Opinions
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Canada on the verge of havinga new vaccine for kids aged 5 to 11 |
Dr. Rey D. Pagtakhan
“It would be any parent’s worst nightmare during this pandemic: a child contracting COVID-19, falling seriously ill and dying.”
Thus opened the CBC News posting a little over half a year ago (Lauren Pelley, CBC News, April 29, 2021). It detailed the occurrences of children getting seriously sick and dying from the disease as experienced by families in several provinces, including in British Columbia, where the “youngest death yet from the illness: a baby who died from COVID-19 while being treated at the children’s hospital” occurred. As a parent and as a physician who spent my entire postgraduate training and practice in pediatrics and child health, I identified with the grim message.
Earlier this month, the STAT + Newsletter posted its health breaking news that the U.S. Centers for Disease Control and Prevention (US-CDC) advisers endorse Pfizer’s COVID-19 vaccine for kids aged 5 to 11.
A momentous day
The “momentous day” – as US-CDC Director Rochelle Walensky calls the authorization for the COVID-19 vaccine to include children – took place barely two weeks ago on October 29 followed by full federal regulatory approval on November 2.
“I value preventing infection in children and I think it could have a huge positive impact on their health, their social and emotional wellbeing, their educational outcomes and their long-term trajectory… and vaccines are really the only consistent and reliable way that we can provide that protection,” said Grace Lee, a professor of pediatrics at Stanford University School of Medicine and chair of the American Advisory Committee on Immunization Practices.
American Academy of Pediatrics President Lee Savio Beers applauded the authorization in a statement: “Pediatricians are eager to participate in the immunization process and talk with families about this vaccine…to ensure that access to this vaccine is equitable, and that every child is able to benefit.”
Canada’s Chief Public Health Officer Dr. Theresa Tam recently briefed the press that “children under 12 continue to have the highest incidence rates across all age groups…and more than four million non-eligible children under 12 have not been vaccinated.” These figures indicate a higher risk of surges of cases and underscores the importance to Canada of the pediatric vaccine.
The new pediatric vaccine is almost here
Health Canada, which received the application from Pfizer a couple of weeks later after its submission to the US regulatory body, is now reviewing both the clinical trial data and the new product formulation. It anticipates making its announcement anytime soon. Naturally, Canadians are expecting a similar greenlight.
The new Pfizer vaccine for this much younger group of children is the first pediatric vaccine. It is one-third the adult dose (10 micrograms of the antigen) and is given in two doses 21 days apart, just like for older children and adults. The formulation is different, but otherwise the same vaccine in efficacy, safety, and quality. The side effects are similar as in adults and the benefits far outweigh the risks.
Does this age group need the vaccine?
The Canadian Paediatric Surveillance Program did a landmark nine-month-long study of all 264 pediatric cases of COVID-19 in hospitals and ICUs during the period March 25 to December 31, 2020. The study validates earlier observations that “children and youth fared better than adults and were at less risk of severe disease or death.” (Olivier Drouin et al. CanMedAssoc Journal. Sept 27, 2021). Since this type of observation could, understandably, influence some parents to vaccine hesitancy for their children, I should emphasize the point that even though young children have not been as seriously affected by the COVID virus, they have not wholly escaped its onslaught. COVID deaths in this age group show rates that exceed deaths from influenza. Also, young children can develop “long COVID,” that is, persistent distressing symptoms after recovery, and multisystem inflammatory syndrome, nearly half of whom are among the 5 to 11 age group.
For these reasons, kids from 5 to 11 years of age do need the vaccine. In addition to protecting them, vaccinating children prevents further spread of the virus and helps in the attainment of community immunity and, eventually, in the control the pandemic and its damage to individuals, community and country.
What should we tell the kids and their parents about the new vaccine?
We should emphasize that the vaccine has been tested in kids, shown to be effective and safe, and will protect them from getting sick. It offers more definitive protection than a natural infection; the side effects are tolerable and temporary; the benefits far outweigh the risks; it can be given in the arms or thighs, whichever works best; the syringes are smaller, but a pinch will still be felt from the needle; and doses are given twice three weeks apart, but the amount of the antigen is only one-third than in the adult vaccine.
We should further share the information that three layers of protection are offered by the vaccination of children, including this age group. It would prevent: 1. infection following exposure, that is, the COVID virus fails to gain a foothold in the vaccinee; 2. moderate disease, that is, clinical manifestations of disease are absent or mild and illness would not require hospitalization should a breakthrough infection occur; and 3. serious disease and death, that is, the necessity for ICU admission and the likelihood of dying when hospitalized are significantly less compared to the unvaccinated.
Finally, we should share the information that immunizing this age group will immensely lessen the public health burden caused by the pandemic. Infected children – even those without symptoms – are capable of spreading it to both peers and adults in their households and in the community, thereby, increasing the opportunity for continuing community circulation of the virus and consequent emergence of potentially even more deadly variants than the Delta.
