Growing up, most adults have experienced what it’s like to be vaccinated by numerous vaccines against ailments and help prevent unnecessary deaths among children. Many have mixed experiences, primarily because of the needles and not really because of the vaccines.
But now, with Covid-19, the question is should children aged 12 to 17 years old be inoculated with a vaccine against a new and complex virus? Can the adult version of the Covid-19 vaccines work on them with the same promised results? Does the country have enough vaccines in its stockpile? Are our children really in danger of Covid-19?
So far, the only Covid-19 vaccines approved by experts for use of the 12 to 17 age bracket in the country is Pfizer/BioNTech and Moderna under an Emergency Use Authorization (EUA) granted by the Food and Drug Administration of the Philippines.
Considerations for vaccination
Dr. Ma. Liza Antoinette Gonzales, Professor at the UP-PGH Department of Pediatrics, said that Covid-19 is generally mild in children and adolescents compared to adults, but the true burden of SARS-CoV-2 virus in children remains unclear. However, there are some factors that may increase the risk of severe Covid-19 in children. These include cardiovascular, neurologic conditions, medical complexity, chronic lung disease including asthma, immunosuppression, hematology/oncology, genetic conditions, endocrine (including diabetes), obesity and prematurity.
When using Covid-19 vaccines on adolescents and kids, certain issues need to be considered. “These include epidemiology [disease severity and complications, emergence of variants], safety, efficacy/effectiveness, mathematical modeling on population level of impact in vaccinating this age group, programmatic implications and potential vaccination delivery strategies and acceptance of vaccination in this age group from people on the street or even the parents,” she noted.
Another thing to consider, Dr. Gonzales said, is herd immunity, which can only happen when there is a significant proportion of the population who are immune, either through vaccination or from getting the infection.
For SARS-CoV-2, the herd immunity threshold is at 60 to 80 percent, but it will depend on the efficacy of the vaccine. If vaccine’s efficacy is at 90 to 95 percent with r-naught of 2.5, vaccination coverage should be around 70 to 80 percent. But with lower vaccine efficacy of about 62 percent, almost “all” or about 80 or 90 percent of the population should be vaccinated, including children.
For the two vaccines with EUA for adolescents, Pfizer (ages 12 to 15) and Moderna (12 to 17), both produced greater or similar immune response compared to young adults, both have a favorable safety profile, and were also highly effective against Covid-19.
Dr. Gonzales also pointed to the Israeli experience with the 16 to 18-year-olds in their population. She noted that vaccine effectiveness was at 98 percent against symptomatic Covid, and 98 percent against hospitalization for that age bracket, with no cases of severe or critical morbidity among vaccinated 16 to 18 year-olds from mid-January to mid-May 2021, with 15 non-vaccinated adolescents hospitalized in severe condition, two in critical, and only one Covid-19 death.
On the local front
There is no doubt the mRNA vaccines (Pfizer and Moderna) are both effective and safe for children. “The Department of Health All-Experts Group reiterates their initial recommendation that vaccination among children and adolescents, even those with comorbidities, should only begin once the supply of vaccines is adequate and stable. So, it’s not really a question of efficacy anymore but more of supply.”
She added that the position is supported by the Philippine Pediatric Society and the Pediatric Infectious Disease Society of the Philippines, who recommended that the priority should still be the more vulnerable adult group. Once a sufficient percentage of this priority adult group have been vaccinated, then vaccinating those 12 years and above can start, and priority should be given to areas with high transmission and those with comorbidities.
Overall, Dr. Gonzales summarized that vaccinating children against Covid-19 will be essential to protect their health and establishing herd immunity.
The government, through President Duterte, already announced that the pilot implementation of pediatric vaccination will start in Metro Manila by October 15. On Monday, October 4, the Department of Health released the list of comorbidities for the pediatric group that will be vaccinated in the pilot implementation, plus the major pre-requisites for the vaccination such as parents’ consent, doctor’s clearance, and assent of the child to be vaccinated.
Also, the National Task Force Against Covid-19 (NTF) announced that the pilot implementation for pediatric vaccination will be held in six sites, namely, Philippine Children’s Medical Center, National Children’s Hospital, the Philippine Heart Center, and the Fe Del Mundo Medical Center, all in Quezon City, the Pasig City Children’s Hospital, and Philippine General Hospital in Manila.
After 14 days, the NTF said the rollout will happen in select local government units in the National Capital Region such as Manila, Pasig, Taguig, Makati, Quezon City, and Mandaluyong, according to the NTF chief implementer and vaccine czar Carlito Galvez Jr.
After 30 days, the vaccination program will cover the rest of the NCR, including other regions that have inoculated at least 50 percent of their senior citizens or A2 group, according to the NTF.