Expert view: Addressing concerns about vaccinating children against Covid-19

It is expected that Covid-19 vaccines for children aged five to 11 will arrive in Ireland shortly, paving the way for this cohort to be immunised against Covid-19 early in 2022. On Wednesday, it was reported that about 480,000 primary school children aged between five and 11 will be offered Covid-19 vaccines after the National Immunisation Advisory Committee (Niac) signed off on their use.

Some of the youngest in the five to 11 year age group have lived more than one-third of their lives under some kind of restrictions as a result of the Covid-19 pandemic, so the recommendation by Niac gives parents the clarity they need to make important decisions about their children’s health.

Last month, the European Medicines Agency (EMA) approved the use of the Pfizer Covid-19 vaccine for children aged five to 11. In its decision, the EMA recommended that these children should receive a lower dose of the vaccine than used in people aged 12 and over (10µg compared with 30µg). As in the older age group, the vaccine will be given as two injections in the upper arm, three weeks apart.

According to the EMA, in a main study in children aged five to 11, “the vaccine was 90.7 per cent effective at preventing symptomatic Covid-19 [although the true rate could be 67.7-98.3 per cent]”.

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“The most common side effects in children aged five to 11 are similar to those in people aged 12 and above. They include pain at the injection site, tiredness, headache, redness and swelling at the site of injection, muscle pain and chills. These effects are usually mild or moderate and improve within a few days of vaccination,” the EMA added.

The EMA, therefore, concluded “the benefits of Comirnaty in children aged five to 11 outweigh the risks, particularly in those with conditions that increase the risk of severe Covid-19”.

Thankfully, the majority of young children who contract Covid-19 get a very mild illness or are asymptomatic. However, for children with certain underlying conditions it can be a very severe illness. There is also the risk, albeit small, that children who contract Covid-19 can go on to develop a condition called paediatric multisystem inflammatory syndrome or Pims. This is a rare but potentially life-threatening condition that has affected a small number of children in Ireland with some requiring ICU admission.

Dr Louise Kyne, consultant paediatrician at Children’s Health Ireland Temple Street in Dublin, and dean of the faculty of paediatrics at the Royal College of Physicians of Ireland (RCPI), says: “It’s a condition we’ve seen with children who present with a temperature, multi-organ involvement inflammation, and we have seen children over this pandemic with this. It’s potentially life-threatening but the outcome has been very favourable in the cases and it’s all about really recognition and treatment.

“Certainly, some of these children can be sick and... paediatric intensive care may be involved with some of these children,” Dr Kyne said.

Increase in ED attendances by children suffering from mental health difficulties, anxiety, behavioural issues and eating disorders

If, for the majority of young children, the direct impacts of Covid-19 on their physical health may not be too onerous, the same cannot be said for the indirect impacts on their social, emotional and mental wellbeing.

Dr Kyne explained that while the paediatric health services had not seen the high morbidity and mortality rates experienced by their colleagues in the adult services, they had seen an increase in ED attendances by children suffering from mental health difficulties, anxiety, behavioural issues and eating disorders.

In outpatient clinics she said parents reported regression in children with special educational needs, and increased waiting lists for screening or assessments as a result of staff redeployment due to the pandemic. Dr Kyne said that as paediatricians they had seen the benefits of vaccinations.

Asked what advice she would have for parents who may have concerns about vaccinating their children against Covid-19, Dr Kyne said vaccines had to meet strict standards of safety, quality and effectiveness. “The evidence to date has shown that the vaccine is safe and we would encourage it,” she said.

Dr Kyne added that parents may have questions in relation to side effects and these can include tenderness at the vaccine site, tiredness, headache, muscle ache or temperature and often these are self-limiting. Coupled with protecting the individual child from Covid-19 and keeping them as healthy as possible, vaccinating children can also increase protection to those around them in the wider community and give the virus less chance to spread.

Dr Anne Moore is a senior lecturer in biochemistry and cell biology in UCC with extensive experience in vaccines and their delivery systems.

Dr Moore explained that the virus was circulating widely in unvaccinated people and five to 11 year olds are a key cohort in this regard. By vaccinating this cohort she said we were protecting the child’s health first and foremost, but we are also minimising the disruption forced on children as a result of contracting the virus such as the need to stay away from school etc, as well as the knock-on effects on family life and the wider community.

Dr Moore explained that we vaccinate to prevent disease and vaccines work by generating an immune response. Therefore, she said that vaccinating children would enable them to mount an immune response to a virus whenever they come into contact with it, be that in the near future or in years to come as an adult.

“If we look back in the start of 2020, nobody had immunity, the whole world was what we call immunologically naive to the virus and you’re leaving yourself completely exposed. Everybody is very exposed, as we have no strong immune capacity to fight to respond to the virus. By immunising children, we are preparing their immune systems for when they do see that infection, whether it’s during the pandemic or in the future.”

Dr Moore also said the immune system had a memory, which allows it to remember and react to infection it has previously encountered years earlier. Therefore, by vaccinating children against Covid-19 we are essentially giving them the tools to fight coronaviruses well into adulthood and beyond. “Vaccinating children now should also ensure that their immunity will protect them in their future lives; as teenagers and adults. So, the top priority absolutely is the health of the child and preventing them from getting disease, but very much after that is the protective effect it has on their current and future life as well as their family’s life.”

Dr Moore said the hope was that by vaccinating children this could help in the overall aim of containing the virus and making it less of a problem overall. “At least as a short-term extra benefit, vaccine-induced immunity will hopefully keep the level of the virus in vaccinated children lower, so there’s less likelihood that they will pass enough virus to somebody else, including family members who are more susceptible to moderate disease due to infection.

“Vaccines are one key public health measure that have been proven to be safe and effective. However, there are multiple inter-connected parameters that affect the success of this vaccine and our success at combatting this virus; major factors include the particular variant of virus that is circulating and our own behaviour. The less space we give this virus to grow, the better we’ll be able to at least contain it and eventually eliminate it, but at least contain it and make it less of a problem.”