What vaccine? When? What do the experts say? Questions and Answers About Vaccination of Young Children
With the approval of the European Medicines Agency, it seems that the next stop in vaccination, that of boys and girls between the ages of 5 and 11, is getting closer and closer. They are the vast majority of the only population group for which there was not yet an authorized drug against COVID-19, however, now the ball is in the court of the countries.
Pediatric vaccination opens a scientific and ethical debate, especially in low-incidence settings. In Spain, Health is waiting for the position taken by the experts of the Vaccine Report, to later go through the Public Health Commission and the Interterritorial Council, but several communities have already announced that they are immersed in the preparations to immunize the 3.2 million minors in that age group. Minister Carolina Darias also has taken for granted this Tuesday that a favorable proposal for vaccination will arrive. These are its main keys:
What vaccine is it?
The only one that the regulatory agencies have so far authorized is Comirnaty, the one developed by Pfizer-BioNTech, the first that obtained favorable results in the trials. However, the European Medicines Agency is already evaluating the pediatric use of Spikevax, Moderna's vaccine.
What results did the trials give?
"The efficacy is in line with that described for other age groups and has a very high safety profile," explains Quique Bassat, epidemiologist and pediatrician at the Barcelona Institute for Global Health. The data provided by the company point to a vaccine efficacy of 90.7% to prevent symptomatic infection. Causes mild and moderate side effects: injection site pain, tiredness, headache, myalgia, and general malaise.
What dose is administered?
For the youngest children, the serum contains 10 micrograms (µg), a third of the dose used for the rest of the age groups, which is 30 micrograms, "because the observed immune response is comparable," he explains. Francisco Álvarez, coordinator of the Vaccine Advisory Committee of the Spanish Pediatric Association (AEP), who a few days ago issued a favorable position on pediatric vaccination. As with adults, two doses should be given three weeks apart.
Are there countries where they are already getting vaccinated?
In the United States, Canada and Israel they have begun immunizing those under 12 with Pfizer. Chile, a pioneer in pediatric vaccination, began the administration of the Chinese drug Sinovac weeks ago.
When will it arrive in Spain?
The first step is for the Vaccine Report to issue a recommendation, which must be approved by the Public Health Commission, where the autonomous communities are represented, and later by the Interterritorial Council of the National Health System. Minister Carolina Darias has assumed that the experts will soon issue a favorable proposal for the expansion and has ensured that Spain will receive the first doses in the second half of December.
What is evaluated?
The point is that, as the age decreases, the chances of becoming seriously ill from COVID-19 and dying are also less. Children do not suffer the consequences of the coronavirus in the same way as adults, so the risk-benefit balance is different. Adverse effects from vaccines are extremely rare, but they are not zero. The chances of minors suffering from severe COVID are also not non-existent, but they are very rare.
To evaluate the decision, to this we must also add the role they play in the control of the transmission. According to the review made by pediatricians of a dozen Spanish hospitals and research networks published in the journal of the Spanish Association of Pediatrics (AEP), minors are not great contagion of COVID: "They rarely cause supercontagion events and seem to be less infectious than adults." However, currently, in the sixth wave, children under 12 are the age group that leads the incidence with 354 cases.
What do the experts think?
The Spanish Association of Pediatrics has already published a position in which you recommend the vaccine. "The risk-benefit balance is different than in adults, but it is clearly favorable," says Álvarez. "There are several reasons for this: the vaccine has been authorized, we will need them to achieve herd immunity and to reduce the circulation of the virus and the appearance of new variants such as the recently detected omicron. In addition, the disease is mild in them, but the risks are not zero. Why should we run them if we have a safe and effective product? "
For the Spanish Association of Pediatrics, there is also another reason: the need to "normalize" their school life, which is still subject to restrictions. "It is a step to achieve and maintain safe educational spaces that allow the normalization of schooling and their interpersonal relationships to promote their psycho-emotional well-being," he assures. Álvarez points to "the right of the boy or girl to their individual protection" as with adolescents between 12 and 17 years old, whose vaccination began in August.
There are also voices that have spoken in favor of waiting. This is the case of Federico Montalvo, president of the Bioethics Committee and one of the authors of the national vaccination strategy, who has ruled out "that children can be vaccinated for the benefit of the community" since the disease "does not affect them particularly. ". "It may be good to vaccinate them, but there is no need to make a decision just as the vaccination strategy is going," with almost 90% of the target population with a complete schedule, he assured EFE in statements.
Is there an official position?
At the European level, this Wednesday the European Center for Disease Prevention and Control (ECDC) issued a technical document with some considerations. The organism emphasizes that for children with previous illnesses, vaccination should be "a priority", but like the rest they are also susceptible to becoming ill and hospitalized, although in a milder way than adults, it emphasizes, "it could be considered" their immunization taking into account the epidemiological situation of each country.
Still, he notes that "the top priority" remains to increase the overall vaccination rate and that before making a decision "potential benefits and harms, including direct and indirect effects on health and well-being, should be considered, along with the epidemiological situation "and adherence to vaccines in each country.
Will it be key to controlling the transmission?
Quique Bassat is also committed to pediatric vaccination due to the current situation, with a sixth wave on the rise. The expert believes that the decision should be conditioned by the epidemiological moment, and now believes that "if we do not vaccinate children, it will cost us more to straighten the curve." In September "I believed that it should be an option for each family, not so much a mass public health recommendation", but "now it is different; the incidence is growing steadily, children are leading new infections and there is evidence of an outbreak in schools" .
The pediatrician and epidemiologist points out that "it is still not very urgent to vaccinate them to protect them", but "things change at the collective level." And even more so "given the potential risk of new, more infectious variants, we cannot trust that they are not very contagious and that they will transmit little because right now reality is telling us that new infections are leading, something that had not happened."
The ECDC has also referred to this aspect, and in its technical position it assures that the data indicate that its immunization "could reduce transmission in the entire population." This impact, however, will be weaker in countries with difficulties to vaccinate and more pronounced in those that, like Spain, have high levels of acceptance.