produced by Pfizer. Actually, in phase 3 clinical trials the number of samples aged 16-18 was relatively limited, but later the Food and Drug Administration granted Pfizer’s request to use the vaccine on those aged 16 and over. Pfizer has also finished clinical trials on 2,260 children aged 12-15 with a very good result (100 percent efficacy). They have even started clinical trials for the 5-11 age group to be followed by 2-5-year-old and six month-2-year-old groups.
To date, the only vaccine already licensed for children is produced by Pfizer.
Three formulations of doses are being tried in this vaccine to minimize side effects and maximize benefits. Moderna, the other mRNA vaccine producer, has also begun clinical trials on children aged 6 months-12 years old with over 6,000 participants being planned. There are three formulations of doses being tested.
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They have also owned data on teenagers aged 12-18. Vaccines based on the adenoviral vector have also joined the race. AstraZeneca-Oxford has for over a month conducted clinical trials on children aged 6-17. The trials had to be halted for a while due to the many reports concerning blood clotting in several countries, prompting the authorities in Britain to take extra safety precautions. The Johnson&Johnson (J&J) vaccine in the U.S. has targeted clinical trials on the 6-17 age group before starting a more challenging phase involving a younger age bracket.
J&J’s vaccine is the only one to be tested on newborns in the next phase. As in the case of AZ’s vaccine, J&J’s product was disturbed by blood clotting reports. The other adenoviral vaccine, Russia’s Sputnik, which is also the first vaccine limitedly licensed in the world, will begin its research on children in May 2021.
For the recombinant protein vaccine of Novavax, its clinical trials on teenagers will only start in the second quarter of 2021 in the U.S and Mexico. Of all the vaccines already licensed, experts have assessed mRNA-based vaccines as the strongest, followed by virus-vector products. Recombinant and inactive/dead vaccines trail behind them. Of the group of dead vaccines, Sinovac and Sinopharm have submitted preliminary data based on clinical trials on 550 children aged 3-17. They have even stepped further by requesting limited licenses from the regulator in their country.
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As a note, the dead vaccines from China have not yet delivered complete results of their main clinical trials to reputed medical journals. This makes it difficult for experts to offer their objective evaluations. With practically all licensed vaccines having started or even finishing their clinical research on children, people can now hope that in phases this year part of the child population in the world will get Covid-19 vaccine shots.
Cautions and benefits
There are some things to be cautious about with regard to giving Covid-19 vaccine injections to children.
The issue of side effects, which is like the two sides of a coin when compared to the strength of the vaccines, the formulations of doses, and the presence of several clinical conditions different from those of adults, such as that observed in child patients infected with Covid-19 (a condition resembling the Kawasaki disease), are examples of some of the cautionary aspects.
The rick of children being infected will be minimized and at the same time the risk of the elderly around them being affected is also reduced.
In order to prevent and overcome them, researchers need to better prepare. Unlike other vaccines, data from adults already accumulated will greatly support the implementation of children’s inoculation. If vaccines are already licensed for distribution, there remains a problem to ponder: how to adjust the group of children to the priority of vaccine distribution, which so far has not yet been accommodated at all throughout the world.
The next constraint is certainly the supply of vaccines in sufficient quantities. Even at present, the rate of vaccine production is unable to meet the existing demand. Understandably, the world population is already 8 billion. The issue of vaccine nationalism has unsurprisingly arisen, which unless promptly resolved will have the potential to create a greater problem of humanity.
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Anyway, all the constraints pose no absolute impediments to the supply of vaccines for children. The benefits to be experienced will far outweigh all the problems. Schools will be opened with minimum anxieties as all children have been protected.
The rick of children being infected will be minimized and at the same time the risk of the elderly around them being affected is also reduced. Outside school, the life of teenagers tending to be hard to control becomes no longer too risky. We will also cut off part of the channel of virus transmission. The achievement of herd immunity will be more realistic.
Dominicus Husada
Another equally important thing is that the impact of Covid-19 on children will be greater than what is now apparent. Not only a physical matter, practically all elements of children’s life will be affected. The extra protection can save the children and it also means the fate of future humanity. This is a very noble action. Hopefully the expectation of millions of people will soon be a reality.
Dominicus Husada, Pediatrician, Head of Children’s Infectious and Tropical Disease Division, Department of Pediatrics, School of Medicine, Airlangga University/Dr Soetomo Regional General Hospital, Airlangga University Covid-19 Vaccine Research Team Member.
This article was translated by Aris Prawira.
