Australia’s four million children aged five to 11 years may be able to receive the Pfizer vaccine against Covid-19 before the end of 2021 if Australia follows the lead of the United States.
On 29 October, the Federal Drug Administration approved Pfizer’s mRNA vaccine for emergency use in American children aged five to 11 years. If it is recommended by the US Centres for Disease Control, which meets this week, the vaccine will be available immediately for 28 million eligible children aged five to 11 years in the US.
Pfizer’s application for use in Australia
Pfizer supplied initial data on the vaccine for five to 11-year-olds to Australia’s Therapeutic Goods Administration (TGA) on 26 October. During the health minister’s press conference the next day, the head of the TGA, Professor John Skerritt, said “it will take a few weeks [for approval of the vaccine for 5-11-year-olds] but I would hope that we get there by the end of November”.
Here’s the crux of the issue about Covid-19 vaccinations for younger children. Australian and international data demonstrate children in this five to 11 age group typically get mild disease; unwell with fever, vomiting, and cough, but worrying parents. However, some do get very sick, need hospitalisation, ICU, get long Covid and rarely, can die. The US has had 558 Covid-19-associated child deaths (0-17 years) and 94 were aged five to 11, Canada has had 17 deaths in children (under 18 years), and Australia has had two deaths in children (in their teens). Yet, according to the Indonesian Paediatric Society, Covid-19 has caused death in more than 1,245 Indonesian children, half of whom were under one year of age. Australia however has had far fewer cases of Covid-19 than most countries globally. Although severe outcomes from Covid-19 are more typical in children with underlying conditions, that is not always the case, and up to 30% of children who become severely ill have no known risk factors.
So, we have vaccines. Pfizer’s is the first trial of a Covid-19 mRNA vaccine for this age group. There were no serious adverse events due to vaccination reported in the trial but we know that mRNA vaccines have, very rarely, caused myocarditis and/or pericarditis in teens and young adults at a rate of one or two per 100,000. The risk of developing myocarditis/pericarditis from the vaccine is much less than with Covid-19 itself: the Australian Technical Advisory Group on Immunisation (Atagi) notes the benefits of vaccination outweigh risks in all age groups.
Many countries have already started vaccinating younger children against Covid-19. For instance, Slovakia launched Pfizer vaccination for vulnerable five to 11-year-olds on 9 September. Cuba has been vaccinating children aged two to 10 with Cuban-developed vaccines. China has been vaccinating vulnerable three- to 17-year-olds since June using Sinovac, and will soon mandate vaccines to attend school. Chile and Cambodia have also been vaccinating six- to 12-year-olds with Sinovac since September. The United Arab Emirates has been giving Sinopharm to three to 17-year-olds since August and India approved their Bharat Biotech’s Covaxin Covid-19 vaccine for two to 18-year-olds two weeks ago.
The impact of Covid-19 on young children
In the current surge of cases in the UK, school-age children are about 15 times as likely to be infected as 80-year-olds and are believed to be driving the high UK case numbers. Similarly, and consistent with international data, children under 10 are the fastest growing age group contracting Covid-19 in Australia.
To date in Australia, 21,616 children aged under nine years and 46,297 children under 19 years have tested positive for Covid-19; with about 2.5% to 3% of these children requiring hospitalisation. This is similar to the US, where about 2% of children with Covid-19 required hospitalisation, out of the 6.3 million American children aged under 18 who tested positive. There have been 5,217 cases of the rare Multisystem Inflammatory Syndrome following Covid-19 infection in children in the US.
Children with Covid-19 can transmit the infection. It is particularly difficult for household members to keep social distance from a sick young child. In New South Wales alone, 67 schools have been closed so far during term four because of a Covid case in a student and/or staff. Kids (and teachers) must take time off school if infected with Covid-19 or are a close contact of a positive case. Parents must take time off work to care for their sick and/or isolating children.
Few good quality data are available on long Covid in children, so we don’t yet know the real risk. Estimates of prevalence of long Covid in children and adolescents range from 0% to 27% with the true prevalence likely about 4%. Affected children report ongoing symptoms such as extreme fatigue, disturbance of taste and smell, headaches, and “brain fog’”.
Anticipated uptake of the vaccine for younger children
Currently there are no alternatives to the Pfizer vaccine for young children though Moderna’s is currently under trial. The AstraZeneca vaccine is not being trialled in this age group.
Atagi may initially recommend the vaccine only for children aged five to 11 years with specific risk factors, children living in a household with a vulnerable family member, or children living in a Covid-19 “hotspot”. This approach was used in the initial rollout of the vaccine to teenagers in both the UK and Australia, with vaccine access later opened to all.
Vaccination remains a key tool against Covid-19. In the US one third of parents with children five to 11 plan to vaccinate as soon as possible and Australia has an enviable record in vaccination uptake (44% of teens (12-16 years) are already fully vaccinated), so this bodes well for our future with Covid-19. We just need to ensure that vulnerable groups are not left behind and that we assist in vaccinating countries in our region.