National Geographic KIDS and FAMILY Editor-in-Chief Rachel Buchholz has offered these three pieces of advice: “1. talk to your kids about what will happen; 2. give them a sense of control, which will help them relax; and 3. don’t lie. Telling a kid that you’re going out for cupcakes only to wind up at the doctor’s office never works.”
Vaccine hesitancy is a crisis of public trust, not a war against science
The history of immunization is a story of medical success. Of the six childhood communicable diseases that used to be seen commonly in clinical practice – whooping cough, measles, rubella (also called German measles), mumps, diphtheria and polio – the latter has been eradicated, whooping cough has been decreased by 87 per cent, and the others decreased by 99 per cent. Indeed, vaccines work.
Thankfully, the vast majority of Canadian parents – close to 70 per cent according to a recent survey by Forum Research of parents of children aged 5 to 11 – would have their children promptly vaccinated for all the right reasons: to protect them from sickness; to prevent them from infecting others and missing in-person schooling, extracurricular activities and public places; and to help control the pandemic.
Unfortunately, vaccine hesitancy to COVID-19 vaccines remains a challenge notwithstanding their effectiveness and safety. The same research survey shows 10 per cent would not and another 20 per cent would wait, citing worrisome side effects, difficulty of access, hasty vaccine development, conflicting public health messages, curtailment of freedom, misinformation, and other conspiracy theory allegations.
Maya J. Goldenberg, an associate professor of philosophy in the Department of Philosophy at the University of Guelph whose research work focuses on the philosophy of science and medicine and the connection between science and values, offers one insight that “ultimately reframes vaccine hesitancy as a crisis of public trust rather than a war on science. She argues that having good scientific support of vaccine efficacy and safety is not enough…(and) advocates for trust-building measures that focus on relationships, transparency, and justice.”
True, access must be facilitated. But establishing trust appears to be the common denominator required. To help achieve this, some public-health campaigns involve getting children and their parents excited about getting the vaccine shot. For example, Toronto Mayor John Tory and Medical Officer of Health Dr. Eileen de Villa announced “Team Toronto Kids,” which features kid-friendly materials.
What is Canada’s childhood vaccine strategy?
“Vaccines for children are almost here. Does Canada have a plan?” reads the Globe and Mail editorial of October 6. It commented that Canada’s roll-out of its mass adult vaccination program left much to be desired – admittedly, not wholly within Canada’s full control. It underscored, this time, is Canada’s “golden opportunity to quickly and dramatically shrink our pool of unvaccinated people” and thereby “increase the safety of all children and adults, while lowering the odds of further pandemic shutdowns of schools and businesses.”
The necessity for a Canadian operational plan to roll-out the new pediatric vaccine is obvious. Any successful childhood vaccine strategy needs not just regulatory approval but a hefty supply of vaccines and their efficient distribution nationwide – the federal responsibility – and the wherewithal to deliver them into arms and thighs of children on time and in quantity – the provincial and territorial obligation.
The operational scenery at this time looks reassuring. Most provinces have posted and described their plans.
Summation
Canada is on the verge of authorizing the COVID-19 vaccine for children aged 5 to 11 – the new pediatric Pfizer-BioNTech vaccine. The US gave this pediatric vaccine its full regulatory green light earlier this month and promptly started its roll-out the following day.
Compared to the previously approved Pfizer vaccine that has now been given to fully immunize hundreds of millions of people 12 years and older worldwide – Canada included – the newly formulated pediatric vaccine comes in smaller vials, can be stored longer in the fridge, is deliverable in small syringes, can be injected into arms or thighs, contains one-third of the mRNA antigen (10 micrograms), and is as safe and effective.
Reportedly, Health Canada is just about ready to favourably announce its medical imprimatur after its own comprehensive and independent review of the clinical trial data and the quality of the new pediatric formulation. It is almost here and may well partially protect thousands of Canadian children before Christmas.
A child’s life lost from a preventable tragedy cannot be allowed. Thus, Canadian public health officials, health care practitioners, parents and guardians, kids and governments at all levels wait for the new pediatric vaccine with great anticipation. No more parental nightmare.
Dr. Rey D. Pagtakhan, P.C., O.M., LL.D., Sc.D., M.D. M.Sc. is a retired lung specialist, professor of child health, author of articles and chapters in medical journals and textbooks, and a former health critic, Parliamentary Secretary to the Prime Minister, and cabinet minister, including Secretary of State for Science, Research and Development. He graduated from the University of the Philippines, did postgraduate training and studies at the Children’s Hospitals of Washington University in St. Louis and the University of Manitoba in Winnipeg, and spent a sabbatical year as Visiting Professor of Pediatrics at the University of Arizona Medical Center. In June 2003, he spoke on “The Global Threat of Infectious Diseases” at the G-8 Science Ministers/Advisors Carnegie Group Meeting in Berlin. Contact: reypagtakhan@gmail.com.