While children wait for their COVID jab, caution is still required

It’s an understatement to say that kids and COVID-19 is a hot topic. Even though disease severity is clearly far lower than in adults, debate still rages in many quarters about the general significance of SARS-Cov-2 infection in children, the nature of prevention methods, and the pace of vaccination. But these arguments cloud two overriding principles that we should rally behind; COVID-19 vaccines are great, and COVID-19 infection in children should be kept low.

Given the current US and Canadian emergency approvals and commencement of their immunisation programs for 5- to 11-year-olds, should our regulators (the TGA and ATAGI) follow with similar speed? Or should they apply additional caution and wait for more data as the Pfizer vaccine is rolled out for millions of US and Canadian children over the next four to six weeks? It seems ATAGI at least is leaning toward waiting a little longer.

Ventilation and other measures remain best practice to keep schools open and protect kids until a suitable vaccine is available.Credit: AP

The recent trial of the Pfizer vaccine in children is good news. Those in the vaccine group had a good immune response and the expected mild side effects were not more common than in older teenagers or young adults, and no serious adverse events were detected. Having said that, the trial was too small to detect any rare but serious side effects should they exist. For example, the myocarditis/pericarditis seen in older teen boys occurs at approximately seven per 100,000 vaccine doses.

If that were to translate to younger children, it would only be detected after a few hundred thousand children were vaccinated, many more than were vaccinated in the trial. That is not to say these side effects are expected, the dose in younger children is just one-third of the dose used in adolescents. But as children’s immune responses are different to adults, caution is warranted. Watching the US and Canadian roll-outs will provide our regulators with data about any potential rare vaccine-side effects. Vaccine procurement and supply issues will also mean Australia will only get the vaccine in early January now.

None of this should cause alarm for parents. It is well documented, and widely agreed, that severe acute consequences of COVID-19 are rare. There is no reason to panic about the prospect of your child getting COVID-19. But the risks of severe illness in children are not non-existent, especially for some children with underlying medical or chronic conditions, who may be at higher risk. The more chronic “long COVID” symptoms appear to be less of an issue for children but, again, this is not non-existent and needs more careful investigation to properly assess its significance. Children are also part of the wider community that can amplify COVID-19 and put others, most especially those in their own household, at risk.

As we open up and try hard to keep children in face-to-face learning and to attend social and sporting activities more generally, preventing infection in children presents many challenges. Victoria has introduced a comprehensive plan for schools to reduce the risk of outbreaks and transmission, with a push to ensure all teachers and school staff are vaccinated, that ventilation is improved in classrooms (with filtration if necessary) and that other vital steps are taken such as mask wearing, outdoor learning and social distancing (the 3 V’s).

Now there are also rapid antigen tests that will enable simple testing of children without symptoms for COVID, particularly the close contacts of cases in schools, to reduce infection and minimise lost days of learning. These are world’s best practice strategies that will, if properly implemented (which is a big issue for example with ventilation/filtration), greatly help to reduce cases and spread in the absence of vaccination; keeping kids safe and maximising their face-to-face learning and time at school.

With our recent super-charged vaccine rollout, Australians are heading into a COVID-19 “honeymoon” period that many other countries now experiencing a resurgence have already had. For the last two years, Australia has bucked the trend and avoided the high caseloads and death tolls of the UK, US and Europe.

Australia should continue to work hard to mitigate infection of our kids and be clear that keeping COVID-19 infection low in children is important. While we wait for the vaccines for kids, we need to work hard to overcome the implementation challenges in schools to prioritise the safety and wellbeing of our children, so that they can enjoy their schooling and social development, and so they can thrive.

Liam Mannix’s Examine newsletter explains and analyses science with a rigorous focus on the evidence. Sign up to get it each week.