Schools have begun to reopen and so has the debate on whether the COVID-19 vaccination drive should cover children. Are there merits of expanding the inoculation campaign or should there be a wait and watch approach? So far, the UK's joint committee on vaccination and immunisation has said it does not recommend vaccinating all 12 to 15-year-olds citing rare side effects of heart inflammation.
In the United States, while children under 12 years of age are not eligible for a vaccine, the country's top infectious diseases expert Doctor Anthony Fauci has said data will be available by October to show whether vaccines are safe for that age group and below. Meanwhile, the European medicines agency has also not approved a shot for children aged 12 and below. It had, however, approved the Pfizer and Moderna vaccines for use in those aged 12 to 15 years in May and June.
Back home in India, according to Dr Gagandeep Kang, there is very little data on severe disease and mortality in potentially infected children. Speaking to CNBC-TV18 Dr Kang emphasised that there is also no risk-benefit analysis on inoculating children, which is necessary before recommending an expansion of the immunisation campaign.
To discuss this further, CNBC-TV18 spoke to Dr Samiran Panda, Head of Epidemiology & Communicable Diseases Division, the Indian Council of Medical Research (ICMR) and Dr Rajib Dasgupta, Chairperson, Centre Of Social Medicine And Community Health, JNU. Dr Dasgupta is also a member of the national AEFI committee that monitors the side effects of vaccines.
While the subject expert committee (SEC) has given emergency use authorisation to the Zydus Cadila vaccine, which can be used on adolescents in the age group of 12 to 18, the Drugs Controller General of India’s (DCGI’s) nod on whether children will be vaccinated or not is still awaited. The National Technical Advisory Group on Immunization (NTAGI) has said that it would prefer if children with comorbidities are vaccinated first.
When asked in light of what has been heard from the UK vaccine Advisory Committee, if a precautionary approach would be preferred given the risk-benefit analysis, Dasgupta said the global wisdom is not to rush into paediatric vaccination. The adolescents are certainly a group that would gain priority over the younger children. Yet there is an element of cautious optimism as far as vaccinating these groups are concerned, he said, adding that the authorisation for vaccines for 12 to 15 year or 12 to 18-year are certainly done but it's still not on a wide-scale basis.
Also one must remember that the approach is of inequities or addressing inequities and therefore,, globally priority groups among adults, such as health workers and those with morbidities, are really the priority and not children or adolescents, said Dasgupta.
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The AEFI committee member added that in the Indian context, the NTAGI is certainly mulling over the comorbidity conditions in children or adolescents that should gain priority over immunising children and adolescents as a whole. “It's certainly not a prerequisite for opening up schools. So schools can open with no need for mandatory vaccinations,” he said.
So far, US has been vaccinating children in the age group of 12 to 15. With the Pfizer and Moderna shots in the EU, France, Italy, Spain, and a few other countries also vaccinating the age group of 12 to 18. However, India does not have access to Pfizer and Moderna, but may have access to Zydus Cadila vaccine by the end of the month.
According to Dr. Kang, there is neither enough vaccine-related data yet and nor is there enough data linked to how the pandemic has impacted children in India. Hence, she believes a more cautious approach should be taken. What's your view?
However, Dr Panda said there are two important issues. “First of all, do we know about epidemiology or the transmission of infection? We are talking about SARS-COV2 in children in India. It is not exactly right that we do not know anything because the fourth round of the National Serological Survey did include children from six to 17 years of age. And that actually contributed a huge amount of data and understanding in terms of where we stand where the infection has gone so far as the children are concerned,” he said.
That National Serological Survey shows that exactly 55 percent of the children have already been exposed and infected with the SARS-COV-2, which points to the presence of antibodies that were detected in the blood collected from children, he added.
So clearly, a substantial and considerable proportion of children have been exposed and infected and have developed antibodies, he said, and added that not many children showed with severe symptoms and were not rushed to the hospital. “That was exactly the case what Dr. Dasgupta said with adults who are elderly or who had comorbidity,” he said.
Dr Panda added that two things need to be thought about. One, what is expected from these vaccines and if the shots are disease-modifying vaccines. Around the discussion on reopening of schools, he said people are worried that children will get infected in the school or if they contract the virus, they may back and spread it among the adults in the family and neighbourhood. “But that is wrong because children have already been infected, even if the schools open,” he said.
The second point he made is even after getting the vaccines and going to school, one cannot prevent the children from getting infected, because the vaccines do not prevent infection. “Not allowing children to go to school actually takes away their opportunity of interaction with teachers, the social interaction, and the life opportunity that they will miss because the impact of it would happen five years down the line or 10 years down the line from now,” Dr Panda explained.
For the entire discussion, watch the accompanying video