EXPERT REACTION: Pfizer recommended for kids 12 and up

Public health concerns need to be focused on vaccinating unvaccinated people in order to control the widespread outbreaks of the delta variant in the community.

The recommendation by ATAGI to vaccinate children from 12 years of age against COVID-19 with the Comirnaty (Pfizer) vaccine is therefore important given they have been identified as a reservoir of COVID-19 and to develop herd immunity in the wider population.

The Comirnaty (Pfizer) vaccine against COVID-19 is currently the only vaccine registered by the Therapeutic Goods Administration for use in this age group.

Children play an important role in transmission of respiratory infections including COVID-19. Fortunately children remain at lower risk of developing severe COVID symptoms even with the emergence of delta strain but a there has been significant impact on their lives due to COVID from school closures.

This important step by ATAGI of approving Pfizer COVID vaccine for children as young as 12 years age will help children go back to school safely, which plays an important role in the mental, cognitive and social well-being.

As data on efficacy of the vaccine in children younger than 12 years of age become available, it will be important for Australia to extend COVID vaccines to younger children in order to have a safe exit plan out of this pandemic.

School-based vaccination programs, which we already have for the vaccine against human papilloma virus (HPV), can be leveraged to reach high COVID vaccine coverage in children. Additionally clinicians and primary care providers can play an important role in improving uptake of COVID vaccine specifically for children who have underlying chronic conditions and need ongoing care.

The decision announced today to include children 12 to 15 years of age in the vaccination roll out is welcome news.

Previously children did not seem to contribute very significantly to the transmission of Sars-CoV-2 in that relatively few children were infected, and they did not seem to readily spread the virus, at least seemingly not as much as adults. This appears to have changed in recent times with many examples in this country and abroad where children have contributed very significantly to the case numbers including the recent cluster focused around school children in Brisbane.

There also seems to be emerging evidence that children can also suffer the consequences of this infection, including so called “long Covid”, although the numbers seem far less than in adults, it is still one of many consequences of this infection worth trying to prevent. There is ample data to support this decision from both clinical trials as well real-world experience in other countries, so we can be confident of the safety and efficacy.

Vaccinating this group will not only have an impact on the susceptibility of the population in general, and therefore likely contribute to our ability to ease restrictions in a safe way when our vaccination rates are high enough overall, it will also hopefully help to allow this group to return to important activities sooner, safely, for example school and even extracurricular activities, which are so important not only from an education perspective, but from a socialisation and developmental perspective.

As a father of 3 small children, I certainly look forward to the day that I have the opportunity to vaccinate my children.

The recommendation of ATAGI to allow vaccination with Pfizer (and eventually Moderna) in children 12-15 is welcome news. Including children in the vaccination rollout will protect them from illness. However, since children of this age rarely get seriously ill with COVID-19, more importantly, it will reduce transmission in the population overall, and provide some protection to teachers.

The Doherty Institute modelling recommended some relaxation of restrictions when the percentage of 16 years and over fully vaccinated reaches 70 per cent and then 80 per cent.

However, recent modelling by other Australian groups, suggests that 80 per cent of the whole population fully vaccinated including children needs to be achieved before Australia can safely open up. ATAGI’s recommendation will help move us towards this target.

Although most children have mild symptoms, we know they can infect adults in their families, as well as outside the home. Some of these adults may be at high risk of serious complications from COVID-19. From what we understand so far, it seems that older children are spreading the virus more easily than younger children. So, it makes sense to move towards immunising the population of these children who may be contributing most to transmission. Furthermore, although infrequent, some children do get very sick from COVID-19, and prevention of serious illness in children is an important goal of vaccination.

Are playgrounds safe?
There are no direct links to any recent outbreaks of COVID19 among children/adults in an open-air environment like the outdoor community playgrounds.  Fewer children than adults have been infected with coronavirus, but children, like adults, are still at risk for getting infected by breathing in droplets from the coughs or sneezes of infected people, or by virus accumulated in or flowing through the air. Infection by contact with contaminated surfaces is possible, but this isn't a primary mode of transmission. Outdoor playgrounds are actually very safe when compared to any indoor poorly ventilated room/place setting for any activities. In my opinion, playgrounds should be open with some covid-safe measures in place.

For example:

·       Encouraging children to wear masks when in contact with others, maintaining proper distancing where possible, follow good hygiene practice (i.e., cough or sneeze into their elbow, using hand sanitizers, bringing in extra masks.

·       Physical distancing at least 6 feet from other children, not sharing, and refraining from touching their eyes, nose or mouth may be hard for kids. But advise them that these things are what they need to do so that no one gets sick.

·       Wash or sanitize your kids' hands before and after they swing or play on other equipment.

·       If the children need to eat or drink, ensure that they do so outdoors and at least 6 feet away from people from outside of your household.

·       Possibility of introducing bar code entry system (using smart phones) to monitor entry and will be easier to contact trace should there be an outbreak

All decisions involving the mass public which might affect their mental health/freedom should be based on scientific evidence. Apart from that, the open air environment proves to be a much safer place for activities compared to a closed environment.