Why it still doesn’t make sense to vaccinate children against Covid-19

Less than 1% of the population between newborns and 19 years of age has required admission to the ICU.

A child receiving a vaccine.

The percentage of the world population that has been in contact with the SARS-CoV-2 virus, measured through seroprevalence, around 5.2% of the populationwhile in the age range from newborns to 19 years old, it corresponds to 1.56%.

As for the mortality rate of Covid-19 worldwide, to date it is 2,168 deaths per 100,000 infected (2.1%), while between birth and 19 years of age it does not even reach 0.08 %. A glance at the data suffices to show that children and young people up to 19 years of age are infected less and die much less than adults.

In pediatrics, between 15 and 35% come into contact with the virus, generating antibodies asymptomatically. In infected children under 9 years of age, The most frequent symptoms are fever and cough, while between 9 and 19 years are headache and cough.

Between newborns and 19 years of age, less than 3% will require admission for need of oxygen and less than 1% will require admission to intensive care.

Within the group analyzed, those under one year of age and those with a history of chronic diseases (oncology, heart disease, transplant patients, chronic kidney failure, immunosuppressed) are those who may present a higher risk of presenting a serious Covid (myocarditis, multiple organ failure and coagulopathy).

Of the healthy children and young people who present or have presented Covid-19, they highlight exaggerated inflammatory responseswhich, although very rare (less than 1.5%), are very serious: Kawasaki type, toxic shock or pediatric multisystem inflammatory syndrome (PIMS or MIS-c).

Of these severe forms of presentation in pediatrics, up to 80% require admission to intensive care. And of all of them, less than 1% die in our environment.

Covid vaccine

Vaccination has been The invention that has saved the most lives in history of Humanity. It is the only way to make deadly diseases such as smallpox or disabling diseases such as polio extinct on a planetary level.

Pediatrics is the branch of Medicine that has the most established concept of universal vaccination. Moreover, this medical specialty could not be conceived without vaccination. Its immunization calendar that has been expanding over time, both in population coverage and in the number of preventable infectious diseases.

So what about the vaccine against Covid-19 in children? The indication of an effective vaccine against a pandemic virus would in principle be universal, but the lack of global supplycauses the vaccination rhythm to be established following criteria of age and associated comorbidities.

At the moment, BionTec’s vaccine is the only one that has presented results of effectiveness and description of possible side effects (review in children of cases of myocarditis). The FDA and EMA have approved its use up to 12 years of age according to technical sheet.

Imbalances in vaccination and risks

In general, the advancement of vaccination has been from older to younger, following the principle of vaccinating those with the highest risk of suffering from severe Covid-19. But vaccination against Covid-19 has advanced at such a pace that in many countries they have already reached pediatric ages. And the doubts appear.

From the outset, there is considerable consensus in making the vaccination cut-off at 12 years until the results of multicenter studies are obtained being carried out with RNA vaccines in children under 12 years of age.

The problem is that, while there are countries that already have more than 65% of their population vaccinated with the full schedule and are considering vaccinating children, there are many others that do not even reach 1% of vaccinated.

This should make us think that, if there are countries with such a tremendous deficit of vaccines, the WHO should act favoring vaccination in those countries that do not have access. Especially since, given that the pandemic is a global problem that affects the entire world population, “herd” immunity will not be achieved with the current imbalance in vaccination.

As long as there are unvaccinated people, the ability of the virus to mutate will generate variants of the virus that can reactivate new pandemics, and countries that today have the capacity to vaccinate children could experience new pandemics in the future. The global vaccination imbalance is a global danger that can send us back to square one.

Order of priorities

That we propose to vaccinate in pediatric ages in developed countries when in other countries they do not have access to vaccines or other basic health resources, should make us reflect as a society about what kind of world we want.

With the data presented at the beginning, this virus has shown that the “strong” have been children. Therefore, they should be the last to be vaccinated.

The priority should be to use existing resources to immunize the world population in a homogeneous way. That would be a wise strategy as a planetwhile not doing so would generate population centers with the circulating virus, mutating and causing the appearance of possible life-threatening variants.

This dangerous imbalance would mean that, on a regular basis, as with the flu vaccine, we end up getting vaccinated every year against the variants circulating at all times.

To the question of whether children have to be vaccinated against Covid-19, the answer would be yes, but non-children too, and in the first place.

*This article was originally published on The Conversation.

**Sergio Flores is Head of Pediatric Cardiology, Hospital Universitario Mútua de Terrassa.

Posted on