When will vaccines to protect children below 18 from COVID-19 be available? This question has become critical with several state Governments planning to open educational institutions.
Telangana State Chief Minister, K Chandrasekhar Rao announced that Schools would open from July one. But later changed it to online as the High Court and many parent organisations requested in view of the risks and lack of vaccinations.
However, with vaccinations available for 18 and above, the situation in colleges and universities could change in the near future. But, risks will continue and challenges remain as the numbers to be vaccinated with two doses is huge and will take time.
The Chief of the AIIMS, New Delhi, Dr Randeep Guleria has stated that availability of the COVID-19 vaccine for children will pave the way for resumption of schools and outdoor activities.
He also indicated that a third wave could be expected in 6-8 weeks. Though, the ICMR has stated that the next wave might take a bit longer and was six months away. With a growing section of the adult population getting vaccinated, youth and children tend to get into the higher risk group. The positive point so far in India and globally, is though children are getting infected even now, the severity is low and they are able to overcome with their natural defence mechanism.
The challenge ahead is what risks the new variants pose and also the infected children could carry the risks to elders in the family who might not have been fully covered by vaccination. India has to still vaccinate over 100 crore population.
Scenario in India
In India two potential COVID-19 vaccines for children are under development—Bharat Biotech and Zydus Cadila. The announcement that the Zydus vaccine (ZyCOV-D) for children above 12 is likely to be available by August after necessary regulatory approvals has come as a welcome news.
The trials of the vaccine from the Ahmedabad based company will be over by July end, said Dr N K Arora, Chairman of the National Technical Advisory Group on Immunisation. Interestingly, the company’s regular vaccine for COVID-19 is also undergoing largescale Phase-3 trials.
On the other hand, Bharat Biotech-NIV, Pune developed Covaxin is going through the phase II/III clinical trial in the age group of 2 to 18 years. The trial initiated in May involves 525 healthy volunteers. The trial is expected to be completed and data expected by September.
Meanwhile, a national expert group formed is reviewing COVID-19 infections in children to evolve strategies to strengthen the nation’s preparedness, NITI Aayog Member (Health), V.K. Paul said.
On the challenge ahead, Dr Paul said a rough guess is for about 13-14 crore population between 12 to 18 years, for whom we will require 25-26 crore doses of the vaccine.
Meanwhile, Maharashtra, which is already seeing the Delta plus variant cases is gearing up it’s preparedness for the third wave. It is readying up to 1500 paediatric beds and special efforts to handle likely, severe cases among children.
Status of children in India
As per the latest data a large percentage of the children in the country suffer from various deficiencies making them vulnerable to infections.
Analysis of the National Family Health Survey (NFHS-5), December 2020 data, shows the nutritional status of children below five years of age is slightly worsening. Stunting or chronic malnutrition (i.e., low height with respect to age) has increased in 11 of the 17 states. Proportion of severely affected children has increased in 13 of the 17 states. Wasting or acute malnutrition refers to low weight with respect to height. Children who are stunted or wasted are more vulnerable to diseases and illness.
The proportion of children who are underweight (low weight with respect to age) has increased in 11 of the 17 states. In Bihar and Gujarat, 40% or more of the children under the age of five years are underweight.
Immunisation among children aged 12-23 months has recorded substantial improvement with more than two-third immunised in all the States and UTs except Nagaland, Meghalaya and Assam. In almost three-fourths of districts, 70% or more children in the age group are fully immunized against childhood diseases.
On comparing NFHS-4 (2015-16) and NFHS-5 data, the increase was to the tune of over ten percentage point and in another four states/UTs between five and nine percentage point. This can be attributed to the initiative of Mission Indradhanush launched by the government since 2015.
As per NFHS-4, 38% of children under five were stunted, 28% are wasted and around 36% underweight. Around 59% of children are also anaemic. Various studies have shown that iron deficiency, leading to anaemia, can weaken the immune system and increase morbidity due to infectious diseases. Only 10% receive a minimum acceptable diet, rendering them more vulnerable.
The US Centers for Disease Control and Prevention (CDC) states that even though all children won’t develop severe symptoms as adults, they will be affected by the virus and potentially spread it to others. At present, it knows very little about the full extent to which COVID-19 affects children in general.
On the Vaccine front, the UK has approved the Pfizer/BioNTech coronavirus vaccine for use in children aged 12 to 15. Experts expect that a COVID-19 vaccination for children under 12 could be available by September or October. China’s Sinovac is already being administered to lakhs of kids in that country.
At present Pfizer and Moderna are carrying out trials in healthy children ages 6 months to 11 years. Johnson & Johnson and Novavax are continuing trials in adolescents between 12 and 17. Most of these vaccines would be ready with enough data to apply for emergency authorisation between September and the end of the year.
Interestingly, in the US nearly 20 percent of the new infections in the last few weeks have been children. That’s because the new infections are going to occur in those who are not immune, and right now, that’s children, because the younger children are not eligible for vaccination yet, officials stated. Once the vaccines are approved for use in young children, the United States will move towards herd Immunity faster, they added.
Somasekhar Mulugu, former Associate Editor & Chief of Bureau of The Hindu BusinessLine, is a well-known political, business and science writer and analyst based in Hyderabad