COVID-19 Vaccines are Safe and Works for Children

Dr Musa Mohd Nordin, Paediatrician
Dr Zulkifli Ismail, Paediatrician
Asst Prof Mohammad Farhan Rusli, Public Health Physician

What’s the prevalence of COVID-19 among children and what kind of complications are we seeing as a result of infections?

In 2020 there were 7,730 cases among children less than 11 years old. In 2021 there were about 379,245 and for the first 3 months of 2022 alone, there have been 119,719 cases. [1]

This is probably an underestimate because children are often asymptomatic, less tested, less detected and therefore least reported. The US CDC sero-prevalence studies showed that 38% of children were infected with COVID [2]

The increased burden of the infectious Omicron variant has led to several serious complications in the unvaccinated children:

The increased numbers of children infected has led to outbreaks in households, day care centers, kindergartens and schools. There were about 367 educational clusters prior to the school holidays. One can expect increasing reports of these clusters with the reopening of schools on 21 March 2022. [3]
There has been a 2.5 fold increase in kids being hospitalized
There is a 2 fold increase in kids admitted to the ICU for serious COVID infections namely due to MIS-C (Multisystem Inflammatory Syndrome in Children).
Increasing number of deaths has also been reported in children below 18 years old. In 2020 there were 6 deaths, which increased to about 110 deaths in 2021. There were 22 deaths in children aged under 12 years old from 1 Jan – 11 March 2022, and 8 deaths were recorded during the second week of March alone, which is the highest in almost 6 months. [4]

The Health Minister, YB Khairy Jamaludin earlier set a target of 50% vaccination for children under 11 years by the start of the school year. We’ve clearly fallen short of this, as at the moment only 34% of children have received their first jab. What explains the slow take-up rate and what needs to be done to address this?

2 major factors have contributed to this low uptake:

Parents are freaked out by the safety of the mRNA vaccines. Misinformation is rife in social media on the dangers of the mRNA vaccines. The anti-vaxxers have been on over drive fear mongering on the Adverse Effects Following Immunisation (AEFI) with the mRNA vaccines. Not surprisingly, most of them who are inflating the dangers of mRNA vaccines are also the same ones who are promoting ivermectin, chloroquine, mega-doses of vitamins, herbs, naturopathy and homeopathy
Parents are in a “wait and see” mode which is very dangerous because the Omicron will not wait. The BA2 Omicron sub-variant which now makes up 27% of the circulating strains is even more transmissible and is creating havoc in Hong Kong, China, US, UK and Europe. Its reproduction number (Ro) is 12, which is very close to measles. This simply means that in a playroom of 10 children, one COVID-19 positive child can potentially infect 7-8 other kids. [5]

There are a few actions that can be undertaken to improve the uptake of the COVID-19 vaccines.

Better, smarter and more imaginative awareness programs should be crafted and disseminated widely to all parents and guardians of children. There needs to be a more concerted effort to go to the ground and educate, even if it means to be done door to door. The BN machinery that was effective in garnering votes in the recent by-elections should be used to do similarly to turn-over the vaccine hesitant parents in the Malay heartland, namely in Kelantan, Terengganu, Kedah and Pahang, whose vaccine uptake are 9.5%, 11.6%, 22.1%, 26.3% respectively as compared to the national average of 35.6% as at 21 March 2022. [6]
If teachers who refused vaccination are transferred to different posts, surely there must be a similar action on school children whose parents have refused their kids to be vaccinated. We are however of the opinion that the teachers “apparently problem solved” was not really a solution, it was simply the easiest thing to do for bureaucrats and politicians who refuse to think out of the box. The evidence thus far shows that the vaccines are effective and safe in school children and thus our school policy should mandate that all children must have completed their vaccination prior to registering for standard one.
There should be more involvement of parent support groups to reassure other parents of the safety and effectiveness of the vaccines.
There is an urgent need for better collaboration with family GPs and paediatricians in the PICKids program. These doctors in the private healthcare sector have been vaccinating kids, adolescents and adults since the 1950s have been thus far marginalized in the campaigns.
The government must be very serious, firm and consistent in it’s handling of persons who continually spread misinformation on the pandemic and the COVID-19 vaccines.

