Introduction by Croakey: Children now account for the highest proportion of COVID-19 cases in Australia and are the largest group not protected by vaccination.
A vaccine for children aged five to 11 is waiting on approval by the Therapeutic Goods Administration and the Australian Technical Advisory Group on Immunisation. Health Minister Greg Hunt said this week that Australia “may well be one of the first countries in the world to begin the 5 to 11s”, while adding that “the critical thing is a full and thorough assessment”.
Professor Allen Cheng, who co-chairs the country’s vaccine advisory group the Australian Technical Advisory Group on Immunisation (ATAGI), was reported yesterday as saying timing on approval is not clear at this stage, “but it would probably be at least December and possibly January before we might start administering vaccines to younger kids.”
In the article below, health policy analyst Martyn Goddard looks at the recent authorisation by the US Food and Drug Administration for the emergency use of the Pfizer vaccine for 5-11 year olds and the international research on children living through this pandemic.
Martyn Goddard writes:
Vaccination against COVID-19 for children aged between five and 11 is expected to be approved in the near future by Australia’s medicines regulator. It has already been approved by America’s Food and Drug Administration for children aged five to 12 and vaccinations there will start this month.
Vaccination of children so far involves only the Pfizer product. Moderna, maker of the other mRNA vaccine, is expected to move for approvals fairly soon. Not to do so would leave the field open to its keenest rival.
What does this mean then for the children themselves, their families and the community at large?
Until recently, there were fears that the risks of vaccination to children – the extremely rare but serious myocarditis (inflammation of the heart muscle) and pericarditis (inflammation of the fibrous sac surrounding the heart) – could outweigh the benefits of protection from COVID-19.
Though these side-effects generally seem to be more likely in younger people, and the risk of death and serious illness less, the latest safety assessment by the FDA has swung the balance towards the need to vaccinate all children over five. The Delta variant changed all these calculations.
The US Centers for Disease Control and Prevention (CDC) endorsed the vaccination of children, saying:
The spread of the Delta variant resulted in a surge of COVID-19 cases in children throughout the summer.
During a six-week period in late June to mid-August, COVID-19 hospitalisations among children and adolescents increased fivefold.”
The FDA’s advisory committee found that more than 1.9 American million children between five and 11 have been infected during the pandemic, with a surge since the Delta variant became dominant. Although children are less likely to need hospital care than adults or adolescents, their share of hospitalisation has soared. The reason is simple: children are the only group of the population still unprotected by vaccination.
Young children can suffer serious and persistent illness from COVID-19. The most dangerous is MIS-C, or multi-system inflammatory syndrome in children, which requires hospitalisation and involves severe inflammation of the heart, lungs, kidneys, brain, skin, eyes, or gastrointestinal organs. The syndrome is most common among 5-11 year olds and, by last month there had been 5,217 cases reported in the US. Of these, between 60 and 70 percent needed intensive care and between one and two percent died.
The FDA Advisory Committee reviewed a randomised clinical trial that involved 4,500 children receiving one-third of the adult dose. It showed protection against symptomatic disease of 90.7 percent. There were no cases of myocarditis or anaphylaxis.
Against this, the FDA and CDC both concluded that the risk from side-effects was outweighed by the benefits of avoiding COVID-19.
Wider benefits
Long COVID is experienced by children too, though less frequently than among adults. The rate of long COVID remains uncertain, but one large British study found 14 percent of children who contracted COVID-19 still had some symptoms at 15 weeks. Another study of British schoolchildren found 44 percent of infected young children experienced fever, 36 percent had a sore throat, 28 percent had abdominal pain and 25 percent developed a persistent cough.
But many of these studies were conducted before Delta became fully dominant. As more and better research emerges, more reliable – and possibly higher – estimates will become available. But even with current data, vaccinating children of primary school age is clearly worthwhile.
The regulatory authorities don’t, and can’t, consider the wider benefits of vaccination. Nevertheless, there are many. One is that children’s schooling is much less likely to be interrupted. Removing the stress of isolation will improve their mental health.
And there is a major potential benefit to families and the broader community in vaccinating children. The huge REACT study by Imperial College London showed households with children were now more than four times as likely to have household transmission as households without children.
The same study, which looked at 67,000 samples across England, revealed a massive surge in cases since Delta became dominant. By the end of October, 1.7 percent of the tested population were infected, including one in every 17 school-aged children. That was double the rate of the previous month. And 10 percent of the total samples showed the new AY.4.2. Delta variant, which may be 10 to 15 percent more infectious than the parent Delta version.
In Australia, there are about 2.28 million children aged between five and 11, accounting for almost nine percent of the population. If the key to controlling the pandemic is to vaccinate as many people as possible, this group cannot be left out.
Martyn Goddard is an independent health policy analyst based in Hobart. He is a former member of the Pharmaceutical Benefits Advisory Committee, the Australian National Council on AIDS and Related Diseases and its clinical subcommittee and was health policy officer for the Australian Consumers’ Association (Choice).
See Croakey‘s archive of stories on vaccination.
