The past few weeks have been abuzz with updates surrounding COVID-19 vaccines.
The United Kingdom has become the first country to approve the Pfizer-BioNTech vaccine for rollout from 'next week’. More of these approvals could follow for Pfizer, Moderna and India’s Covishield (expected to receive authorisation by January 2021). It is extremely likely that we’ll have a vaccine for limited use in the coming months if things go well - all good news.
The news is also accompanied with schools reopening and questions around possible outbreaks.
What does all this vaccine development mean for our kids? Will children be getting the vaccine too? Do they need it in the first place? FIT answers.
First things first, do we need to vaccinate children at all?
Even though the disease is found to be less severe in children, kids could still get infected and spread the infection to those around them.
A study of 85,000 COVID cases and 6 lakh of their contacts, published in the journal Science, found that children of all ages can be infected with the virus and spread it to others. Dr Joseph Lewnard, an epidemiologist at the University of California, Berkeley, who led the study, said, “The claims that children have no role in the infection process are certainly not correct. There is, granted, not an enormous number of kids in the contact tracing data, but those who are in it are certainly transmitting.”
Children less than 15 years of age comprise around 26% of India’s population (367million out of 1.4billion). This makes it a crucial segment of the population to eventually need vaccination.
Moreover, complications specific to kids have been reported in rare cases of Kawasaki disease as well as Multisystem Inflammatory Syndrome in Children (MIS-C) with COVID. So while the risk of a severe infection is lesser among kids, it still exists, especially if they have other medical problems.
Have the COVID-19 vaccine trials included children?
Vaccine trials are usually done in stages - starting with healthy adults. Once the safety profile among this section is established, the study is expanded and taken to the next level to cover younger and older people.
Companies that have applied for emergency approvals have all sought authorization to vaccinate only adults, and not children. This is because the large-scale trials haven’t been conducted on kids as of yet.
Moderna, for instance, said on Wednesday, 2 December, that it would begin testing its vaccine in children ages 12 through 17, covering at least 3,000 of them. But the recruiting has not yet begun, and according to Colleen Hussey, a spokeswoman for the company, it is not yet certain when testing sites would be listed or start accepting volunteers, reported The New York Times.
Pfizer began testing its vaccine in children as young as 12 in October. However, the more than 95% efficacy has been found only among adults, and the emergency use authorisation in Britain has also been granted for only those above 16 years of age as of now.
The phase 3 trials being carried out in India for Bharat Biotech’s Covaxin and SII’s Covishield are also being conducted in volunteers aged above 18.
Why do we need separate trials for children?
Vaccine trials are typically first conducted on adults to assure safety and to minimize any potential risks that may emerge. A vaccine that is safe and efficacious in adults may not necessarily be safe among children.
Kids generally have more active immune systems, which could lead to stronger reactions to vaccination, including higher fever, muscle aches, joint aches and fatigue. Age could also determine the number of required doses and the most appropriate interval between those doses
Dr William Schaffner, an infectious disease specialist at Vanderbilt University and an adviser on vaccines to the Centers for Disease Control and Prevention, told the NYT how separate trials can provide more clarity on exactly how the vaccine would work in children.
“They may be more out of sorts than adults for a day or two. You really do want to know, if it’s given in adolescents, what can parents expect? You really want to be able to tell them clearly how you might feel for 24 or 48 hours after you receive the vaccine. And obviously, we really want to be able to tell parents it works. If a child had intense side effects and parents were not prepared for it, they might be reluctant to go back for the second shot.”
In most cases, however, vaccines do work equally well in children and adults. The key difference may emerge in the dosage. For instance, with the hepatitis B vaccine, different doses are required for adults and kids. Moderna will be studying the same dose in children that it has tested in adults.
When will the vaccine reach children?
Not any soon, experts from around the world have said.
As discussed, the lack of clinical trials among kids has meant that it is not yet safe to vaccine this segment. Emergency use authorisation granted to Pfizer, for instance, is also only for those above 16 years of age. Moderna’s application is also only restricted to adults.
In conversation with FIT, Dr Shahid Jameel, a leading virologist and Chairperson, Trivedi School of Biosciences, Ashoka University, said exactly this, “All the vaccine trials have been done in people 18 years of age and older. Since safety and efficacy is not tested in children, the vaccines would not be approved for children.”
Dr Anthony Fauci, the top infectious disease expert in the US, has said that it could be months before children get a vaccination. “It’s going to be months. And the reason is traditionally when you have a situation like a new vaccine, you want to make sure, because children as well as pregnant women, are vulnerable,” he said.
“So, before you put it into the children, you’re going to want to make sure you have a degree of efficacy and safety that is established in an adult population, particularly an adult, normal population,” he added.
Back in India, Serum Institute of India’s CEO and owner Adar Poonawalla also implied the same at the Hindustan Times Leadership Summit 2020. “They (kids) can still be carriers of the contagion though and may be the last ones to be vaccinated. It will possibly take more than 4 months for the vaccine to be available for children since they are the least vulnerable,” he said.
Can we afford to wait before vaccinating children?
Considering the fact that the trials have not been conducted on kids and the vaccines would initially be available in limited supply, we may have no option but to wait before vaccinating kids.
But Dr Shahid Jameel tells FIT that vaccinating adults for now could be sufficient in containing the spread of the infection. The adult vaccines could, by themselves, achieve the following goals:
- Generate herd immunity to protect everyone, including those not vaccinating (eg: children)
- Reduce mortality. Groups at higher risk of complications would need to be prioritized, and as we know, the infection is normally asymptomatic or mild in children
- Control the pandemic. There is every indication from efficacy trials so far that the vaccine will work across adults, even among the elderly. So there may not be a need to vaccinate children for now
In order of priority set out by various governments; healthcare workers, care home residents and staff, elderly and those with pre-existing health problems are expected to be given the vaccine first. As and when we have a sufficient supply of doses and trials conducted in children, the administration could be extended to cover this section of the population as well.
(This article was first published on FIT and has been republished with permission.)
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