The merits of rolling out COVID vaccination to children are debated in an article in the 9 July edition of the BMJ. Some authors argue that at present the net benefit of vaccinating children is unclear, and vulnerable people worldwide should be prioritised instead. Others say that millions of children have been vaccinated already, and that children are at greater risk of harm from COVID-19 infection than from being vaccinated.
Meanwhile, columnist Alison Barrett reports below on some of the latest publications about children, young people, COVID and vaccination. She also contrasts some other countries’ COVID communications with the ‘Arm Yourself’ campaign just launched in Australia – check out the videos and other materials.
Alison Barrett writes:
Some countries, such as the United Kingdom (UK), Israel and United States (US), have reported an increase in the number of children, adolescents and young adults becoming infected with SARS-CoV-2 in recent months. As children around most of the world currently remain unvaccinated, they are at increased risk of acquiring the virus.
According to data collected by UK’s Zoe COVID Symptom Study, cases have been increasing more rapidly in unvaccinated people since the middle of May, and in particular, in the age range from newborns to 29-years-old. It is unclear from the reported data what proportion of cases in the age group between newborns and 19 years of age are in adolescents versus younger children.
Similarly, the US Centers for Disease Prevention and Control recently reported that one-third of the cases in the US in May were among people aged between 12 and 29 years.
The increase of reported cases in children, adolescents and young adults could be for numerous reasons, including the relaxation of COVID-19 prevention measures, and the increase of the Delta variant in many countries, which may be influencing the transmission of the virus in the younger age groups.
The Delta variant is more infectious than other variants to date, and confirmed cases of this variant have been reported in 104 countries. It is the dominant variant in several countries, including the UK, and rapidly becoming the dominant variant in many others.
The impact of the Delta variant on children and adolescents is not yet fully known; however, a recent report from Scotland found that the Delta variant was most common in younger groups.
Additionally, as more older adults are now vaccinated than children, adolescents, and young adults, this is likely to impact the incidence of the virus, as children, adolescents and younger adults comprise a larger share of the populations who are not vaccinated and therefore are at greater risk.
Pfizer/BioNTech is currently the only vaccine approved by World Health Organization for use in people aged between 12 and 15 years.
Since results of the Pfizer vaccination in 12 to 15 year-olds were published in May, adolescents from the age of 12 have been included in COVID-19 vaccination programs in the US, Israel and Canada.
In May, Australia’s Therapeutic Goods Administration (TGA) advised they would investigate the use of Pfizer in people aged 12 years and older. To date, no approval has been confirmed.
The phase three randomised control trial of the Pfizer COVID-19 vaccination in 12 to 15-year-olds included 2,250 participants, half of whom were given 30 micrograms of Pfizer (the same dose given to adults). The others were given a placebo of saline.
Results of the trial found that Pfizer had 100 percent efficacy against COVID-19, meaning that no cases of COVID-19 were identified in the group of 12 to 15-year-olds who received the Pfizer vaccine. This is compared to 18 cases of COVID-19 identified in the placebo group.
The trial also found the Pfizer vaccine produced a greater immune response in the 12 to 15-year-olds when compared to a group of 16 to 24-year-olds included in the part of the trial that assessed immunogenicity (the ability of a vaccine to influence an immune response).
Mild to moderate side effects that were reported included pain at injection site, fatigue and headache, resolving within two days after the vaccination. Similar to the phase three trial of Pfizer in adults, systemic side effects (headache, fever, fatigue) were reported more commonly after the second dose than the first.
While the trial was conducted in a small population sample and the published results only include follow-up data for one month after the two doses, it indicates favourable results and benefits for the use of Pfizer in people aged 12-15 years. This group is being monitored for two years after their second dose to determine long-term safety.
Trials of Pfizer are currently underway in children under 12.
COVID’s long-term impacts
While children and adolescents tend to have mild symptoms from COVID-19, the long-term impacts of COVID-19 in children and adolescents are not yet well understood.
Most research about long-COVID to date has been in adult populations. However, evidence is slowly emerging that, similar to adults, children may be susceptible to long-COVID, the term used to describe persistent symptoms of COVID-19 that last for two or more months.
A case report published in November 2020 described persistent COVID-19 symptoms in five Swedish children that were consistent with those found in adults with long COVID.
These children experienced symptoms including fatigue, dyspnoea, heart palpitations and chest pain for between six and eight months, at time of publication, after their diagnosis of COVID-19, severely disrupting their education.
A study in Italy that included 129 children who were 18 years old or younger, found that one-third of the children in the study reported one or more COVID-19 symptoms in the months after diagnosis. Nearly one-quarter (22.5%) experienced three or more long-term symptoms.
Similar to the Swedish cohort, the most common symptoms reported in these children include insomnia, respiratory symptoms, nasal congestion, fatigue, muscle and joint pain and difficulties concentrating.
While limitations exist in both studies including the self-reported nature of symptoms and small population samples, they indicate the need to gain a clearer understanding of long-COVID in children.
As Buonsenso and colleague wrote:
Childhood is a delicate and fundamental period of life, critical for acquisition of social, behavioural and educational development. The evidence that COVID-19 can have long-term impact on children as well, including those with asymptomatic/pauci-symptomatic COVID-19, highlight the need for paediatricians, mental health experts and policymakers of implementing measures to reduce impact of the pandemic on child’s health.”
Indicative of the impact on younger children, the National Health Service in the UK has recently announced the implementation of long COVID specialist centres for children and young adults (as Croakey reported recently).
As countries begin to reopen and restrictions relax, given the potential long-term health and social effects of COVID-19 in children, adolescents and young adults, it is important to protect those who are not yet able to be protected by vaccines.
More COVID-19 vaccine promotion communications
Regular readers know that I am keeping a watching brief on how different countries are promoting vaccination. Below are some more examples found since the last COVID-19 Wrap.
United Kingdom: To celebrate the National Health Services’ 73rd birthday and success of the UK’s vaccination program, this jazzy video performed to the song, ‘The Rhythm of Life’, was published on 3 July.
Singapore: In addition to the catchy ‘Get your shot’ video published in May, another informative and engaging video about COVID-19 vaccines was published in June, ‘I’m getting my shot. Get yours too.’
In July, the Singapore Government published a “safety briefing” outlining their three-step plan (test, trace, vaccinate) to reopen the country called, ‘Together, towards a new normal.’
France: French health authorities have released a new vaccine campaign highlighting the social and romantic advantages of getting immunised against COVID-19, with the message: “Yes, the vaccine can have desirable effects.” The posters can be viewed here (and see one below).
Australia: The long-awaited COVID-19 vaccine campaign by the Australian Federal Government was released on 11 July, encouraging all to ‘arm yourself’ with a vaccine.
Lieutenant General John Frewen, head of Australia’s vaccine task force, advised the campaign will be released in 36 languages and adapted again before the end of the year.
After watching Australia’s new vaccine campaign, I was left feeling completely underwhelmed. The message was simple and easy to understand, but may not appeal to a wider audience, especially as the delivery fell flat and was not engaging.
One of the main differences I felt between the Australian ‘arm yourself’ campaign and some of the others (such as France’s ‘with each vaccination, life begins again’ video, New Zealand’s ‘Ka kite, COVID’, and Singapore’s ‘Get your shot!’ video) is that it did not provoke feelings of hope, something we so desperately need, 18 months into the pandemic.
Alison Barrett is a Masters by Research candidate and research assistant at University of South Australia, with interests in public health, rural health and health inequities. Follow on Twitter: @AlisonSBarrett. Croakey thanks her for providing this column as a probono service to our readers.
See previous editions of the COVID wrap.
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