When is the ideal time for children to get the COVID-19 vaccine? Experts give their opinion

A Subject Expert Committee has ruled that Bharat Biotech’s Covaxin is safe for children between 2-18 years of age. The next step in the approval process is getting the Drugs Controller General of India (DCGI) to accept the recommendation. While the actual vaccine is similar to that given to adults and India currently is the second country with the highest number of vaccinated adults, not everyone is on board with the kids being vaccinated. In May, during a virtual conference, Dr Tedros Adhanom Ghebreyesus, World Health Organisation’s Director-General said that while he understands that people want to vaccinate their children, he urged them “to reconsider.” “In low- and lower-middle-income countries, COVID-19 vaccine supply has not been enough to even immunise healthcare workers, and hospitals are being inundated with people that need lifesaving care urgently,” he said. Dr Gagandeep Kang, a virologist and member of the government’s COVID-19 working group of National Technical Advisory Group on Immunisation (NTAGI), also feels the same way. During an interview with The Quint, she said, “I am not sure yet if healthy children really need the COVID vaccine.” However, she believes that while not all children need the vaccine, there are some - like those who are immunocompromised - that can benefit from the vaccine. AIIMS chief Dr Randeep Guleria said, “Children will also get vaccinated very soon because that’s the only way to get rid of the pandemic… As we know that children mostly have mild diseases, so due to the limited supply of the vaccination, we are prioritising those people who can have severe disease.” The coronavirus is not affecting children the same way it is affecting adults. If infected, they are mostly facing a mild or asymptomatic infection, but there have been a few exceptions. This statement was also supported by Dr Sanjay K Rai, the principal investigator of Covaxin trials on children. He said “Only a very mild infection is present. In a few children, it’s milder than the common cold. Currently, we don’t have any justification on whether Zydus Cadila, Bharat Biotech, Pfizer or Moderna… which is the mildest. These vaccines are reducing the severity of the infection, but not the infection.” When the vaccines do roll out, who gets the first doses? Kang says vulnerable children be vaccinated first. “Vaccinating children with comorbidities with an inactivated vaccine should be generally safe. The immune response may not be the best, but it will offer some protection,” she added. Dr Rajeev Jayadevan, vice-chairman, research cell, Indian Medical Association (IMA), Kerala, also told The Hindu those who are at risk should get the vaccines first. He said, “We should prioritise children who need vaccines the most. These will be children with comorbidities, who are more likely to develop complications. An additional subgroup will be children who live with people with cancer and immunosuppressed or elderly relatives – these children also may be considered for vaccination on a case-by-case basis." In an interview with Mirror Now, Dr N K Arora, COVID task force member on vaccination plan and chairman of NTAGI, spoke about the government’s plans for pediatric immunisation. He said, “Children are our most valuable asset. We will immunise them in a similar model that we immunised adults… We are preparing ourselves for pediatric immunisation.” Arora said there are 44 crore children in the country, which is a sizeable population. The immunisation plan will be conducted in a phased manner with those with co-morbidities being vaccinated first. By the first quarter of 2022, healthy children will begin getting their vaccine doses. “We are in the process of making a comorbidities list which is based on national and international data and those who are at a higher risk of getting diseases from COVID… We are in the process of identifying and once the list is ready, we will make it public,” he added. Kang added that any rollout of the vaccine should be paired with strict monitoring to measure the immune response in children to see if the vaccine works for this specific group. Currently in India, we have two potential COVID-19 vaccines for children. The world’s first DNA vaccine from Zydus Cadila has already been approved, while Covaxin is in the process of getting approvals. Arora said India will have four vaccines for children. Two are still in the clinical trials phase, but results are expected soon. These vaccines will be available soon for children between 12-17 years of age. He said ZyCov-D has been approved and Covaxin has been approved by the SEC, but several steps remain. India has two protein-based vaccines - Novavax from Serum Institute and Biological E’s Corbevax. Trials are ongoing, and results should be made available in the next six to eight weeks. Arora said, “Very soon, mRNA vaccine is also coming. Based on international data, it is very encouraging that we can use that for children.”