Vaccinating our children

Saula Tikalau Muriwaqa a year twelve student of Queen Victoria School recieve's his first dose from Staff Nurse Mereseini Baba at the Gospel High School hall after the launch of the Students vaccination drive on Monday, September 20, 2021. Picture: ATU RASEA

Love for one’s children is altruistic in most individuals.

Our genetics and survival as a species dictates that we have built-in protective instincts for our progeny.

Biologically speaking, human beings, similar to some other mammals care for their young for almost a quarter to a third of their lifetimes.

This longevity of caring is seen in other mammals such as African Elephants where the male spends a third of its life at home and female Orcas who spend their entire lives in their pods.

This innate protective behavior ensures that the young are cared for and nurtured appropriately until they have developed physical and psychological attributes that will enable them to survive independently.

Human beings have been blessed with a conscience which allows us to have deep, life-long connections with our young.

The love and protection we offer them is unconditional and we will fight tooth and nail to ensure their safety.

During times of strife such as natural or man-made disasters, we will go out of our way to protect our children.

The current COVID-19 crisis is no exception.

Similar to adults, children are susceptible to COVID-19 and our in-built parental instinct is to protect our children from this disease.

As parents, we have to be cognizant of three worrying facts about COVID-19:

  1. Children can get COVID-19;
  2. They can get very sick or even die from it depending on their immune systems; and
  3. Once they have COVID-19, they can potentially spread it to more vulnerable individuals.

Thankfully, COVID-19 does not seem to pose a life-threatening risk in the majority of our children.

Children are not just miniature adults.

Their immune system has some advantages when coping with novel (new) pathogens.

In the first months of life, babies are primarily protected from infectious diseases by the antibodies transferred to them from their mother.

As these initial antibodies diminish, children are often more susceptible to all kinds of microorganisms, because they are new to their bodies.

Thus, children’s immune systems are in a very active state as they continuously encounter new pathogens.

Since SARS-CoV-2 is a novel virus to both children and adults, it is very likely that children’s immune systems react more effectively to combat it.

Two significant components influence the increased robustness of children’s immune response to novel pathogens: the number of naïve T-cells and the location of those T- cells.

Children have millions of naïve T-cell warriors, just waiting to be exposed to pathogens.

This innate immune response to new pathogens is the first step in building immunity.

In the second step, the body creates “memories”, in the form of memory immune cells that prepare it to respond to these pathogen invaders in the future.

Children have a distinct advantage over adults in building immunity because as you age, your umber of naive T-cells decreases.

This also means that adults are slower to mount an immune response to a pathogen because they do not have as many T-cell warriors ready to react.

The location of these naive T-cells also contributes to the more robust immune response to COVID19 in children.

A 2019 article in Nature Mucosal Immunology found that children have more naïve T-cells in specific tissues, not just in their blood.

Another report in Nature noted that children also typically have increased exposure to other coronaviruses, like those that cause the common cold, contributing to a quicker immune response to SARS-CoV-2.

For these reasons, children’s immune response to vaccinations and related side effects can differ from those seen in adults.

Thus, separate clinical trials in children were critical to prove safety and efficacy in this unique population and optimise appropriate dosing and clinical protocols.

Not all children are the same in terms of their immunity.

If a child has a weak immune system for whatever reason, then COVID-19 can be a serious and even a lifethreatening illness.

When these vulnerable children get the virus, their vulnerable lungs can quickly become overwhelmed leading to respiratory failure and a need for ventilatory support.

If definitive care is not provided in a timely fashion, the outcome can be death.

Sadly, we have seen deaths in children during this outbreak in Fiji.

According to MOH statistics, there have been 8345 children who have contracted COVID and seven have died from it with the youngest being six months of age.

These statistics are worrying indeed. In fact, the actual number of children affected in Fiji may be significantly higher than 8345.

So, we have to ensure COVID-19 safe practices such as frequent hand-washing and physical distancing are also ingrained in our children.

