Covid-19 pandemic: Vaccinating children not a priority for now, say experts

They say mRNA vaccines could offer best protection for vulnerable children

After India’s expert panel recommended an approval for Bharat Biotech’s Covaxin for use in children aged two years and above, experts in the fields of immunology, microbiology and public health said there was no rush to inoculate children against Covid-19 at this point.

Certain experts, such as Gagandeep Kang, microbiologist and professor at Christian Medical College, Vellore, pointed out that data on children with co-morbidities seems to suggest that mRNA vaccines are the best bet.

Are children a priority now?

Some public health experts feel there is no need to vaccinate children below 12. “The purpose of vaccination is to save lives. And that risk is not there for children. A committee may be technically competent, but from a public health point of view, there is no justification,” said Jayprakash Muliyil, chairman of the Scientific Advisory Committee of ICMR NIE. At this stage, Muliyil said the purpose of vaccination is to reduce transmission. 

Giving approval to the vaccine is one thing and to administer it is a different matter, experts said. At this stage, Muliyil said the purpose of vaccination is to reduce transmission.

“If the vaccination is to help children who are at risk of dying, then there is no evidence that the vaccine will work. Many can get infection even after vaccination,” Muliyil added. 

Kang seemed to agree. She said vaccine trials are done on a limited number of people and in tightly controlled conditions.

At present, we do not have national-level granular data on how many infected children landed in hospitals, or the number of severe cases. “We know from sero-surveys that almost 60 per cent of children are infected. This means, around 240 million children were infected with the virus (of an estimated 400 million children overall). We need to know how many of them had to be hospitalised, how many suffered serious symptoms, or how many died. We do not have this data at the national-level,” she said.

“Am reluctant to vaccinate children now for the reason of science, and also for the reason of ethics, as many elderly have not been covered,” she said.

Scientifically, experts said, which vaccine the children get as their first shot matters. “There is a concept of immune imprinting for some infections such as influenza, dengue and even HIV. The first time you encounter something and respond to it, that shapes your immune system to all subsequent versions of that same thing,” she explained.  

“There are some infections that children seem better equipped to handle than adults. We are already seeing that children are faring better than adults in case of Covid-19,” Kang said.

Some experts, however, differed.

Jacob John, former head of Centre for Advanced Research in Virology at the Indian Council of Medical Research (ICMR), said the time to vaccinate children is now. “The game plans have changed, when we were dealing with the epidemic it was to save lives... Now we are endemic and the goal is not to save lives, but to reduce risk of infection for everybody, including children,” he said.

While the subject expert committee has recommended the approval for Covaxin and the regulatory authority is yet to make up its mind, John said wide consultations are required as these are difficult times to make decisions. 

He said if the subject expert committee has recommended approval for a vaccine, it meant it was satisfied with the safety of the vaccine, from a scientific point of view. “If the number of children (in the trial) is small, then we have to collect more data as we roll out the vaccine. Rolling out and data collection has to be simultaneous because if you want more trial data, it will delay things,” John said. 

Which is best for children?

Experts also differed on the choice of platforms. While Kang seemed to be of the opinion that mRNA vaccines work best for children who are vulnerable, she even said the government should consider allowing imports of mRNA vaccines to protect vulnerable children.

John, however, felt while safety problems had been detected in the mRNA vaccine with cases of myocarditis in young boys, no problem had been detected in the inactivated virus vaccine (Covaxin). This has to be studied in greater detail with more data, John said. 

Cadila Healthcare’s ZyCoV-D is approved for use in children aged 12 years and above. It is a completely new platform, just like the mRNA platform.

“We have data on about 1,400 children in the 12-17 age group for ZyCoV-D, and they have had no safety events. We have a safety database on 25,000 adults for this vaccine. As for immunogenicity, we only have data on 10 children, and we have zero data on efficacy in this age group,” she said.

Should we vaccinate all children at once?

Giving a few pointers on how the vaccination for children should be rolled out, John said it should be started with an age group, with a cut-off at maybe 10 years of age, after which a confirmed safety profile has to be built. The vaccination should be under doctor’s supervision and a follow up should be necessary. 

“Eventually we will have to vaccinate all children... We don’t have a track record of developing reliable data, but that should not hold up the vaccination programme,” John said. 

K Srinath Reddy, president, Public Health Foundation of India, said, “We can come down to 12 years, depending on vaccine supplies. One cannot vaccinate all age groups simultaneously.

One may come down to 5 years or even below, depending on what kind of evidence is building up in India and abroad.”

The expert panel’s approval does not mean the Centre will give it to all children above 2 years at one go. Vaccine administration policy would be decided in a phase-wise manner, Reddy said.

“The 2-5-year age group is not an immediate priority unless we are flooded with vaccines and vaccinators,” he added.