The government has approved Sinovac as one of the vaccines under PICKids. What does one make of this decision, especially in light of research from Chile that showed Sinovac was only 38% effective in preventing infections in children?

One does not need to go too far to Chile. Our own local research (Real-World Evaluation of Covid-19 Vaccines Under the Malaysia National Covid-19 Immunisation Programme (RECoVaM) and the National Medical Research Register (NMRR) showed that the vaccine effectiveness (VE) of Sinovac drops from 76% following immunization to 28% after 3-5 months of the shots. The mRNA (Pfizer) vaccine is more effective only dropping from 89% to 68%. The MOH in no uncertain terms has recommended the mRNA (Pfizer) vaccines as the vaccine of choice for children 5-11 years of age. Only if the child develops a severe reaction to the mRNA (Pfizer) vaccine or its contents should they switch to the Sinovac vaccine. We are sure that as parents and guardians you would not want to give your children a second best vaccine! [7]

Are paediatricians in the private sector participating in the programme? Has the process been easy and is that improving the take up rate?

The Malaysian Paediatric Association (MPA) has surveyed our colleagues and 97.8% of them strongly supported vaccination of kid 5-11 years.

The executive committee of the MPA recently met with the team from Protect Health which operates the PICKids program. Apparently only 20 thousand doses are being utilised daily which is very disappointing and up until 21 March 2022, only 35.6% of our 5-11 year olds are vaccinated. [6]

We are exploring new strategies to increase the uptake because as we all know the 3Cs of any successful vaccination program are Coverage, Coverage, Coverage. We are hopeful that kids would soon be able to get their shots from their family GPs and pediatricians whom parents and guardians trusted to care for their child’s health and who have given them their routine shots since birth.

What do you make of the government’s handling of the tragic death of Revnesh Kumar? Has this had an impact on perceptions of vaccine safety for children and teenagers?

It is most unfortunate that the government’s handling of the case has impacted adversely on the level of vaccine confidence among parents and guardians of children. And the drama was further conflated by the irresponsible nuances of the vaccine hesitant lobby. We’ve had to undertake a lot of damage control and intensify our awareness programs to counter the misinformation.

It has to be clearly and unequivocally stated that the COVID-19 vaccines are not in any way causally linked to any deaths in children.

The US has the largest experience with mRNA vaccines in children 5-11 years old. They have prescribed about 8.7 million doses. The AEFI were mostly mild and brief and consisted mainly of pain at the injection site, fatigue and headaches. There were 11 reported cases of myocarditis and all of the affected children recovered fully after 2-7 days. There were NO causal links to any deaths. [8]

Our own NPRA has reported the use of 1.1 million doses of mRNA vaccines up until 11 March 2022. There were 182 reports of AEFI, a rate of 0.17 per 1,000 children which is very similar to the reports from Canada and Australia. 97% of the AEFI were non serious and did not effect the child’s daily activities. These were mainly fever, pain at the injection site, headaches and body-aches which often disappeared after 1-2 days. There were 5 children with serious AEFI who were admitted and were later discharged well. A 7-year old girl with an underlying health condition was classified as Brought In Dead (BID) and the case is still under investigation. [9]

We hope all parents and guardians would be reassured by these facts and figures and do not become victims of the misinformation disseminated by the fear-mongering anti-vaccine groups. Please consult your trusted family GP or pediatrician if you have any further concerns about the vaccines.

References:

COVID-19 Vaccines are Safe and Works for Children

Related Posts

Pakar Perubatan bidas dakwaan vaksin mengandungi virus SV40 sebabkan barah

Aly Mishal-FIMA Lifetime Achievement Award 2024