Of course, the best and most fail-safe protection comes from vaccination.

In their landmark phase three clinical trial that started in late July 2020, Pfizer/BioNTech enrolled 2260 adolescents aged 12-15 without evidence of prior SARS-CoV-2 infection who received the COVID-19 BNT162b2 vaccine under the
same two-shot protocol being used for adults.

Among these participants, 1131 were given the vaccine and 1129 were given a placebo.

There were zero infections in the vaccine group and 18 infections in the placebo group.

The data showed the vaccine to have 100 per cent efficacy in this age group, and serum antibody testing also showed a more robust antibody response in this age group than was seen in the 16-25 age group tested in previous trials.

The adverse effects reported in this study did not differ from the effects that have been reported in other age groups and were generally mild.

Thus, based on the available data, the Pfizer/BioNTech vaccine has proven to be very effective and safe for children 12 years and older.

Pfizer/BioNTech has also committed to monitoring all children in the clinical trial for an additional two years to ensure there are no long-term consequences from the vaccine.

Following the success of this trial, Pfizer/ BioNTech also initiated a phase one clinical trial with children six months to 12 years of age.

Similarly, the European Medicines Agency (EMA) has granted an extension of indication for the COVID-19 vaccine Moderna to include use in children aged 12 to 17 years.

The effects of Moderna have been investigated in a study involving 3732 children aged 12 to 17 years.

The study showed that Moderna produced a comparable antibody response in 12 to 17-year-olds to that seen in young adults aged 18 to 25 years (as measured by the level of antibodies against SARS-CoV-2).

In addition, none of 2163 children receiving the vaccine developed COVID-19 compared with four of 1073 children given a dummy injection.

These results allowed the EMA to conclude that the efficacy of Moderna in 12 to 17- year-olds is similar to that in adults.

Based on scientific evidence, many countries have approved use of these vaccines in children as young as 12 years of age.

In May 2021, US and Canadian regulators were the first to approve the Pfizer jab for use in children from 12 years and older.

The rollout started immediately at sites across the US with two injections given three weeks apart.

By the end of July, 42 per cent of 12 to 17-year-olds had received their first dose and 32 per cent their second dose of either the Pfizer or Moderna shots.

The drive to vaccinate children came as the US started to battle a rise in infections driven by the Delta variant.

The latest report from the Centre for Disease Control said that the number of children hospitalised with COVID-19 was between 3.4 to 3.7 times higher in states with the lowest vaccination coverage.

A handful of US school boards have voted to make the jab mandatory for children aged 12 and over to attend class.

Similarly in May, the European Medicines Agency (EMA) approved the Pfizer vaccine for 12 to 15-year-olds. Later in July, EMA approved use of Moderna in the same age group.

Different EU countries have moved at different speeds.

Denmark (12 to 15-year-olds) and Spain (12 to 19-year-olds) have both now vaccinated most of their child population with at least a single dose.

France too has been moving quickly with 66 per cent of those aged 12 to 17 now single jabbed, and 52 per cent fully vaccinated.

In June, Germany’s scientific advisers recommended the vaccine should only be offered to children aged 12 to 15 with underlying health conditions.

But in August, after the Delta variant started spreading more widely, the rollout was extended to all those over 12 years old.

As the rollout of vaccines is extended to our children in Fiji and we have apprehensions, we can be confident in the scientific evidence from clinical trials which show that Pfizer and Moderna vaccines are safe in children and it protects them from developing the disease.

We can be further comforted with the fact that many countries are already vaccinating children with these vaccines and they are not only safe and effective, but also preventing children from being carriers of the virus and potentially infecting more vulnerable individuals.

The big picture here is, as the bulk of our population gets vaccinated, we will downgrade the threat of COVID-19 from a killer to one where it is like getting a nonlethal common cold at the worst.

We will once again have our lives and indeed our livelihoods back.

  • DR BASHARAT MUNSHI is the president of the Fiji Medical Association. The opinions expressed in this article are not necessarily the views of this newspaper.

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