Corona Daily 319: No Covid Vaccine For Our Children?

An academic paper published last week by Dr Evan Anderson and others raises an important issue. Currently at least 38 vaccines are in clinical trials. Another dozen will soon enter the trial phase. All of them will be tried on adults. Not a single vaccine has plans to run trials on children.

In the past, many vaccines were designed for children: measles, polio and tetanus. In April 1954, the polio vaccine was tried on 1.8 million children in the USA. By 1964, polio was eradicated from that country. Childhood measles vaccines prevented 12.7 million deaths worldwide between 2000 and 2008.

Vaccines for adults do not get an automatic approval for children. Children are not small adults. Their smaller airways make them more vulnerable to low levels of inflammation. The vaccine dose for adults and children also varies. Based on the weight of the patient, medicines can have varying impact. As a rule, children will be given a smaller dose of medicine than an adult. Vaccines work differently. The job of a vaccine is to educate the immune cells so they can recognize a virus or bacteria later. Children get a smaller dose of hepatitis A and hepatitis B, but a bigger dose of diphtheria and pertussis than adults. From the latter two vaccines, adults are more likely to experience side effects.

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Trials on children take a long time. Children are not a homogenous group. A vaccine that is safe and effective on adults will be first tried on teenagers. In steps, it will move after many months to the age group 3-8. Finally, it will be tried on the youngest, below 3 years of age. The process has different protocols, different approvals, and the parents have to give an informed consent.

True, Covid-19 is not known to be dangerous for children. As per the CDC data, out of the 190,000 deaths in the USA, only 121 were under the age of 21. Children are considered a low risk group, and are low on the priority list of the vaccine developers.

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India is demographically a young country. 41% of its population, 574 million are under 18 years of age. Vaccines are likely to be available for Indian adults by end 2021 in the best case scenario. If the trials on children were to start after that, we may be waiting for a pediatric vaccine till 2023.  

Yes, the 574 million Indian children are not a high risk group. Still, all of them are currently locked up in their homes, the majority unable to attend schools and colleges. Will this continue till the pediatric vaccine is available?

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Children may not succumb to covid-19, but they can transmit the virus. In the absence of a pediatric vaccine, they can continue to spread the disease to non-vaccinated adults. USA is already debating whether the government can or should mandate a vaccine for school attending children.

In my research, I could find three vaccines with some plans for children. The Oxford plans include a trial on an age group 5-12, to be completed by August 2021. Later this month, China’s Sinovac Biotech will try CoronaVac on 552 Chinese children aged between 3-17. Russia says it may start a trial on children after nine months.

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Dr Anderson’s concern is valid. He wants the developers to start the trials for children now, so they could start safe school life in autumn 2021. Children’s going to school is pivotal to the world coming out of the pandemic.

Ravi