Should we vaccinate our children?
THE recent statements by a minister and health director-general regarding Covid-19 infections and the severity in children have worried many parents. It was reported that 82,341 children had been infected with Covid-19 from Jan 25, 2020 until May 30 this year, the vast majority happening in 2021. Infections have happened to children of all ages, with 19,851 of those under the age of five. The Health Ministry (MOH) director-general also reported that three children under the age of five years had died in the first five months. In addition, 27 children had been admitted to paediatric intensive care units, with 19 of them aged under five. While we take every protective measure to prevent children from getting infected, we need to ask ourselves if we should consider vaccinating children against Covid-19. Some issues to consider, including risks and benefits, are discussed below. A key determinant to vaccination is the severity of any illness. From available data, it appears that most children infected with Covid-19 get a mild or asymptomatic illness, and that severe illness is rare. One rare, severe complication of Covid-19 in children is multisystem inflammatory syndrome. A comparison of mortality in seven countries estimated that 1.7 out of every million children died when infected with Covid-19. Adolescents appeared to have a higher mortality rate than younger children. A local evaluation of our deaths was published in Code Blue, and showed that death rates among children aged 0-4 years and 13-17 years were both higher than that of primary school children (analysis is limited by the small number of deaths). However, it must be remembered that in this pandemic, parents may have been shielding children from Covid-19 infections and this may underestimate infections and mortality. There are emerging reports that Covid-19 is causing severe illness in young children in Brazil, with more than 2,200 deaths under the age of 10 years. This is unlike any other nation, and may reflect emerging variants of concern which cause more severe illness. There is growing evidence that children can suffer from Long Covid and be unwell for months after the infection. More data and work is required to clarify the size and severity of this problem in children. The Pfizer-BioNTech vaccine has shown good efficacy against Covid-19 in children aged 12-15 years of age in preliminary phase three trial results. Sinovac has announced that its vaccine is safe in children ages 3-17 years. AstraZeneca and other vaccine companies are doing trials in children aged 6-17 years. Before the use of any vaccines in children, our National Pharmaceutical Regulatory Agency will have to approve their use based on available data. We must have a vigilant surveillance on its safety signals at all times and act early, if any appear. Although clinical trial data is appearing about the safety and efficacy of some vaccines in children, we need to recognise that we will not see rare side-effects until we use the vaccines in large populations. The rare side effects of Oxford/AstraZeneca (blood clots) and Pfizer/BioNTech (myocarditis) in younger people were only recognised when populations were vaccinated. While children rarely have severe illnesses, we see the devastation Covid-19 has on adults, especially those who are elderly or have chronic illnesses. We also recognise that children can spread Covid to adults. Although no one is certain of the percentage of the population required to be vaccinated before we can hinder the spread of Covid-19 (herd immunity) in the community, we do know that this will be difficult without vaccinating children. I recently wrote about whether we can achieve herd immunity. Approximately 30% of our population is under the age of 18 years  some will choose not to vaccinate, others will be too ill or have a contraindication to vaccination, our large economic migrant and refugee populations are another factor. Hence, we will not be able to reach sufficient rates of vaccination in the population without vaccinating children aged 12-18 years of age. Remember that children cannot be a priority until we first vaccinate all adults that are keen. This includes the elderly, those with chronic illnesses, younger adults who comprise our workforce and our migrant workers. A number of nations have approved its use, predominantly in those aged 12 years and older. However, there are global ethical issues in using Covid-19 vaccines in children. There is a limited supply of vaccines and using them for children in wealthier nations (where a high proportion of adults have already been vaccinated) limits their access to poorer nations. The World Health Organisation (WHO) does not recommend that children be vaccinated. WHO has urged affluent nations to reconsider vaccinating children/adolescents, and donate vaccines to low and lower-middle income countries, where supply has been insufficient to immunise even healthcare staff. Summary  The pandemic impacts all of us, even those not infected. We will have to grapple with these issues as parents and a society as we decide about Covid-19 vaccination for children. How effectively we control the outbreak locally and the spread, and impact of variants (mutations) will also determine our response and decision regarding this issue. In Malaysia, we have yet to make a serious impact on vaccination rates for those at high risk of severe illness and death (the elderly and those with chronic illnesses). No matter how much we want to support children, it is imperative that we push for those at highest risk to be vaccinated first. In addition, it is vital to vaccinate young adults who are working and mobile as they are important drivers of the pandemic. However, we should consider selectively vaccinating children with severe disabilities. My preference would be not to subject our children to mass vaccination, however, to control Covid-19, we may have to vaccinate children aged 12-17 years. The recovery of our nation means the recovery of our children from the mental strain that impacts them. Vaccination is an important measure to return our society to a semblance of normality. Datuk Dr Amar-Singh HSS is a consultant paediatrician. Comments: letters@thesundaily.com