Children get multiple benefits with even a single Covid-19 vaccine

More than one-quarter of Malaysian children aged five to 11 have been fully vaccinated against Covid-19 to date. — ZHAFARAN NASIB/The Star

Malaysia's National Covid Immunisation Programme for Children (PICKids) started for children aged five to 11 years old on Feb 2 (2022).

About six weeks later, 34% of all children in this age group have already received one dose of a Covid-19 vaccine.

In comparison, 91% of all adolescents (aged 12-17) and 97% of all adults (aged 18 and over) have received two doses, but vaccinations for these two groups started much earlier (on Sept 15, 2021, for adolescents and on Feb 24, 2021, for adults).

There is growing evidence for the safety and effectiveness of the Pfizer-BioNTech vaccine in preventing illness in children aged five to 11.

The recommendations of Malaysia’s Covid Immunisation Task Force (CITF) are consistent with the US Centres for Disease Control and Prevention (CDC), which “recommends everyone ages five years and older get a Covid-19 vaccine to help protect against Covid-19”.

Currently, there are two vaccines for children five to 11 years old in Malaysia: those from Pfizer-BioNTech and Sinovac.

The recent conditional approval for the Sinovac vaccine for this age group will hopefully provide a choice for parents who do not prefer the Pfizer-BioNTech vaccine.

Indonesia and China are the two other countries using the Sinovac vaccine in children five to 11 years old.

It is understandable for parents to be concerned about the side effects of vaccines in young children, although there is increasing evidence of vaccine safety.

For example, the risk of myocarditis with the Pfizer-BioNTech vaccine in children aged five to 11 years is in the range of two per million (for girls) to four per million (for boys) after the second dose.

This is very much lower than the reported rate in adolescents aged 12 to 17 years old.

We are not able to provide reliable side effect rates for the Sinovac vaccine in children when used in mass vaccination programmes, as the data is still being collected.

Protecting the heart

The Sinovac vaccine is one of two Covid-19 vaccine options available for five- to 11-year-old children. — CHAN TAK KONG/The Star

We believe that all five- to 11-year-old children should be vaccinated against Covid-19 using either the Pfizer-BioNTech or Sinovac vaccines.

This is to protect children against Covid-19 in two ways.

One, there are more Malaysian children affected by the SARS-CoV-2 Omicron viral variant wave than the Delta viral variant wave.

Two, these children are at risk of multi-system inflammatory syndrome in children (MIS-C) and long Covid, should they get Covid-19.

A study, published in The Lancet journal last month (Feb 2022), of 6,800 adolescents in the United Kingdom, showed that three months after recovering from Covid-19, 39% of adolescents had tiredness, 23% had headaches and 23% had shortness of breath.

The UK Office for National Statistics estimates that 44,000 children (two to 11 years old) and 73,000 adolescents (12 to 16 years old) have long Covid.

That is approximately 1% of primary school children and 2.7% of secondary school students.

These are large numbers of children suffering from Covid illnesses that can be prevented with vaccination.

Moreover, a recent paper in the Journal of the American Medical Association (JAMA) shows that patients with long Covid have increased risk of cardiovascular (heart) disease one year after recovering.

This increased risk of cardiovascular disease is regardless of age, gender, race and concurrent diseases.

The paper also shows that the rate of myocarditis (inflammation of the heart muscle) was not related to whether the patient was vaccinated or not.

Therefore, vaccinating the entire population – including children aged five to 11 years old – is needed to reduce the risk of cardiovascular complications from Covid-19.

Needed for education

Vaccinating children provides both physical, as well as educational benefits.

As Covid-19 becomes endemic, we must learn to live with the SARS-CoV-2 virus.

Therefore, vaccination becomes the path to freedom and to schools reopening, and children resuming their extra-curricular activities and going back to playgrounds, camping and parties.

The physical benefits of vaccinating children are much easier to quantify, compared to the social and economic benefits.

For example, the World Bank estimates that 30% of children in low-income households in Malaysia have lacked access to online classes during the Covid-19 pandemic.

A large Education Ministry survey conducted in March-April 2020 showed that 37% of children did not own any digital device, and only 15% of students had personal computers, with 50% relying on smartphones.

This is borne out by anecdotal reports from teachers sharing that 30% to 40% of Malaysian children were not able to attend online classes.

Unesco estimates that the average school in our world delivered only half their intended teaching time during the pandemic.

In other words, the average child lost one full year of schooling in the two years of the pandemic.

We are not able to quantify the impact of missed schooling for Malaysian children, but we can guess that the impact will be very high.

Of course, we are not saying that vaccination is the magic solution to allow all schools to reopen overnight.

Resuming schooling and activities depends on many variables, like adults acting responsibly, everyone wearing face masks and the government imposing appropriate public policies.

However, we believe that vaccinations will play an important part in helping us live with Covid-19 and helping children return to school safely.

An Education Ministry survey found that half of school children relied on a smartphone to attend online classes during the pandemic. — Filepic

Communicating with parents

We believe in vaccinating children, and the scientific data increasingly supports our position.

However, we also believe that vaccinating children is not just scientific.

We must find ways to communicate this data to the public, in ways that are easy to understand and non-judgmental.

This requires the government to lead a multi-stakeholder programme for vaccine confidence, which should include religious groups, civil societies and grassroots organisations.

Winning the hearts and minds of parents will be crucial in building vaccine confidence.

This will require appropriate two-way communication channels, where parents are encouraged to voice their opinions and ask their questions in safe and constructive spaces.

We recommend that community leaders organise these sessions with locally-based doctors and nurses who are trusted by parents.

This hyper-local level of engagement is the best way to build trust, as they are based on pre-existing relationships.

During the period of November-December 2021, there was a small divergence of opinion between paediatricians and public health specialists on when to start vaccinating children.

This divergence is now replaced by a united belief of the value of vaccinating children, due to two major developments.

They are the emergence of the Omicron viral variant and increasing data on the effectiveness and safety of vaccinating children.

This unity between paediatricians and public health specialists is important, because any division between experts is fertile ground for anti-vaxxers to exploit.

As more and more data emerges on vaccinating children, anti-vaxxers will find less and less ground to spout their dangerous beliefs.

Prevent from harm

Due to their vulnerable state, children are the most deserving of society’s protection.

Therefore, we should do everything in our power to protect children from Covid-19 and to prevent them from physical, social or cognitive harm.

Vaccinations remain the best tool to protect our children, and we strongly recommend it for our children in Malaysia.

Datuk Dr Amar Singh is a consultant paediatrician, Professor Dr Mohd Zamrin Dimon is a cardiothoracic surgeon and former Dean of Medicine at Universiti Teknologi Mara, and Dr Khor Swee Kheng is a physician specialising in health policies and global health. He tweets as @DrKhorSK. The views expressed here are entirely their own. For more information, email [e-mail]. The information provided is for educational and communication purposes only. The Star does not give any warranty on accuracy, completeness, functionality, usefulness or other assurances as to the content appearing in this column. The Star disclaims all responsibility for any losses, damage to property or personal injury suffered directly or indirectly from reliance on such information.