Why we need to vaccinate our kids against Covid
Children may become the main source of continuing endemic transmission of Covid. To minimise transmission and mutation risks, inoculating them becomes a public health imperative
Published: 23rd October 2021 12:15 AM | Last Updated: 23rd October 2021 04:39 PM | A+A A-
Now that the pandemic has waned in India, we are in for the long haul of endemic Covid. Even now, for the individual who gets Covid, the attendant risks—serious disease, hospitalisation and death—are just the same as during the peak of the pandemic. We cannot let our defence down just because the toughest phase is over.
The whirlwind of vaccine development and rollout has enabled high inoculation coverage in many rich countries; among developing nations, India leads, with around 30% of adults vaccinated with two doses, while many are struggling to even reach two-digit figures. We anticipate that one or more vaccines may be approved for children fairly soon.
In endemic times, the coronavirus infection will affect three groups of individuals: primary infection in the non-immune, reinfection in those previously infected and breakthrough infections in those vaccinated. Now vaccination should be repurposed by giving (1) highest priority to save the lives of the elderly and vulnerable who must be specifically targeted; (2) second priority for the non-immune, including children (as soon as a vaccine is approved) to retard virus transmission; (3) third priority to boost immunity in previously infected (to prevent reinfection) and previously vaccinated (to prevent break-through infection).
Of these groups, children constitute the majority in view of our demographics. The 6-18 age group is a staggering 320 million. The 4th ICMR sero-survey showed that 50% of children were already infected by the end of July, leaving a susceptible pool of 160 million.
True, Covid is not a frequent killer disease in normal children; Multi-System Inflammatory Syndrome of Covid is very rare. But the long-term consequences of non-life-threatening Covid are largely unknown; only careful long-term follow-up will inform us about the natural history of childhood Covid. While we wait for follow-up studies, prevention must also go on in parallel.
Covid in children tends to affect socio-economically disadvantaged families to a disproportionately greater extent, a study in the US showed. For them, the need for hospital admissions and ICU care are greater than in children of well-to-do families. Furthermore, like adults, children with comorbidities—asthma, obesity, malnutrition, etc.—are at higher risk of severe disease. These factors underscore the need to swiftly plan a Covid vaccination programme for children in India.
Vaccination is the most cost-effective public health tool of intervention, so are all medical students taught. Vaccination is not just for saving lives of the lucky ones who get vaccinated, but it is also a tool in the epidemiologic management of infectious diseases. Vaccination in healthcare is to prevent disease in the individual (individual benefit); vaccination as a public health programme is to control human-to-human transmitted infectious diseases by building up herd immunity (community benefit).
The Expanded Programme on Immunisation (EPI, 1974) chose vaccines against six killer diseases—childhood TB, diphtheria, whooping cough, tetanus, measles and polio—initially. That gave the impression that only vaccines against diseases with high mortality are relevant in childhood. The early years are also an opportunity to lay the foundation for lifelong immunity against many diseases, like the Hepatitis B and Human Papillomavirus vaccines to prevent serious chronic adult diseases, one for liver cirrhosis/cancer and the other for cancer of the uterine cervix. Even the Covid jab should be considered one more such vaccine. As more and more adults are fully vaccinated, the need for the adult Covid jab will dwindle, but the childhood vaccination programme is for the long-term, till such time as the virus is virtually eradicated.
Those who believe that childhood Covid vaccination is unnecessary err, because:
1. In the interests of society at large, most parents have only one or two children, therefore society, in turn, must protect the life of every child. Vaccination then becomes the birthright of every child.
2. William Wordsworth has famously said, “The child is father of the man.” With endemic Covid, every non-immune child will one day get the infection. Should they wait for their 18th birthday for vaccination? Administering a safe vaccine as early as possible to children elicits the best immune responses and forms a firm foundation for life-long immunity.
3. With schools opening up, children and adolescents who contract the coronavirus infection at school will carry it home and spread it to the elderly and vulnerable and those with waned immunity. A very recent important paper by investigators in Harvard University concludes: “Asymptomatic and symptomatic children can carry high quantities of SARS-CoV-2 irrespective of disease severity. Our results suggest that children can serve as potential reservoirs for SARS-CoV-2 and viral evolution.” Indeed, children may become the main source of continuing endemic transmission. In order to minimise virus transmission and the risk of emergence of new variants by mutations, vaccinating children becomes a public health imperative.
Of course, we need to be cautious—the vaccine should be safe, on par with all other childhood shots. Careful short- and long-term follow-up of vaccinated children to monitor their safety is mandatory.
As soon as regulatory agencies declare any vaccine safe and effective in children and the supply is enough to avoid clashing interests of adults versus children, the government ought to roll out vaccination in kids. Now is the time to plan.
The first priority should be children with comorbidities, who are at increased risk of serious disease when infected. Their follow-up should be meticulous so as to provide accurate information on safety and efficacy.
The next priority is school going children aged 12 to 18. Plans ought to be ready when any vaccine is approved. Parents, public and all school and health authorities should be well-informed through all available channels. A nationwide school-based vaccination campaign is doable. It may be piloted in selected schools to cover about 10,000 children while collecting daily follow-up information for two to four weeks before a nationwide campaign. For the next group, children aged 6 to 12, a similar school-based strategy can be implemented.
Finally, Covid vaccination could be started in the 2-5 age group and nested within the Universal Immunisation Programme—either as a standalone vaccine or concurrent with others. Concurrent vaccination calls for immediate research to confirm non-interference between different jabs.
We are on the threshold of extending Covid vaccination to children as part of routine immunisation. This important and futuristic public health action must be carried out with due diligence and caution.
Dr T Jacob John
Former Professor of Clinical Virology, CMC, Vellore
Dr M S Seshadri
Medical Director, Thirumalai Mission Hospital, Ranipet