Fifth phase to include youngsters

PETALING JAYA: Children between the ages of 12 and 17 are expected to be included in the National Covid-19 Immunisation Programme in its fifth phase, says Health Minister Datuk Seri Dr Adham Baba.

He said this phase, which would likely kick off in August, would only take place if the National Pharmaceutical Regulatory Agency (NPRA) gives its approval for the Pfizer vaccine to be used on children in this age group.

Dr Adham, when contacted, said so far only Pfizer had submitted a request for its vaccine to be used on children.

Currently, Covid-19 vaccines available in the country can only be given to those aged 18 and above, as regulated by the NPRA.

Dr Adham said as most of the Pfizer vaccine supply is expected to have arrived by then and herd immunity for adults would have been achieved, the government intends to also ensure children are protected from the virus.

“Data on the safety and efficacy of the vaccine in children is already out and the US Food and Drug Administration (FDA) has approved its use on children.

“However, locally, Pfizer would need to submit an application to the NPRA to expand the use of its Covid-19 vaccine in children aged 12 and above.

“In the interim, the Special Committee on Covid-19 Vaccine Supply Access Guarantee and the Disease Control Division under the Health Ministry would also have to endorse the use of the vaccine in children, ” he added.

Dr Adham said that as of now, Pfizer is still waiting for a reply to its letter to the NPRA dated May 31.

“Only after the NPRA goes through all the necessary procedures and gives its approval in black and white will the government proceed with the administration of the vaccine on children in Phase Five.

“As this involves children, we will take all precautions and efforts to make sure the vaccines given to our children are safe and protect them from Covid-19, ” he added.

He also pointed out that Malaysia would not be the first in the region vaccinating children in that age bracket as authorities in Singapore and the Philippines had approved the Pfizer vaccine for children between 12 and 17 years of age.

Meanwhile, consultant paediatrician and paediatric cardiologist Datuk Dr Zulkifli Ismail said although children admitted with Covid-19 were generally active and relatively asymptomatic, it could be fatal if the child had malnutrition to begin with.

“It appears that children are less affected from the beginning and when they are infected, they don’t get such severe infections as adults.“In data that we have received from our paediatric colleagues, the only exception to this is in Indonesia, where many children were affected from the very beginning, with high rates of deaths reported there.

“This was attributed to the higher rates of concomitant malnutrition, ” said Dr Zulkifli when contacted.

The specialist with KPJ Selangor Specialist Hospital in Shah Alam is also involved in the National Covid-19 Immunisation Programme through Immunise4Life, a collaboration between the Health Ministry, Malaysian Paediatric Association and Malaysian Society of Infectious Disease & Chemotherapy.

“There have been more deaths and more severe infections among children of late because we now have community spread.

“Overall, Covid-19-positive children are still not as severely affected as adults. The deaths documented by the ministry have been mainly from those with comorbidities, ” said Dr Zulkifli.

These comorbidities include malnutrition (as in Indonesia) or obesity, childhood cancers and tumours, children with respiratory illnesses like chronic asthma on steroids, or those with chronic lung disease requiring oxygen, diabetes, complex congenital heart diseases and those who have undergone or are awaiting surgery, and thalassaemia patients on regular transfusions.

“Even though children sometimes cannot express themselves and tell anyone if they are unwell, there would be signs of problems like rapid breathing, lethargy, being generally unwell, and persistent crying that would indicate to us that the child is more unwell than we think.

“The treatment protocol for children in categories 4 and 5 is similar to adults. They will require oxygen or ventilation if they deteriorate, ” said Dr Zulkifli.

He added that before embarking on the mass vaccination of children, it would be better to complete the vaccination of adults first as they are the ones who bring the virus home.

“In order for children to be vaccinated, the vaccines have to show no long-term effects, especially with the risk of auto-immune diseases.

“We know that children below 18 years of age make up 32% of our population, so eventually the age will have to be lowered – but not before definite results of long-term safety, ” said Dr Zulkifli.

He advised parents to teach their children to be aware of their surroundings, practise physical distancing, avoid crowds, wash their hands frequently and wear masks.

“Many children are sent to nurseries or childcare centres where they will bring back infections. So, parents have to ensure the carers have all been vaccinated and practise good hygiene. The same for kindergartens and schools.

“Our priority should be to protect our children so all staff in these schools, kindergartens and daycare centres must show proof they have been vaccinated, ” said Dr Zulkifli.